Minimizing the Inappropriate Use of Physical Restraint

The aim of this project is to be able to improve patient safety by minimizing the inappropriate use of physical restraints from 45% to about 20% in the acute respiratory unit which caters to patients with acute respiratory issues, such as exacerbation of chronic obstructive pulmonary disease (COPD), patients with new or old tracheostomy, needing bipap, rigorous nebulizer treatment, and other respiratory-related devices, not to mention the multiple comorbidities that oftentimes very difficult to stabilize which makes the hospital stay longer than usual. The Clinical Nurse Leader (CNL) as an educator and an outcome manager is an agent to empower the staff to think critically as well as to reflect on their values and behavior prior to the application of restraints, in promoting a safe and compliant environment to all the patients, health care providers, and families. A fishbone diagram, SWOT analysis was conducted, one on one teaching and in-services were provided due to budget constraint. A PowerPoint presentation was presented to those who have the time to listen and it will be sent to the Education Department to include in the MyJourney online class annually. The distribution of handouts, communicating with the stakeholders regularly, and posting information on the board such as the policy and procedure of the physical restraint for review purposes was utilized as well. Currently, the nurses are more diligent in using physical restraint. Physicians even spend time to assess the appropriateness of the restraints. I am hoping that this project will be able to be implemented in the macrosystem so that in the near future, we can strive for a restraint-free hospital

Life History of Women with Fibromyalgia: Beyond the Illness

Fibromyalgia is a chronic pain syndrome, which mostly affects middle age women and whose etiological factors remain unclear. Psychosocial aspects may have a relevant role as predisposing, triggering, and/or perpetuating factors for this syndrome, raising the interest about life history of patients with fibromyalgia. In this study, we interviewed 10 women with a diagnosis of fibromyalgia, who had identified a critical or very stressful life event before the onset of the syndrome. The interview about the life history comprises the whole life, before and after the onset of the syndrome, and the narratives were analyzed with interpretative phenomenological analysis. Nine themes emerged: struggle, focus on adversities, positive overlaps the negative, scars of unhappy childhood, help others, perfectionism and desire to achieve, unsatisfactory present, perception of injustice, and keep feelings inside. A difficult life history is prevalent in these women and the themes identified are discussed in their relation with other qualitative studies and their possible role as predisposing and perpetuating factors for fibromyalgia. The ability to value the positive side of things, despite the adversities these women emphasized, is highlighted as an aspect to explore in psychological intervention, to enable a better management of this syndrome

Garnet-biotite diffusion mechanisms in complex high-grade orogenic belts : understanding and constraining petrological cooling rates in granulites from Ribeira Fold Belt (SE Brazil)

Cooling rates based on the retrograde diffusion of Fe2+ and Mg between garnet and biotite inclusions commonly show two contrasting scenarios: a) narrow closure temperature range with apparent absence of retrograde diffusion; or b) high result dispersion due to compositional variations in garnet and biotite. Cooling rates from migmatites, felsic and mafic granulites from Ribeira Fold Belt (SE Brazil) also show these two scenarios. Although the former can be explained by very fast cooling, the latter is often the result of open-system behaviour caused by deformation. Retrogressive cooling during the exhumation of granulite-facies rocks is often processed by thrusting and shearing which may cause plastic deformation, fractures and cracks in the garnet megablasts, allowing chemical diffusion outside the garnet megablast – biotite inclusion system. However, a careful use of garnets and biotites with large Fe/Mg variation and software that reduces result dispersion provides a good correlation between closure temperatures and the size of biotite inclusions which are mostly due to diffusion and compositional readjustment to thermal evolution during retrogression. Results show that felsic and mafic granulites have low cooling rates (1–2 °C/Ma) at higher temperatures and high cooling rates (~100 °C/Ma) at lower temperatures, suggesting a two-step cooling/exhumation process, whereas migmatites show a small decrease in cooling rates during cooling (from 2.0 to 0.5 °C/Ma). These results agree with previously obtained thermochronological data, which indicates that this method is a valid tool to obtain meaningful petrological cooling rates in complex high-grade orogenic belts, such as the Ribeira Fold Belt

Assumptions and problems with Fe-Mg garnet - biotite diffusion based petrological cooling rates : a case study in granulites and migmatites from central Ribeira Fold Belt, SE Brazil

O sector São Fidelis - Santo António de Pádua, pertencente à zona central da Faixa Ribeira, é fundamentalmente composto por migmatites, granulitos e blasmilonitos. A aplicação de diferentes metodologias com o objectivo de obetr taxas de arrefecimento baseadas na difusão Fe-Mg entre granada e respectivas inclusões de biotite revelou-se infrutífera. Tal deve-se fundamentalmente a: a) elevada dispersão dos resultados causada pela existência de um sistema aberto; b) estreita variação das temperaturas de fecho do sistema causada por re-homogeneização da granada e altas temperaturas seguida de arrefecimento muito rápido. Os resultados obtidos são fundamentalmente qualitativos, mas estão de acordo com resultados termocronológicos previamente obtidos baseados na integração de múltiplos sistemas isotópicos

C-O-H isotopic evidences for fluid sources of granulites in Ribeira Belt, SE Brazil

Publicado em: Geochemica et Cosmochimica Acta, Vol. 72, issue 12, Suppl. 1, A7

Pseudosection and thermobarometry constraints on the P-T-t evolution of Ribeira Belt, SE Brazil

Geochemica et Cosmochimica Acta, Vol. 72, issue 12, Suppl. 1, A66