La signification de l'apprentissage du caring pour des étudiantes dans un baccalauréat en sciences infirmières basé sur la formation par compétences

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal

L'évolution des valeurs de soin humain : une analyse dialectique de la proposition d'humanisation de Watson à la lumière d'une perspective nietzschéenne

La pratique du soin infirmier d’aujourd’hui hérite d’une longue et complexe évolution de valeurs. Outre les valeurs traditionnellement humaines de soigner, la pratique infirmière d’aujourd’hui intègre aussi des valeurs qui façonnent notre monde moderne. Ainsi, nous retraçons d’abord l’évolution de quelques-unes des valeurs traditionnelles rattachées au soin humain conservées dans les pratiques infirmières. Puis, nous montrons que certaines valeurs traditionnelles de soin humain sont progressivement supprimées au profit de valeurs qui émanent des idéologies modernes. En effet, il apparaît que plusieurs valeurs néolibérales, technocrates et bureaucrates s’enracinent à même les fondements de la pratique infirmière et entrainent ainsi des problèmes inquiétants de déshumanisation et d’instrumentalisation des services sanitaires. Face à ce constat inquiétant, et parmi l'éventail de solutions proposées, certains auteurs promeuvent l’humanisation des systèmes sanitaires à l’aide de la théorie du soin humain – TSHW de Jean Watson (1979 - 2013). Cette théorie propose de pallier à l’instrumentalisation par deux propositions : l’adoption d’une pensée métaphysique transcendantale de même qu’un humanisme altruiste. Or, plusieurs critiques interrogent la cohérence théorique de ces propositions, voire la légitimité même de cette théorie pour faire face à l’instrumentalisation. Considérant tous ces faits, nous avons analysé ces deux propositions afin de clarifier les débats, de contribuer à son développement éventuel, mais surtout pour tester ces affirmations et proposer d’éventuelles voies de solution. Cependant, la mise à l’épreuve dialectique des deux propositions (opposant les discours de la TSHW à plusieurs concepts nietzschéens) montre des écueils de cohérence et de pertinence importants conduisant à la réfutation du projet d’humanisation inscrit à même cette théorie. Plus spécifiquement, nous montrons que la TSHW peut paradoxalement contribuer à perpétuer le dualisme et le nihilisme conduisant à la conversion inéluctable aux discours et valeurs instrumentales au lieu de freiner leurs envahissements de la pensée et de la pratique infirmière. Enfin, nous recommandons une voie alternative à l’instrumentalisation – dans une éthique de la Vie - qui découle de la synthèse de nos dialectiques et qui favorise un retour-à, et un respect de la nature même de l’être humain. Mots clé : Humanisme, métaphysique, soin humain, Jean Watson, Friedrich Nietzsche, nihilisme, ressentiment.Nursing today is heir to values that have developed over many years. In addition to the values of human care, present-day nursing embraces values that shape our modern world. This dialectical study first traces the evolution of a number of the traditional values associated with human care that nursing has retained. It goes on to show how some of the values of human care have been cast aside in favour of modern—neoliberal, technocratic and bureaucratic—values which have in turn given rise to disturbing problems of instrumentalization. Watson’s theory of caring proposes two ways to remedy such instrumentalization: espousing a transcendental, metaphysical mode of thought and adopting an altruistic humanism. However, many critics have questioned the theoretical consistency and very legitimacy of the theory as a means of dealing with instrumentalization. This study analyzes Watson’s proposals, using a Nietzschean dialectic approach to test them and to suggest possible solutions. Significant problems in terms of both consistency and relevance are brought to light, tending to refute Watson’s notions. More particularly, our findings suggest that the application of Watson’s theory may paradoxically perpetuate dualism and nihilism and, rather than curb their invasive impact, lead inevitably to a conversion to instrumental values. In conclusion, we suggest an alternative, ethics-of-life approach based on the synthesis of our dialectics that would foster a return to, and respect for, humanity’s essential nature. Keywords : Humanism, metaphysics, human care, Jean Watson, Friedrich Nietzsche, nihilism, Ressentiment

Demand Response for Reducing Coincident Peak Loads in Data Centers

Demand response is a key aspect of managing uncertainty and reducing peak loads in electric grids. This paper considers the capability of a datacenter to provide responsiveness to grid signals through cooling system control. The strategy is based on pre-cooling the center for provision of load reduction during demand response events, and is evaluated using a numerical model of a cooling system, validated against experimental data obtained from a small telecommunication data center. The pre-cooling strategy is applicable to a wide-range of demand response programs, but is illustrated on the example of an established critical peak pricing program; specifically the 4 coincident peak (4CP) program in the ERCOT ISO. Precooling reduced the annual cost of electricity used by the cooling system by 7.8% to 8.6%, while increasing the total energy use only by 0.05%. This translated into 2% to 2.6% reduction in the electric bill of the whole data center. The developed demand response strategy is suitable for data centers with power densities below 500 W/m2 which do not use server air containment systems

Early and Long-Term Results of Unprotected Left Main Coronary Artery Stenting The LE MANS (Left Main Coronary Artery Stenting) Registry

ObjectivesThe aim of the study was to evaluate early and late outcomes after percutaneous coronary intervention (PCI) of unprotected left main coronary artery disease (ULMCA) and to compare bare-metal stent (BMS) and drug-eluting stent (DES) subgroups.BackgroundPCI is an increasingly utilized method of revascularization in patients with ULMCA.MethodsThis multicenter prospective registry included 252 patients after ULMCA stenting enrolled between March 1997 and February 2008. Non–ST-segment elevation acute coronary syndrome was diagnosed in 58% of patients; ST-segment elevation myocardial infarction cases were excluded. Drug-eluting stents were implanted in 36.2% of patients.ResultsMajor adverse cardiovascular and cerebral events (MACCE) occurred in 12 (4.8%) patients during the 30-day period, which included 4 (1.5%) deaths. After 12 months there were 17 (12.1%) angiographically confirmed cases of restenosis. During long-term follow-up (1 to 11 years, mean 3.8 years) there were 64 (25.4%) MACCE and 35 (13.9%) deaths. The 5- and 10-year survival rates were 78.1% and 68.9%, respectively. Despite differences in demographical and clinical data in favor of BMS patients, unmatched analysis showed a significantly lower MACCE rate in DES patients (25.9% vs. 14.9%, p = 0.039). This difference was strengthened after propensity score matching. The DES lowered both mortality and MACCE for distal ULMCA lesions when compared with BMS. Ejection fraction <50% was the only independent risk factor influencing long-term survival.ConclusionsStenting of ULMCA is feasible and offers good long-term outcome. Implantation of DES for ULMCA decreased the risk of long-term MACCE, and particularly improved survival in patients with distal ULMCA disease

Extended Reach Drilling on the example of Reelwell Drilling Method: Influence examination of different drill pipes on drilling performance on Idun field on the Norwegian Continental Shelf by PGNiG Norway AS.

Master's thesis in Petroleum engineeringHorizontal or extended reach drilling is incredibly fast growing technology. Although in some areas of the world ERD is still novelty, most of oil companies have been using the technology reliably and successfully for dozens of years. And those companies want to improve well-worn solutions to obtain better performance, thereby reducing costs. One of the main aspects that affects drilling performance and efficiency is adequate choice of drill pipes. The paper describes way of drill pipes’ selection that is based on detailed analyses and calculations of such factors as: a) fatigue resistance & wear phenomenon b) drag & torque issues c) torsion strength, buckling tendencies d) BHA design For each of the factors shown above, appropriate analyze model has been chosen to simplify the train. Moreover all of the calculations required were presented and explained in accessible way. Additional comments were run where needed. Further, three different drill pipes have been selected to show possible ways of improvement. They differ with material (S-135 steel DP, Aluminum DP, Composite DP), with size (4 ½”, 5”, 5 ½” for steel and aluminum pipes, 3 3/8”, 5 ½” for composite pipes) as well as with different mechanical properties. To cast light on technical feasibility, theoretical assumptions regarding wellbore design, wellbore and environmental conditions have been made. Data such as drill pattern, drill design, wellbore size(s), TVD, MD and temperature had to be assumed. They are specified, not to have them wrong, with the real data provided by Dolphin Drilling Company. Furthermore, all of the results are briefly presented and detailed comparison has been made. The best solution, for the given wellbore conditions, has been chosen and shown with close comment and justification. Finally, alternative solutions have been presented as well. Possibility of the results improvement with additional equipment has been explained.PGNiG Norway A

Advanced analysis of steel frames with effects of joint deformability and partial strength accounted for

The paper summarises the current progress in methods of advanced analysis for design of frames with semirigid joints. The methods presented in the paper belong to general secondâ€order refined plasticâ€hinge methods that allow for the combined effects of joint stiffness degradation and distributed plasticity along the member length as well as across the member sections. The advanced analysis for steel frame design, proposed by the authors, is based on the springâ€inâ€series model. The effect of joint semiâ€rigidity and partial strength is taken care of by specifying certain values of the initial stiffness, ultimate moment and the shape factor of the momentâ€rotation characteristic for the spring representing the joint. The effect of imperfections affecting the performance of imperfect structural members in compression is modelled by the application of a simplified tangent modulus concept combined with the reduction of the initial value of the elasticity modulus. The effect of residual stresses is taken care of by specifying certain values of the shape parameter for the momentâ€rotation characteristic of the spring representing the gradual yielding of the member. It is dependent upon the crossâ€section type and fabrication method (ie upon the residual stress pattern resulting from rolling or welding processes). A case study analysis is presented. Concluding remarks referring to the application of advanced analysis in design, pertaining to the study case considered, are drawn. First Published Online: 14 Oct 201

Identifying predictive motor factors for falls in post-menopausal breast cancer survivors.

OBJECTIVE:Breast cancer treatment, including radical surgery, is also pursued as late as the 7th - 8th decade of women's lives. Standard physical rehabilitation procedures offered to those women are predominantly focused on attenuating specific functional deficits of the upper limb and trunk. Seldom do they entail any regimens specifically aimed at recovering overall functionality, and reducing exposure to falls-risk. The study aimed to assess potential interrelationships between the self-reported falls, individual functional capabilities and appreciably reducing exposure to falls-risk in a group of post-menopausal, post-surgical breast cancer survivors. METHODS:The study recruited 102 women (aged 65-79; mean age 70.2), post-surgical breast cancer survivors. The subjects were stratified by age into three groups: Group 1 (65-69 years); Group 2 (70-74 years), and Group 3 (75-79 years). Individual functional capabilities were assessed with Eight-foot up & go test (8UG), chair stand test (CST), and 2-minute step test (2ST). Tinetti POMA test was applied to assess gait and balance disorders. Self-reported falls in the past year were ascertained through a questionnaire. RESULTS:Assessment of individual aerobic endurance (2ST) also demonstrated a clear deficit in the mean scores category in all respective age sub-groups, as compared against the reference values. The deficits ranged from 4.86 to 15.90 steps less than the normative values; the oldest subjects demonstrating the largest deficit. The aerobic endurance tests results significantly impacted the ultimate assessment of an individual falls-risk in the oldest group. The analysis of the number of falls sustained within the recent year indicated that 43.67% of the subjects fell victim of such incidents. CONCLUSION:An individual exposure to falls-risk was found to be appreciably more dependent upon individual aerobic endurance rather than overall strength of the lower part of the body in the breast cancer survivors over 75