How do nurses in the acute surgical setting make sense of the care that they provide?

Introduction – This study seeks to explore how nurses sensemake the reality of the care they provide, including understanding the influences on how they make sense of their care. Few studies have explored how nurses sensemake the care they provide, focusing instead on how nurses understand, plan and deliver their care. Methodology – The study uses ethnomethodology to explicate how members of a particular social group, nurses in an acute hospital ward, create and maintain a sense of order in social life and how they shape, construct, and maintain their everyday worlds. To gain greater insight into the practice of caring, Sensemaking Theory (Weick, 1997) influenced the data analysis, discussion and understanding. Data collection was carried out in two surgical wards in an acute hospital, to triangulate different constructions of reality and generate a broader understanding. Methods used were the shadowing of eight nursing shifts, followed by semi-structured interviews with six registered nurses and a review of the nursing section of the hospital’s Electronic Patient Record (EPR) system. Data analysis was an iterative process, with the data collected from each phase coded to identify the key areas of understanding. Findings – The main finding is that nurses do not have one single understanding of nursing care. Instead, they construct and maintain multiple realities of care to give structure to how they deliver care. This finding suggests that nurses move seamlessly and unknowingly through these realities; this is supported by their use of specific language that they can effortlessly adopt. Dual processes of care were also identified, namely the activities involved in meeting a patient’s care needs alongside a parallel process of delivering care the nurse needs to provide. The exploration of the EPR found that the full complexity of nursing care was not appreciated or captured. In addition, the language used by nurses to create and maintain their realities was influenced by the EPR Conclusion – In appreciating the complexity of the realities of nursing care, this study has shown that nurses construct and maintain multiple realities; and that nurses have not been adequately prepared to manage these multiple realities in practice. Policy needs to reflect the work involved in managing these different realities in order to capture the quantum of nursing care required. Without this appreciation, nurses will remain ill prepared and attempts to determine the resource required will fail to reflect the complexity of care that nurses provide. Workforce planning and staffing calculation are based on a single reality, therefore underappreciating the impact and value of nursing care. The EPR focuses on capturing the physical interventions of care, and this caused frustration for the nurses using i

Project OASIS: The Design of a Signal Detector for the Search for Extraterrestrial Intelligence

An 8 million channel spectrum analyzer (MCSA) was designed the meet to meet the needs of a SETI program. The MCSA puts out a very large data base at very high rates. The development of a device which follows the MCSA, is presented

Precession during merger 1: Strong polarization changes are observationally accessible features of strong-field gravity during binary black hole merger

The short gravitational wave signal from the merger of compact binaries encodes a surprising amount of information about the strong-field dynamics of merger into frequencies accessible to ground-based interferometers. In this paper we describe a previously-unknown "precession" of the peak emission direction with time, both before and after the merger, about the total angular momentum direction. We demonstrate the gravitational wave polarization encodes the orientation of this direction to the line of sight. We argue the effects of polarization can be estimated nonparametrically, directly from the gravitational wave signal as seen along one line of sight, as a slowly-varying feature on top of a rapidly-varying carrier. After merger, our results can be interpreted as a coherent excitation of quasinormal modes of different angular orders, a superposition which naturally "precesses" and modulates the line-of-sight amplitude. Recent analytic calculations have arrived at a similar geometric interpretation. We suspect the line-of-sight polarization content will be a convenient observable with which to define new high-precision tests of general relativity using gravitational waves. Additionally, as the nonlinear merger process seeds the initial coherent perturbation, we speculate the amplitude of this effect provides a new probe of the strong-field dynamics during merger. To demonstrate the ubiquity of the effects we describe, we summarize the post-merger evolution of 104 generic precessing binary mergers. Finally, we provide estimates for the detectable impacts of precession on the waveforms from high-mass sources. These expressions may identify new precessing binary parameters whose waveforms are dissimilar from the existing sample.Comment: 11 figures; v2 includes response to referee suggestion

Stress concentrations around voids in three dimensions : The roots of failure

Funding This work forms part of a NERC New Investigator award for DH (NE/I001743/1), which is gratefully acknowledged. Acknowledgments The authors would like to acknowledge the reviewers, Elizabeth Ritz and Phillip Resor. Their reviews were very constructive, both helping to improve the manuscripts consistency and highlighting a number of errors in the initial submission. The authors would also like to thank Lydia Jagger's keen eye and patience, she helped greatly in removing a number of grammatical errors from the initial draft.Peer reviewedPublisher PD

Modelling of wave climate and sediment transport patterns at a tideless embayed beach, Pirita Beach, Estonia

Nearshore sand transport patterns along the tideless, embayed Pirita beach, Tallinn, Estonia, have been investigated utilizing high-resolution modelling of wave processes combined with bathymetric surveys and sediment textural analyses of the nearshore sea floor. Textural analysis showed the mean grain size is about 0.12 mm. Fine sand (0.063–0.125 mm) accounts for about 77% of the sediments. Coarser-grained sand (0.28 mm) dominates along the waterline. Based upon the spatial distribution of the mean grain size and basic features of the local wave activity, properties of the Dean Equilibrium Beach Profile were determined. Alongshore sediment transport was calculated based upon a long-term time series of wave properties along the beach, and the CERC formula applied to about 500 m long beach sectors. The time series of wave fields and the properties of the local wave climate were modelled using a triple nested WAM wave model with an extended spectral range for short waves. The model is forced by open sea wind data from Kalbådagrund for the years 1981–2002. Results indicate that typical closure depth at Pirita is 2.5 m. The width and mean slope of the equilibrium profile are 250 m and 1:100, respectively. Southward transport dominates in the northern sections of the beach whereas no prevailing transport direction exists in the southern sections. This pattern has several nontrivial implications for the planning of beach protection activities

Intrinsic selection biases of ground-based gravitational wave searches for high-mass BH-BH mergers

The next generation of ground-based gravitational wave detectors may detect a few mergers of comparable-mass M\simeq 100-1000 Msun ("intermediate-mass'', or IMBH) spinning black holes. Black hole spin is known to have a significant impact on the orbit, merger signal, and post-merger ringdown of any binary with non-negligible spin. In particular, the detection volume for spinning binaries depends significantly on the component black hole spins. We provide a fit to the single-detector and isotropic-network detection volume versus (total) mass and arbitrary spin for equal-mass binaries. Our analysis assumes matched filtering to all significant available waveform power (up to l=6 available for fitting, but only l<= 4 significant) estimated by an array of 64 numerical simulations with component spins as large as S_{1,2}/M^2 <= 0.8. We provide a spin-dependent estimate of our uncertainty, up to S_{1,2}/M^2 <= 1. For the initial (advanced) LIGO detector, our fits are reliable for $M\in[100,500]M_\odot$ ($M\in[100,1600]M_\odot$). In the online version of this article, we also provide fits assuming incomplete information, such as the neglect of higher-order harmonics. We briefly discuss how a strong selection bias towards aligned spins influences the interpretation of future gravitational wave detections of IMBH-IMBH mergers.Comment: 18 pages, 15 figures, accepted by PRD. v2 is version accepted for publication, including minor changes in response to referee feedback and updated citation

Surf zone currents and influence on surfability

Surfing headlands are shallow and exposed coastal features that provide a specific form of breaking wave allowing a board-rider to ride on the unbroken wave face. The seabed shape and refraction of the waves in relation to depth contours provide the greatest influence on the quality of the surf break. The large scale and orientation of the Raglan headland allows only the low frequency swells to refract around the headland to create seven different surfing breaks. Each represents a compartmentalization of the shoreline along the headland. This creates variability in wave and current characteristics depending on the orientation and bathymetry at different locations. This provides not only potential access points through the surf-zone (ie: smaller currents), but greater surfability in a range of conditions that is not possible on small scale headlands. Headlands with surfing waves can be classified as mis-aligned sections of the coast, where the higher oblique angle of the breaking surf generates strong wave-driven currents. These currents are far greater than that found on coastlines in equilibrium with the dominant swell direction, where comparatively insignificant longshore drift is found. The strength and direction of wave-driven currents in the surf zone can influence the surfability of a break. At a surfing headland strong currents flowing downdrift along the shoreline make it difficult for a paddling surfer to get to the "take-off" location of the break, or maintain position in the line-up. In comparison currents flowing updrift along headlands makes getting "out the back" relatively easy, although surfers can be taken out to sea past the "take-off" point by a fast flowing current. Field experiments at Raglan, on the west coast of New Zealand have been conducted to measure current speed and direction during a large swell event. Observations of surfers attempting to paddle through the breaking-wave zone, confirms the strength of the wave-driven currents with surfers being swept rapidly down the headland. Results from the experiments at Raglan, have shown strong currents in the inshore breaking wave zone with burst-averaged velocities attaining 0.8 ms-1, and maximum bed orbital velocities of up to 2.0 ms-1. Interestingly, further offshore the currents have been found to flow in a re-circulating gyre back up the headland. Comparisons are made from observations of waves and currents found at other surfing headlands around the world. The effect that strong currents may have on the surfability of artificial surfing reefs needs to be considered in the design process, if the surfing amenity is to be maximised for large surf conditions