The Nature of evidence to inform critical care nursing practice.

This thesis presents a body of publications, in the area of critical care nursing, for consideration for the award of Doctor of Philosophy by Publication. The thesis is presented in three chapters: Introduction; Body of Work; and Research, Knowledge, Evidence and Practice. In the first chapter the emergence of evidence-based practice is described, in general. Initially, an overview of the origins and trends of nursing research methodology is provided; the purpose of which is to set in context the body of work. Utilising a narrative approach (Boje, 2001; McCance et aL, 2001; Sandelowski, 199 1; Vezeau, 1994) as a 'personal journal of discovery' I then reflexively describe my own development as a nurse researcher practitioner, drawing on my own publications to illustrate my progress, the development of my thinking, my research practice and the development of my understanding of pragmatice pistemology. The second chapter is comprised of my publications relevant to critical care nursing. Spanning a period of eleven years, they represent my contribution to critical care nursing knowledge. In the concluding chapter I have summarised initially my own contribution to critical care nursing knowledge, before moving on to a more detailed critique of evidence-based practice. Finally I have made recommendations for the way forward. In addition to presenting my body of work, the aim of this PhD is to challenget he current concept of evidence-based practice, arguing that its definition is too narrow to encompass the rage of different types of knowledge that nurses use when caring for critically ill patients. I have utilised my own publications, to demonstrate how a variety of approaches are necessary to provide the best evidence for developing practice. I have positioned my argument within a theoretical understanding of pragmatic epistemology. In this way, I am working towards the development of a science of practice. Simultaneously I am also, to some extent, challenging conventional concepts of what constitutes doctoral level knowledge and how a PhD looks. My conclusion is that critical care nursing knowledge is drawn from many sources, and should be applied in an integrated way that enables practitioners to make a positive difference to the life of patients.Knowledge that is not or cannot be applied to practice is therefore of no value. The valuing of practice knowledge brings with it the requirement that all forms of knowledge (and their relevant methodologies) are considered as equal,in terms of their potential to impact on practice and that nothing should be rejected on paradigmatic grounds. In contemporary healthcare evidence is hierarchically valued and this raises many questions of equity. Where the value of knowledge becomes unequal is when its application to practice is limited. The corollary of a pragmatice pistemology is that it requires a pragmatic process to make it work. For me, at this point in time, the best available is practice development. In summary,this thesis represents a construction of work that makes an original contribution to knowledge. The product of my thesis is a theory of pragmatic epistemology as the basis for a science of practice

Family presence during resuscitation: Validation of the risk–benefit and self-confidence scales for student nurses

© 2016, © The Author(s) 2016. Background. There is increasing debate about the advantages and disadvantages of family-witnessed resuscitation. Research about the views of healthcare providers depends upon reliable tools to measure their perceptions. Two tools have been developed for use with nurses (26-item cost-benefit tool, 17-item self-confidence tool). Objectives. Firstly, to validate these tools for use with student nurses in the UK. Secondly, to report on the perceived risks and benefits reported by student nurses, and their self-confidence in dealing with this situation. Methods. A sample of 79 student nurses were invited to complete the tools. Item-total correlations and Cronbach’s α were used to determine internal consistency. Factor analysis was computed to assess construct validity. The correlation between the two scales was explored. Results. 69 students completed a questionnaire. Very few had experience of family-witnessed resuscitation. Mean total scores were 3.16 (standard deviation 0.37; range 2.04–4.12) on the risk-benefit scale and 3.14 (standard deviation 0.66; range 1.94–4.82) on the self-confidence scale. Four of the original items were removed from the risk-benefit scale (Cronbach's α 0.86; 95% confidence interval ≥0.82). None were removed from the self-confidence scale (Cronbach's α 0.93; 95% confidence interval ≥0.91). There was a significant correlation between the two scales (r = 0.37, p = 0.002). Conclusions. There is growing evidence that these tools are valid and reliable for measuring student nurses’ perceptions about family-witnessed resuscitation

Reexamining age, race, site, and thermometer type as variables affecting temperature measurement in adults – A comparison study

BACKGROUND: As a result of the recent international vigilance regarding disease assessment, accurate measurement of body temperature has become increasingly important. Yet, trusted low-tech, portable mercury glass thermometers are no longer available. Thus, comparing accuracy of mercury-free thermometers with mercury devices is essential. Study purposes were 1) to examine age, race, site as variables affecting temperature measurement in adults, and 2) to compare clinical accuracy of low-tech Galinstan-in-glass device to mercury-in-glass at oral, axillary, groin, and rectal sites in adults. METHODS: Setting 176 bed accredited healthcare facility, rural northwest US Participants Convenience sample (N = 120) of hospitalized persons ≥ 18 years old. Instruments Temperatures (°F) measured at oral, skin (simultaneous), immediately followed by rectal sites with four each mercury-glass (BD) and Galinstan-glass (Geratherm) thermometers; 10 minute dwell times. RESULTS: Participants averaged 61.6 years (SD 17.9), 188 pounds (SD 55.3); 61% female; race: 85% White, 8.3% Native Am., 4.2% Hispanic, 1.7 % Asian, 0.8% Black. For both mercury and Galinstan-glass thermometers, within-subject temperature readings were highest rectally; followed by oral, then skin sites. Galinstan assessments demonstrated rectal sites 0.91°F > oral and ≅ 1.3°F > skin sites. Devices strongly correlated between and across sites. Site difference scores between devices showed greatest variability at skin sites; least at rectal site. 95% confidence intervals of difference scores by site (°F): oral (0.142 – 0.265), axilla (0.167 – 0.339), groin (0.037 – 0.321), and rectal (-0.111 – 0.111). Race correlated with age, temperature readings each site and device. CONCLUSION: Temperature readings varied by age, race. Mercury readings correlated with Galinstan thermometer readings at all sites. Site mean differences between devices were considered clinically insignificant. Still considered the gold standard, mercury-glass thermometers may no longer be available worldwide. Therefore, mercury-free, environmentally safe low-tech Galinstan-in-glass may be an appropriate replacement. This is especially important as we face new, internationally transmitted diseases

Sports coaching and the law of negligence: implications for coaching practice

The ordinary principles of the law of negligence are applicable in the context of sport, including claims brought against volunteer and professional coaches. Adopting the perspective of the coach, this article intends to raise awareness of the emerging intersection between the law of negligence and sports coaching, by utilising an interdisciplinary analysis designed to better safeguard and reassure coaches mindful of legal liability. Detailed scrutiny of two cases concerning alleged negligent coaching, with complementary discussion of some of the ethical dilemmas facing modern coaches, reinforces the legal duty and obligation of all coaches to adopt objectively reasonable and justifiable coaching practices when interacting with athletes. Problematically, since research suggests that some coaching practice may be underpinned by ‘entrenched legitimacy’ and ‘uncritical inertia’, it is argued that coach education and training should place a greater emphasis on developing a coach’s awareness and understanding of the evolving legal context in which they discharge the duty of care incumbent upon them

Historical literacy and consciousness

A ideia de literacia histórica - enquanto conjunto de competências de interpretação e compreensão do passado - surge associada à proposta de desenvolvimento da consciência histórica, tal como defende Peter Lee. Esta necessidade de orientação temporal exige identificações múltiplas, a várias escalas (do local ao global), e a consideração de pontos de vista diversificados, apresentados quer por historiadores quer por outras fontes para a História. Assumindo a relevância desta problemática para a formação da consciência histórica, é pertinente interrogarmo-nos acerca de como desenvolvem os alunos universitários (futuros professores de História) as suas competências de literacia histórica. No âmbito da disciplina de Metodologia do Ensino da História, no 4º ano da Licenciatura em Ensino de História (Universidade do Minho), explorararam-se as seguintes questões de investigação: 1) Que critérios utilizam os futuros professores de História quando decidem entre versões históricas diferentes? 2) Como é que estes futuros professores fundamentam os seus argumentos a favor ou contra uma determinada versão? Aos dezoito alunos do curso participantes neste estudo, foi proposta uma tarefa de avaliação de dois textos históricos, um de Luís de Albuquerque, historiador português, outro de Sanjay Subrahmanyam, historiador indiano, sobre a primeira viagem marítima dos portugueses à Índia (com suporte em várias fontes, nomeadamente um excerto do diário de viagem de Gama). Conjugando-se as dimensões de interpretação substantiva das mensagens com a de uso de critérios históricos, os dados sugeriram uma categorização global constituída por cinco níveis de ideias. Os padrões mais observados ligam-se a noções de viés (a validade histórica depende de uma maior ou menor neutralidade) ou de influência do contexto de produção nos historiadores. A aceitação da validade de versões diferentes, enquanto algo genuíno no conhecimento histórico, emergiu entre alguns poucos alunos universitários. Esta tipologia coincide com os níveis de idéias observados em adolescentes e crianças portuguesas, em estudos anteriores, embora os níveis mais elaborados apareçam mais frequentemente entre os alunos universitários.The idea of historical literacy - as a set of competences of historical interpretation and understanding - is emerging as linked to the proposal of developing historical consciousness, as Peter Lee argues. This need for temporal orientation demands multiple identifications at several scales (from the local up to the global scale) as well as the consideration of diversified points of view, given either by historians or many other sources of history. Assuming the relevance of this issue, it is pertinent to question about the way university students (preservice history teachers) are developing their own competences of historical literacy. In the context of the Methodology of History Teaching subject, at year 4 of the Teaching of History Graduate Course (University of Minho), the following research questions were explored: 1) What criteria do the preservice history teachers employ when deciding about different historical versions? 2) How those preservice history teachers support their arguments for or against a given version? An assessment task of two historical texts, one written by Luís de Albuquerque, Portuguese historian, another by Sanjay Subrahmanyam, Indian historian, was accomplished by the 18 participants of this study. The historical texts focussed on the first Portuguese maritime voyage to India (and they were grounded on several evidence, namely an excerpt of the Gama trip log). Combining the dimensions of substantive interpretation of messages and use of historical criteria, data suggested a global categorization with five levels of ideas. The most observed patterns are related to notions of bias (historical validity depends on neutrality) or notions of influence of the historical production context). The recognition of validity of different versions as a genuine element of the historical knowledge emerged just among a few university students. Such a tipology matches with the levels of ideas observed among Portuguese children and adolescents in former studies, although the most elaborate levels appear more frequently among the university students

Research strategies for organizational history:a dialogue between historical theory and organization theory

If history matters for organization theory, then we need greater reflexivity regarding the epistemological problem of representing the past; otherwise, history might be seen as merely a repository of ready-made data. To facilitate this reflexivity, we set out three epistemological dualisms derived from historical theory to explain the relationship between history and organization theory: (1) in the dualism of explanation, historians are preoccupied with narrative construction, whereas organization theorists subordinate narrative to analysis; (2) in the dualism of evidence, historians use verifiable documentary sources, whereas organization theorists prefer constructed data; and (3) in the dualism of temporality, historians construct their own periodization, whereas organization theorists treat time as constant for chronology. These three dualisms underpin our explication of four alternative research strategies for organizational history: corporate history, consisting of a holistic, objectivist narrative of a corporate entity; analytically structured history, narrating theoretically conceptualized structures and events; serial history, using replicable techniques to analyze repeatable facts; and ethnographic history, reading documentary sources "against the grain." Ultimately, we argue that our epistemological dualisms will enable organization theorists to justify their theoretical stance in relation to a range of strategies in organizational history, including narratives constructed from documentary sources found in organizational archives. Copyright of the Academy of Management, all rights reserved