The management of critically ill patients at end-of-life (EOL) is concerned with shifting the focus of care from curing disease to maximizing comfort and ensuring the needs of the patient and family (Carey & Cosgrove 2006). Despite the availability of a wide range of EOL care studies, there appears to be inadequate knowledge of how best intensive care nurses can cope and provide ethical, quality, humane, holistic and comfort care for the dying patients including these patients’ family members in the ICU. Purpose: To develop best practice guidelines for end-of-life care for intensive care nurses in adult intensive care units at three tertiary level III hospitals in Gauteng province. Objectives: 1) To search and analyze for quality research discourse on EOL care by means of a systematic review, 2) To search for evidence on EOL care through interviews with family members, interviews with critically ill patients and focus group discussions with intensive care nurses. 3) To develop best practice guidelines for intensive care nurses on EOL care. 4) To verify the tentative best practice guidelines using an Appraisal of Guidelines Research and Evaluation (AGREE) II instrument. Design: Both quantitative and qualitative approaches were used to achieve the aim of the study. Systematic review, semi structured interviews and focus group discussions were utilized during data collection in the various steps of the study. During data analysis, meta-synthesis was utilized for systematic review; Tesch’s (1992) eight steps of analysis were used for semi structured interviews whereas the long-table approach was used to analyze transcripts from focus groups. The process of guideline development was divided into three stages: Stage I involved the search for quality research evidence on EOL care (this was conducted in 4 steps: In step 1, a systematic review of both qualitative and quantitative articles on EOL care was conducted yielding 23 articles, step 2 included individual interviews with 17 purposively selected family members, step 3 involved individual interviews with 16 purposively selected critically ill patients whereas step 4 included three focus group discussions with 24 purposively selected intensive care nurses). Stage II involved development of best practice guidelines in form of recommendations by means of synthesising and integrating conclusions from stage I. stage III involved verification of the guidelines by four purposively selected verifiers using the AGREE II instrument. Findings: The main findings obtained from the four steps in stage I of the study were as follows: step 1) the findings from systematic review were grouped as factors that enable or complicate EOL care, patients’/family members’/nurses’ experiences of EOL care and decision making processes at EOL. Step 2) Five major themes emerged from the experiences of family members on EOL care. These included: “most of the time we are in darkness”, “emotional support”, “involvement”, “you feel you should see her face more often” and “spiritual support”. Step 3) Five major themes were identified from the experiences of critically ill patients on comfort care and they included: “being in someone’s shoes”, “communication”, “trust”, “presence” and “religion and spirituality”. Step 4) Focus group discussion with the intensive care nurses led to five major themes including: “difficulties we get”, “discussion and decision making”, “support for patients”, support for families” and support for nurses. Conclusions drawn from stage I provided evidence for the development of best practice guidelines. Based on the conclusions drawn, guidelines developed were divided into three categories related to: communication, caring and negative aspects impacting on EOL care. The tentative guidelines were verified by a panel of four experts. The verifiers’ feedback, recommendations, criticisms and suggestions were analysed and incorporated into the guidelines. Conclusions: Guidelines were developed to inform nursing practice, nursing management and nursing education. Communication recommendations focused on how to effectively communicate as a health care team as well as instituting communication strategies in dealing with dying patients and their families. Caring recommendations were intended to promote quality care for patients and families at EOL and more so, the care needed by nurses in order for them to continue rendering holistic nursing care. Negative factors impacting on EOL care reflected on what need to be improved so as to ensure quality EOL care. In general, the guidelines were rated to be of high quality and were recommended for use by the verifiers.

La actitud es definida como un estado de disposición nerviosa y mental organizada mediante la experiencia que ejerce un influjo dinámico o directivo sobre las respuestas que un individuo da a todos los objetos y situaciones que se relaciona. Por ello la enfermera cuando cuida al paciente en los últimos momentos de su vida se enfrenta a la muerte, considerándola no solo fenómeno instantáneo, sino biológico además de ser psicosocial, que ocurre en diferentes etapas. Durante el proceso de morir se experimentan intensas emociones difíciles de contener, en el que se encuentran involucrados la persona moribunda, la familia y la enfermera que cuida. La presente investigación tuvo como objetivo: describir y analizar la actitud de la enfermera que labora en dicho hospital, cuando se encuentra frente al paciente moribundo. El marco teórico se basó en la teoría de Hildergard Peplau. La metodología fue cualitativa, con abordaje de estudio de caso, el escenario lo conformó el servicio de medicina varones y mujeres del hospital. Los sujetos de estudio fueron las enfermeras con experiencia de 5 años continuos en dicho servicio y se hizo una triangulación con los familiares para obtener datos informativos más fidedignos. El análisis de datos fue de contenido temático y en toda la investigación se respetó los principios éticos y de cientificidad. / Tesis

Thesis (M. Soc. Sc.)--University of Hong Kong, 2006.

Mobile police officers perform many of their daily duties within vehicles. Combined workspace inflexibility and prolonged driving exposure creates a risk for developing musculoskeletal issues. Limited research exists that quantitatively describes postural and load exposures associated with mobile police work. This study characterized officer activity during a typical workday and recommended a cruiser configuration that minimized musculoskeletal risk through laboratory quantification of physical loading during simulated police patrol tasks. A field study captured and analyzed digital video of traffic constables (N = 10) using custom Regional Enforcement Activity Characterization Tool (REACT) software. Mobile data terminal use represented over 13% of in-car activity time and was identified as a primary site for targeted design change. A laboratory study included 20 (10 male, 10 female) participants aged 18-35 with no recent history of right upper limb or low back disorder. Five mobile data terminal (MDT) locations and two driver seat designs were tested in two simulated police patrol testing sessions in a custom driving simulator. A self-selected mobile data terminal location reduced mean right shoulder elevation angle as well as perceived discomfort in both the low back and right shoulder relative to all other tested locations. Muscle activity was lowest at the self-selected location and current MDT location for all recorded muscles, with significant effects shown in posterior deltoid (p < .0001) and supraspinatus (p < .0001). Using a global ranking system, the self-selected location was identified as the best of all tested locations, followed by the current mobile data terminal location. The ALS driver seat effectively reduced discomfort (p < .0001) in the low back during a simulated police patrol session from 15.4mm in the Crown Victoria seat to 11.1mm on a VAS scale. Under these experimental conditions, a self-selected MDT and ALS driver seat reduced discomfort and physical loading compared to the current configuration.

Mobile police officers perform many of their daily duties within vehicles. Combined workspace inflexibility and prolonged driving exposure creates a risk for developing musculoskeletal issues. Limited research exists that quantitatively describes postural and load exposures associated with mobile police work. This study characterized officer activity during a typical workday and recommended a cruiser configuration that minimized musculoskeletal risk through laboratory quantification of physical loading during simulated police patrol tasks. A field study captured and analyzed digital video of traffic constables (N = 10) using custom Regional Enforcement Activity Characterization Tool (REACT) software. Mobile data terminal use represented over 13% of in-car activity time and was identified as a primary site for targeted design change. A laboratory study included 20 (10 male, 10 female) participants aged 18-35 with no recent history of right upper limb or low back disorder. Five mobile data terminal (MDT) locations and two driver seat designs were tested in two simulated police patrol testing sessions in a custom driving simulator. A self-selected mobile data terminal location reduced mean right shoulder elevation angle as well as perceived discomfort in both the low back and right shoulder relative to all other tested locations. Muscle activity was lowest at the self-selected location and current MDT location for all recorded muscles, with significant effects shown in posterior deltoid (p < .0001) and supraspinatus (p < .0001). Using a global ranking system, the self-selected location was identified as the best of all tested locations, followed by the current mobile data terminal location. The ALS driver seat effectively reduced discomfort (p < .0001) in the low back during a simulated police patrol session from 15.4mm in the Crown Victoria seat to 11.1mm on a VAS scale. Under these experimental conditions, a self-selected MDT and ALS driver seat reduced discomfort and physical loading compared to the current configuration.

Modern airport terminal design approaches the needs of passengers on a primarily logistical level. Over time, genuine interest in passenger comfort and satisfaction has become diluted in the face of an increasingly efficiency and money-driven aviation industry. The airport experience has been reduced to getting in and out of the terminal as quickly as possible, simply because there is little incentive to slow down or even go in the first place. Uninspiring interior designs, crumbling infrastructure, claustrophobic spaces, security hassles, and a lack of access to food, shops, services, and entertainment are just a few of the issues that must be dealt with in order to restore a certain level of appeal and comfort. This thesis suggests that a more sensitive and responsive approach to airport design can change an ingrained mentality that characterizes airports as places to be dreaded rather than be inspired by. Over time, stress has become an inherent part of travelling, due largely to incremental increases in security checks and measures. This is an unfortunate by-product of the era we live in and is not likely be changed entirely, as public safety must remain a paramount goal in any airport design. At the same time, architects must feel compelled to design in a way that reduces passenger stress at every point along their terminal experience. Only then can passengers feel free to truly take in the architecture of their surroundings -- an architecture that should aim to satisfy functional and efficiency-related standards, as well as symbolize gateways to new places and embody the essence of flight. The design of tomorrow's airport must anticipate and respond holistically to passenger needs, on both a practical and an aesthetic level, so as to create an experience that manifests in quality rather than quantity. The degree of that response at various airports around the world is what this thesis measures, deconstructs, and reimagines as a foundation for the final design proposal.

Determining the optimal terminal box airflow is a complex process which is influenced by various factors, such as weather condition, supply air temperature, primary air fraction and internal load. A guideline for determination of a cost efficient minimum airflow setpoint for VAV terminal box units is drawn in this research. The most efficient optimal minimum airflow setpoint should not be a fix setting, but should be changing with zone load and ventilation requirement. A fixed minimum airflow is used in conventional control strategies. The terminal box minimum airflow required is not a constant since the supply air temperature, fresh air fraction and zone load are different. It is important to set up the minimum airflow to ensure IAQ and thermal comfort and to minimize energy consumption. Analysis has been carried out to compare how the supply air temperature, fresh air fraction and zone load affect the minimum airflow setting of an exterior zone. And 30% of design airflow is not always a good number, and may cause comfort issue or ventilation problem. If the minimum airflow is set higher than required, terminal boxes will have significantly simultaneous heating and cooling, and consume more fan power in the AHUs. If the minimum airflow is set lower than required, indoor air quality (IAQ) will be a concern. Energy saving ratio study is conducted to estimate the energy saving benefit by implementing an optimized minimum airflow.

Floating LNG terminals are a relatively new concept with the first such terminal in the world installed this year. The hydrodynamic interaction effects between the terminal and a LNG carrier in a side-by-side offloading arrangement is investigated. The side-byside arrangement is compared with each body floating alone to identify the interaction effects. The hydrodynamic coefficients are obtained using the Constant Panel Method and the analysis of body motions, mooring line tensions are done in time domain. The relative motion between the two bodies is analyzed using WAMIT in frequency domain and WINPOST in time domain to ascertain the offloading operability of the terminal under 1 year storm condition.

Thesis (M.P.H.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 79-92).

Thesis--Columbia University. / On spine: Attitude toward death in nursing students. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 54-62).