Implementation of the evidence for the improvement of nursing care to the critical patient's family: a participatory action research

Background: There are many descriptive studies regarding the needs of the family, as well as those regarding nursing care aimed directly at family members. However, there is no widespread application of such evidence in clinical practice. There has also been no analysis made of the evolution of patterns of knowing during the act of improving clinical practice. Therefore, the purpose of the study is to understand the change process aimed at improving care to critical patient's families, and to explore the evolution of patterns of knowing that nurses use in this process. Methods: Qualitative study with a Participatory Action Research method, in accordance with the Kemmis and McTaggart model. In this model, nurses can observe their practice, reflect upon it and compare it with scientific evidence, as well as define, deploy and evaluate improvement strategies adapted to the context. Simultaneously, the process of empowerment derived from the Participatory Action Research allows for the identification of patterns of knowing and their development over time. The research will take place in the Intensive Care Units of a tertiary hospital. The participants will be nurses who are part of the regular workforce of these units, with more than five years of experience in critical patients, and who are motivated to consider and critique their practice. Data collection will take place through participant observation, multi-level discussion group meetings and documentary analysis. A content analysis will be carried out, following a process of codification and categorisation, with the help of Nvivo10. The approval date and the beginning of the funding were December 2012 and 2013, respectively. Discussion: The definition, introduction and evaluation of care strategies for family members will allow for their real and immediate implementation in practice. The study of the patterns of knowing in the Participatory Action Research will be part of the theoretical and practical feedback process of a professional discipline. Also, the identification of the construction and evolution of knowledge will provide decision elements to managers and academics when choosing strategies for increased quality

Life cycle greenhouse gas emissions of blended cement concrete including carbonation and durability

The final publication is available at Springer via http://dx.doi.org/10.1007/s11367-013-0614-0Purpose Blended cements use waste products to replace Portland cement, the main contributor to CO2 emissions in concrete manufacture. Using blended cements reduces the embodied greenhouse gas emissions; however, little attention has been paid to the reduction in CO2 capture (carbonation) and durability. The aim of this study is to determine if the reduction in production emissions of blended cements compensates for the reduced durability and CO2 capture. Methods This study evaluates CO2 emissions and CO2 capture for a reinforced concrete column during its service life and after demolition and reuse as gravel filling material. Concrete depletion, due to carbonation and the unavoidable steel embedded corrosion, is studied, as this process consequently ends the concrete service life. Carbonation deepens progressively during service life and captures CO2 even after demolition due to the greater exposed surface area. In this study, results are presented as a function of cement replaced by fly ash (FA) and blast furnace slag (BFS). Results and discussion Concrete made with Portland cement, FA (35%FA), and BFS blended cements (80%BFS) captures 47, 41, and 20 % of CO2 emissions, respectively. The service life of blended cements with high amounts of cement replacement, like CEM III/A (50 % BFS), CEM III/B (80 % BFS), and CEMII/B-V (35%FA), was about 10%shorter, given the higher carbonation rate coefficient. Compared to Portland cement and despite the reduced CO2 capture and service life, CEM III/B emitted 20 % less CO2 per year. Conclusions To obtain reliable results in a life cycle assessment, it is crucial to consider carbonation during use and after demolition. Replacing Portland cement with FA, instead of BFS, leads to a lower material emission factor, since FA needs less processing after being collected, and transport distances are usually shorter. However, greater reductions were achieved using BFS, since a larger amount of cement can be replaced. Blended cements emit less CO2 per year during the life cycle of a structure, although a high cement replacement reduces the service life notably. If the demolished concrete is crushed and recycled as gravel filling material, carbonation can cut CO2 emissions by half. A case study is presented in this paper demonstrating how the results may be utilized.This research was financially supported by the Spanish Ministry of Science and Innovation (research project BIA2011-23602). The authors thank the anonymous reviewers for their constructive comments and useful suggestions. 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Optimization of concrete I-beams using a new hybrid glowworm swarm algorithm

In this paper a new hybrid glowworm swarm algorithm (SAGSO) for solving structural optimization problems is presented. The structure proposed to be optimized here is a simply-supported concrete I-beam defined by 20 variables. Eight different concrete mixtures are studied, varying the compressive strength grade and compacting system. The solutions are evaluated following the Spanish Code for structural concrete. The algorithm is applied to two objective functions, namely the embedded CO2 emissions and the economic cost of the structure. The ability of glowworm swarm optimization (GSO) to search in the entire solution space is combined with the local search by Simulated Annealing (SA) to obtain better results than using the GSO and SA independently. Finally, the hybrid algorithm can solve structural optimization problems applied to discrete variables. The study showed that large sections with a highly exposed surface area and the use of conventional vibrated concrete (CVC) with the lower strength grade minimize the CO2 emissionsGarcía Segura, T.; Yepes Piqueras, V.; Martí Albiñana, JV.; Alcalá González, J. (2014). Optimization of concrete I-beams using a new hybrid glowworm swarm algorithm. Latin American Journal of Solids and Structures. 11(7):1190-1205. doi:10.1590/S1679-78252014000700007S11901205117Alinia Ahandani, M., Vakil Baghmisheh, M. T., Badamchi Zadeh, M. A., & Ghaemi, S. (2012). Hybrid particle swarm optimization transplanted into a hyper-heuristic structure for solving examination timetabling problem. Swarm and Evolutionary Computation, 7, 21-34. doi:10.1016/j.swevo.2012.06.004Chen, S.-M., Sarosh, A., & Dong, Y.-F. (2012). Simulated annealing based artificial bee colony algorithm for global numerical optimization. Applied Mathematics and Computation, 219(8), 3575-3589. doi:10.1016/j.amc.2012.09.052Collins, F. (2010). 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Genealogy as a critical toolbox: Deconstructing the professional identity of nurses

[eng] Aim. To discuss the Foucauldian concept of genealogy as a framework for understanding and transforming nurses' professional identity. Background. The professional identity of nurses has primarily been defined by personal and interpersonal attributes and by the intradisciplinary dimensions of nursing, leading to its conceptualization as a universal, monolithic phenomenon. The Foucauldian genealogical perspective offers a critical lens to examine what constitutes this professional identity; Spanish nursing offers a historical case study of an active effort to impose an identity that fits the monolithic ideal. Data sources. Five of the 33 professional conduct manuals for nurses' training published from 1956 1976 during the Franco dictatorship in Spain and six interviews with nursing instructors or students at the time were analysed using a theoretical framework drawn from Foucault's writing. Discussion. Foucault's genealogical framework considers practices of normalization and resistance as a means of understanding knowledge continuities and discontinuities, clarifying practices that constitute nurses' professional identity in a particular way in specific contexts and analysing the implications of this theoretical frame. Implications for nursing. The genealogy concept offers valuable tools to determine how professional identities are constituted, questions assumptions about the profession and its professionals and envisions alternative approaches. This theoretical approach helps both scholars and practitioners understand, question and transform their practices as needed. Conclusion. The genealogical approach prioritizes analysis of the phenomenon over its description and challenges many unknown, forgotten, excluded and/or unquestioned aspects of identity from a position of diversity and complexity

Transforming a conservative clinical setting: ICU nurses' strategies to improve care for patients' relatives through a participatory action research

[eng] This study focuses on change strategies generated through a dialogical-reflexive-participatory process designed to improve the care of families of critically ill patients in an intensive care unit (ICU) using a participatory action research in a tertiary hospital in the Balearic Islands (Spain). Eleven professionals (representatives) participated in 11 discussion groups and five in-depth interviews. They represented the opinions of 49 colleagues (participants). Four main change strategies were created: (i) Institutionally supported practices were confronted to make a shift from professional-centered work to a more inclusive, patient-centered approach; (ii) traditional power relations were challenged to decrease the hierarchical power differences between physicians and nurses; (iii) consensus was built about the need to move from an individual to a collective position in relation to change; and (iv) consensus was built about the need to develop a critical attitude toward the conservative nature of the unit. The strategies proposed were both transgressive and conservative; however, when compared with the initial situation, they enhanced the care offered to patients' relatives and patient safety. Transforming conservative settings requires capacity to negotiate positions and potential outcomes. However, when individual critical capacities are articulated with a new approach to micropolitics, transformative proposals can be implemented and sustained

Economic crisis, austerity discourses, and caregiving: How to remain relevant through engagement and social justice

[spa] Este artículo relacionado con la línea de justicia social y determinantes sociales del Grupo de Investigación Crítica en Salud se publica a partir de los resultados obtenidos del proyecto financiado por el Fondo de Investigación Sanitaria del Instituto de Salud Carlos III (PI 1100123) titulado, Análisis de las políticas de la atención a la dependencia y de igualdad: impacto percibido por hombres y mujeres cuidadoras de diferentes generaciones en el ámbito doméstico en Mallorca, en el cual soy investigadora colaboradora. Se trata de un artículo de opinión en base a los resultados de este proyecto y de investigaciones previas llevadas a cabo por miembros del Grupo de Investigación Crítica en Salud (Moreno, 2004; Bover & Gastaldo, 2005; Gastaldo & Bosi, 2010) sobre las consecuencias en el modelo de bienestar en España y en concreto sobre la salud, tras el cambio económico y social ocurrido en Europa por la implantación de políticas neoliberales. Se describen las políticas españolas relacionadas con los cuidados antes y después de la crisis de 2008 y, se analizan los efectos estructurales ejecutados por varios países europeos. Finalmente, se discute la necesidad de que los investigadores y profesionales de la salud se comprometan con visiones alternativas del cuidado de la salud que sean sensibles a las limitaciones del neoliberalismo y centradas en la justicia social para garantizar la salud de las poblaciones