Thesis (Ph. D.)--University of Wisconsin--Madison, 1982. / Typescript. Vita. eContent provider-neutral record in process. Description based on print version record. Discography: leaf 287; bibliography: leaves 288-303.

Background: Pressure ulcers have during a long time ages caused great suffering for the patients. The factors affecting the occurrence of pressure ulcers can be both internal and external, such as immobility and malnutrition. Nurses´ role is to assess risks and thus pay attention to prevent and treat pressure ulcers. The nurse may use various assessment tools to highlight and document patients at risk for developing pressure ulcers. Aim: This study was to describe health professionals´ thoughts and actions about the pressure ulcers. Method: A literature review was used to study the selected study area. The review was based on nine quantitative and three qualitative articles. The writers looked for similarities and differences in performance of articles. Results: The results showed that knowledge was good among health professionals´ staff but was not used in practical nursing. Health professionals were using methods which were not evidence based for example massage. The staff felt that lack of time and materials was a barrier to care about pressure ulcers. The documentation carried out by nurses was inadequate. Resulted showed five themes, having knowledge of the risks of pressure ulcers, believing or knowing, applying knowledge, recording, managing and developing. Conclusion: There was good knowledge of pressure ulcer prevention and treatment by health workers and the nurses were able to identify the risk of developing pressure ulcers. The knowledge was not used in practice. Non recommended methods are still used by nursing staff in nursing care. .

Background: An increasing number of patients with an oncology diagnose will be seen in the future. The oncology care is complex and in great need of nurses with a high level of competence. There is a lack of previous research in the specialist oncology nurses competence and therefore knowledge of their skills can reveal an understanding of their competence. Aim: The aim of the study was to describe the competence of the specialist oncology nurse. Method: Four oncology nurses and two directors of oncology care were interviewed. The interview text was analyzed using qualitative content analysis. Results: The result showed that the oncology nurses had developed six different competences within different areas. These competence areas were assertiveness, patient-centered care, ethical and moral-, pedagogical-, to lead and develop- and theoretical competence. They described their competences in a way of feeling more confident and they had a deeper theoretical knowledge. They also described that the needs of the patient as central. They found it easier to communicate and to give information and had a greater ambition to develop the oncology care. Conclusion: Deeper theoretical knowledge is a necessity to develop new competence. Theoretical knowledge seems essential in order to develop new competence. To be able to use their new competences, time, opportunities and support must be given to the specialist oncology nurse. It is also important for the specialist oncology nurse to claim and believe in her competence.

Abstract Swanson silastic arthroplasty, introduced by Alfred Swanson in the late sixties, has long been the treatment of choice for metacarpophalangeal (MCP) arthroplasty in cases of rheumatoid arthritis. Silastic implant arthroplasty has a significant role in the reconstruction of eroded MCP joints, but the method does not recreate a normal MCP joint. The Sutter implant has been designed to improve the function of the MCP joint, and especially to reduce the extension deficit. There are numerous studies concerning the Swanson implant, but limited number of previous articles on the use of the Sutter implant. The aim of this thesis was to determine the outcome of MCP arthroplasty with the Sutter implant in patients with inflammatory joint disease. This thesis is based on two studies concerning Sutter implant arthroplasty in patients with advanced rheumatoid arthritis. One of these was a prospective study performed at Oulu University Hospital in which patients were randomised into Swanson and Sutter implant groups representing 49 hands and 174 implants, with a mean follow up time of 4.8 years, and the other was a prospective study performed at the Rheumatism Foundation Hospital in Heinola in which Sutter implant arthroplasty was carried out on 117 hands employing 350 implants, with a mean follow-up time of 5.3 years. The main results were that arthroplasty yields similar results with both of these implants with respect to clinical parameters such as range of motion, ulnar deviation, grip strength and pain. Furthermore, the revision rate in our Sutter follow-up study was high, and survival, with revision surgery as the end point, was poor. We created a new radiographic grading system for bone resorption, i.e. osteolysis, in MCP arthroplasty and found this to be more severe after Sutter than Swanson implant arthroplasty, for some unknown reason. Moreover, we found that osteolysis was symptom-free but related to implant fractures. As a conclusion silicone implant arthroplasty should be used only with rheumatoid patients with advanced destruction. High implant fracture rates and high amounts of osteolytic changes in radiographs are not favourable for the use of the Sutter implant. If continuous development of new prostheses achieves implant with as good clinical outcome and reasonable costs as Swanson implant, the use of the silicone implants will be questionable.

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit by Paula A. Rodney MSN, California University of Pennsylvania, 2011 BSN, University of Virginia, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University April 2015   Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were rising on the pilot unit. The purpose of this non-experimental correlational design quality improvement project was to combine information from focus groups, a content analysis of the literature on Kristen Swanson's theory of caring, and relationship-based care, to develop and implement a relationship-based care delivery model. An additional aim was to determine its impact on patient satisfaction and the reduction of HAPU, falls, and CAUTI. The model was designed and implemented by a team consisting of bedside care providers, leaders, an educator, and a student facilitator. The components of the model included scheduling for continuity of care, whiteboards, seated bedside report, hourly rounding, a nurse advocate, and 5 focused minutes of attention per shift. Descriptive statistics were used to determine the mean change in HCAHPS scores before and after implementation of the model, and revealed improvements in dimensions of communication with nursing by 13.2%, responsiveness by 12.5%, overall rating of care by 14.5%, and willingness to recommend by 8.7%. The result of audits of the pilot unit's medical records indicated a reduction in falls by 3, HAPU by 2, and CAUTI by 2 from August, the baseline month. As a result of these findings the model will be implemented on all inpatient nursing units. The target audience for this project includes nursing leaders, educators, and bedside providers with interest in patient-centered care and staff empowerment.

This study investigates a way to characterize the geology and biology of the seafloor in two Marine Protected Areas on the West Florida Shelf. Characterization of benthic habitats needs to include sufficient detail to represent the complex and heterogeneous bottom types. Characterizations can be interpreted from multiple data sets and displayed as benthic habitat maps. Multibeam sonar bathymetry and backscatter provide full spatial data coverage, but interpretation of such data requires some form of ground truth (to characterize the habitat). Imagery from towed underwater video provides continuous transects of seafloor data, which provide a more efficient method than data from sediment grabs, stationary cameras, or video from slow-moving remotely-operated vehicles while a ship is on station. Two Marine Protected Areas, Steamboat Lumps and Madison-Swanson, were previously mapped by the USGS using a 95 kHz multibeam sonar system. Researchers at the University of South Florida, using a 300 kHz high-resolution multibeam sonar in 2002 and a 400 kHz high-resolution multibeam sonar in 2016, filled in the northeast triangular portion of Madison-Swanson. Bathymetry and backscatter data were compared to towed underwater-video observations. A modified version of the Coastal and Marine Ecological Classification Standard (CMECS), utilizing a scale-based hierarchy, was used for habitat characterization of video images. Identifiers from the geoform and substrate components of CMECS, as well as substrate-influencing biologic components, were characterized using still images at 15-second intervals from towed underwater video collected using the Camera-Based Assessment Survey System (C-BASS). These characterizations were then georeferenced (located in three-dimensional space) for comparison with bathymetry and backscatter data. In Steamboat Lumps, eight substrate variations were identified from video, while in Madison-Swanson 27 substrate variations were identified, including many combinations of hard and soft substrate types. Four new hard-bottom textures are identified from video in Madison-Swanson: exposed high-relief, moderate-relief, and low-relief hard bottom, as well as covered low-relief hard bottom identified by the presence of attached biota. Hard- and mixed-bottom substrate types identified from video are more heterogeneous than can be resolved from 95 kHz Kongsberg EM 1002 multibeam sonar bathymetry and beam-averaged backscatter. However, in soft bottom areas, more changes are evident in beam-averaged backscatter than are visible in video, though this may be attributed to changes in sonar settings. This does not appear to be the case with high-resolution and ultra-high resolution multibeam sonars, such as the 300 kHz Kongsberg EM 3000 and the 400 kHz Reson SeaBat 7125, which can use time-series rather than beam-averaged backscatter. Analyses of the multibeam bathymetry data indicate that 94.5% of Steamboat Lumps is “flat” (slope < 5°) versus “sloping” for the remaining area (5° < slope < 30°). Only 87% of Madison-Swanson is “flat” versus “sloping”. Both marine protected areas have very low rugosity, i.e., the surface of the seafloor is nearly planar.

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En esta investigación se defiende que las concepciones de libertad, público y privado son categorías privilegiadas para abordar tanto la cultura griega como la filosofía práctica de Aristóteles. Apelando a los textos clásicos, se analizan tanto la génesis como la trascendencia de estos tres conceptos, lo que posibilita una clara percepción de lo que estos representan en la cultura griega y el cometido que desempeñan en la filosofía de Aristóteles. Desde estas premisas se examinan las dispares interpretaciones que de la filosofía aristotélica han realizado tanto la republicana Hannah Arendt como la liberal Judith Swanson. Análisis que concluye en que ambas pensadoras realizan lecturas incorrectas de los textos aristotélicos así como que el error de estas diferentes interpretaciones reside en que extrapolan sus propias concepciones de libertad, o la moderna concepción de la separación de esferas, trasladándolas anacrónicamente al análisis de los textos clásicos griegos. / This investigation intends to demonstrate that the concepts of liberty, public and private, are privileged categories which explore both Greek culture and Aristotle´s practical philosophy. Using the classic texts as background, the genesis and the transcendence of these three concepts are analyzed, which gives a clear perception of what they represent in Greek culture and their role in Aristotle´s philosophy. This thesis also examines the polarized interpretations of the Aristotelian philosophy of both the republican Hannah Arendt, and the libertarian Judith Swanson. This analysis concludes that due to the thinkers´ extrapolation of their own notions of liberty and a modern interpretation of the separation of spheres theory to the classic Greek texts, resulting in an anachronism, the Aristotelian texts are incorrectly interpreted.

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