Modelo de autocuidado para pessoas com 65 e mais anos de idade, necessidades de cuidados de enfermagem

Tese de doutoramento, Enfermagem, Universidade de Lisboa, com a participação da Escola Superior de Enfermagem de Lisboa, 2014Constatamos que a população com 65 e mais anos de idade tende a, exponencialmente, ter uma maior representatividade demográfica a nível mundial, sendo que tal se observa especialmente nos países do sul da Europa, sobretudo em Portugal. Várias organizações e diversas teorias sugerem o estudo do comportamento de autocuidado como um indicador de previsão das necessidades de cuidados daquele grupo etário em distintos contextos, para a reorganização dos cuidados de saúde em geral e de enfermagem em particular. Objetivos: Avaliar a funcionalidade das pessoas com 65 e mais anos de idade da região do Alentejo; Padronizar a funcionalidade em função da idade; Definir as necessidades de cuidados de enfermagem em função dos diferentes níveis de funcionalidade, com base num modelo de autocuidado. Metodologia: Estudo I: estudo transversal, descritivo; amostra aleatória, estratificada, com 931 pessoas com 65 e mais anos de idade; nível de confiança de 95%; margem de erro de 3,2%; levado a cabo na região do Alentejo. Estudo II: estudo transversal, descritivo; amostra de conveniência, com 427 pessoas com 65 e mais anos de idade; levado a cabo nas ECCI’s de Odivelas e da região do Alentejo Litoral, na UCC do Redondo e no Lar de Idosos dos SAMS. No decurso dos estudos, utilizámos diversas técnicas que permitiram construir e analisar a sensibilidade, fidelidade e validade do Core set dos Idosos (CSI) e do Elderly Nursing Core Set (ENCS). Resultados: Na região do Alentejo, do ponto vista médio, em relação ao comportamento de autocuidado, as pessoas no grupo etário dos 65 aos 84 anos de idade situam-se em autocuidado na atividade e as pessoas com 85 e mais anos de idade situam-se em défice de autocuidado terapêutico moderado. No cômputo geral, as pessoas do sexo feminino, com o estado civil de viuvez, que não sabem ler/ não frequentaram a escola, com 85 e mais anos de idade, baixo peso (IMC), com défices emocionais e auditivos e com situação económica não conducente à satisfação das necessidades de alimentação, habitação e saúde, apresentam maior nível de problema. No segundo estudo, verificámos diferenças estatisticamente significativas entre as necessidades de cuidados de enfermagem, ao nível dos sistemas de apoio educativo e de compensação parcial ou total, e o contexto onde a pessoa está inserida. Observámos necessidades de cuidados de enfermagem mais evidentes ao nível da ECCI da região do Alentejo Litoral e de Odivelas, seguidas do Lar de Idosos dos SAMS e, por fim, da UCC do Redondo. Conclusão: Propomos a avaliação das necessidades de cuidados de enfermagem das pessoas com 65 e mais anos de idade com base na apreciação do comportamento de autocuidado, descrito no M65+Autocuidado por uma estrutura conceitual em que se integra a avaliação do autocuidado, a capacidade funcional e capacidade de conhecimento.We assumed that the population over 65 years old tend have an exponentially superior demographic representation worldwide, particularly in the southern countries of Europe and mainly in Portugal. A number of organizations and different theories propose that the study of the behavior of self-care can result in a predictive indicator of care needs for that age group in different contexts, as a mean for the reorganization of health care in general, above all as far as nursing is concerned. Objectives: To assess the functionality of people over 65 years old in the region of Alentejo (Portugal); To standardize the concept of functionality depending on age; To describe the needs for nursing care according to the different levels of functionality, established on a model of self-care. Methodology: Study I: cross-sectional, descriptive, stratified random sample, with 931 people over 65 years of age; confidence level of 95 %, a margin of error of 3.2 %; carried out in the Alentejo (Portugal). Study II : cross-sectional, descriptive, convenience sample, with 427 people over 65 years of age, carried out in the Continuing Care Units (CCU) of Odivelas (Portugal) and Alentejo Litoral (Portugal), in the CCU of Redondo (Portugal) and in a Home for the Elderly of SAMS (Medical and Social Assistance Services). Throughout our studies, we applied several techniques which allowed building and analyzing sensitivity, reliability and validity of Core Set of Indicators for the Elderly (CSI) and the Elderly Nursing Core Set (ENCS). Results: In Alentejo and regarding self-care behavior, people in the age group 65 to 84 years old show self-care activity and those who have 85 years old and more present moderate therapeutic self-care deficit. Overall, females, widows, who cannot read/ did not attend school, with 85 and more years old, underweight (BMI), with deficits and impaired emotional and economic situation that cannot satisfy needs of food, housing and health, show higher levels of problems. In the second study, we found statistically significant differences between the needs for nursing care, the level of educational support systems and partial or total compensation as well as the insertion context. The needs for nursing care are more evident at the level of the CCU region of Alentejo Litoral and Odivelas, followed by the Nursing Home of SAMS and, finally, by the CCU of Redondo. Conclusion: We recommend the evaluation of nursing care needs of people over 65 years of age based on the assessment of self-care behavior, described in M65+SelfCare for a conceptual framework which would incorporate the assessment of self-care, functional capacity and knowledge capacit

SPH study of the evolution of water–water interfaces in dam break flows

The mixing process of upstream and downstream waters in the dam break flow could generate significant ecological impact on the downstream reaches and influence the environmental damages caused by the dam break flood. This is not easily investigated with the analytical and numerical models based on the grid method due to the large deformation of free surface and the water-water interface. In this paper, a weakly compressible Smoothed Particle Hydrodynamics (WCSPH) solver is used to study the advection and mixing process of the water bodies in two-dimensional dam-break flows over a wet bed. The numerical results of the mixing dynamics immediately after the release of the dam water are found to agree satisfactorily with the published experimental and numerical results. Then further investigations are carried out to study the interface development at the later stage of dambreak flows in a long channel. The analyses concentrate on the evolution of the interface at different ratios between the upstream and downstream water depths. The potential capabilities of the mesh-free SPH modelling approach for predicting the detailed development of the water-water interfaces are fully demonstrated.The first author acknowledges the Jafar Studentship during her PhD study at the University of Cambridge. The other authors acknowledge the support of the Major State Basic Research Development Program (973) of China (No. 2013CB036402), Open Fund of the State Key Laboratory of Hydraulics and Mountain River Engineering, Sichuan University (SKHL1404; SKHL1409), Start-up Grant for the Young Teachers of Sichuan University (2014SCU11056) and National Science and Technology Support Plan (2012BAB0513B0).This is the accepted manuscript. The final version is available at http://link.springer.com/article/10.1007%2Fs11069-015-1726-6

Potential application of mesh-free SPH method in turbulent river flows

A comprehensive review has been completed on the simulation of turbulent flow over rough beds using mesh-free particle models. Based on the outcomes of this review, an improved Smoothed Particle Hydrodynamics (SPH) method has been developed for open channel flows over a rough bed, in which a mixing length model is used for modeling the 2D turbulence and a drag force equation is proposed for treating the boundary shear. The proposed model was applied to simulate a depth-limited open channel flow over a rough bed surface. The results of the velocity profile and shear stress distribution show a good agreement with the experimental data and existing analytical solutions. This work reveals that in order to correctly model turbulent open channel flow over a rough bed, the treatment of both flow turbulence and bed roughness effect is equally important

A review on approaches to solving Poisson’s equation in projection-based meshless methods for modelling strongly nonlinear water waves

Three meshless methods, including incompressible smooth particle hydrodynamic (ISPH), moving particle semi-implicit (MPS) and meshless local Petrov–Galerkin method based on Rankine source solution (MLPG_R) methods, are often employed to model nonlinear or violent water waves and their interaction with marine structures. They are all based on the projection procedure, in which solving Poisson’s equation about pressure at each time step is a major task. There are three different approaches to solving Poisson’s equation, i.e. (1) discretizing Laplacian directly by approximating the second-order derivatives, (2) transferring Poisson’s equation into a weak form containing only gradient of pressure and (3) transferring Poisson’s equation into a weak form that does not contain any derivatives of functions to be solved. The first approach is often adopted in ISPH and MPS, while the third one is implemented by the MLPG_R method. This paper attempts to review the most popular, though not all, approaches available in literature for solving the equation

A Virtual Testing Approach for Laminated Composites Based on Micromechanics

International audienceThe chapter deals with a crucial question for the design of composite structures: how can one predict the evolution of damage up to and including final fracture? Virtual testing, whose goal is to drastically reduce the huge number of industrial tests involved in current characterization procedures, constitutes one of today’s main industrial challenges. In this work, one revisits our multiscale modeling answer through its practical aspects. Some complements regarding identification, kinking, and crack initiation are also given. Finally, the current capabilities and limits of this approach are discussed, as well as the computational challenges that are inherent to “Virtual Structural Testing.

A parameter-free total Lagrangian smooth particle hydrodynamics algorithm applied to problems with free surfaces

This paper presents a new Smooth Particle Hydrodynamics computational framework for the solution of inviscid free surface flow problems. The formulation is based on the Total Lagrangian description of a system of first-order conservation laws written in terms of the linear momentum and the Jacobian of the deformation. One of the aims of this paper is to explore the use of Total Lagrangian description in the case of large deformations but without topological changes. In this case, the evaluation of spatial integrals is carried out with respect to the initial undeformed configuration, yielding an extremely efficient formulation where the need for continuous particle neighbouring search is completely circumvented. To guarantee stability from the SPH discretisation point of view, consistently derived Riemann-based numerical dissipation is suitably introduced where global numerical entropy production is demonstrated via a novel technique in terms of the time rate of the Hamiltonian of the system. Since the kernel derivatives presented in this work are fixed in the reference configuration, the non-physical clumping mechanism is completely removed. To fulfil conservation of the global angular momentum, a posteriori (least-squares) projection procedure is introduced. Finally, a wide spectrum of dedicated prototype problems is thoroughly examined. Through these tests, the SPH methodology overcomes by construction a number of persistent numerical drawbacks (e.g. hour-glassing, pressure instability, global conservation and/or completeness issues) commonly found in SPH literature, without resorting to the use of any ad-hoc user-defined artificial stabilisation parameters. Crucially, the overall SPH algorithm yields equal second order of convergence for both velocities and pressure

Architecture, symbolic capital and elite mobilizations: The case of the Royal Bank of Scotland corporate campus

In this article, we apply the conceptual framework of Pierre Bourdieu, in particular forms of capital, social fields, field of power and modes of domination, to demonstrate how the study of a symbolically powerful building can provide insights into what are often opaque elite interactions. In order to do this, we focus on the corporate campus headquarters of a powerful financial institution, the Royal Bank of Scotland in the context of Scotland in the period 2000–2009. We pose the following questions: What is the relationship between corporate space and the field of power? What role does a corporate building play in circuits of capital conversion? What does this case tell us about the role of architecture in elite mobilisations? In addressing these questions, we contribute to critical organisation studies by identifying and theorising the role of corporate space in inter-elite dynamics and circuits of capital conversion. This approach, we argue, provides a methodological lever which could be applied to other symbolically important buildings in order to understand the nature and role of inter-field interactions in the conception and realisation of such buildings

Everything you always wanted to know about SDPD⋆ (⋆but were afraid to ask)

An overview of the smoothed dissipative particle dynamics (SDPD) method is presented in a format that tries to quickly answer questions that often arise among users and newcomers. It is hoped that the status of SDPD is clarified as a mesoscopic particle model and its potentials and limitations are highlighted, as compared with other methods