Nurses' workarounds in acute healthcare settings: A scoping review

Background: Workarounds circumvent or temporarily 'fix' perceived workflow hindrances to meet a goal or to achieve it more readily. Behaviours fitting the definition of workarounds often include violations, deviations, problem solving, improvisations, procedural failures and shortcuts. Clinicians implement workarounds in response to the complexity of delivering patient care. One imperative to understand workarounds lies in their influence on patient safety. This paper assesses the peer reviewed empirical evidence available on the use, proliferation, conceptualisation, rationalisation and perceived impact of nurses' use of workarounds in acute care settings. Methods. A literature assessment was undertaken in 2011-2012. Snowballing technique, reference tracking, and a systematic search of twelve academic databases were conducted to identify peer reviewed published studies in acute care settings examining nurses' workarounds. Selection criteria were applied across three phases. 58 studies were included in the final analysis and synthesis. Using an analytic frame, these studies were interrogated for: workarounds implemented in acute care settings by nurses; factors contributing to the development and proliferation of workarounds; the perceived impact of workarounds; and empirical evidence of nurses' conceptualisation and rationalisation of workarounds. Results: The majority of studies examining nurses' workarounds have been published since 2008, predominantly in the United States. Studies conducted across a variety of acute care settings use diverse data collection methods. Nurses' workarounds, primarily perceived negatively, are both individually and collectively enacted. Organisational, work process, patient-related, individual, social and professional factors contribute to the proliferation of workarounds. Group norms, local and organisational culture, 'being competent', and collegiality influence the implementation of workarounds. Conclusion: Workarounds enable, yet potentially compromise, the execution of patient care. In some contexts such improvisations may be deemed necessary to the successful implementation of quality care, in others they are counterproductive. Workarounds have individual and cooperative characteristics. Few studies examine nurses' individual and collective conceptualisation and rationalisation of workarounds or measure their impact. The importance of displaying competency (image management), collegiality and organisational and cultural norms play a role in nurses' use of workarounds. © 2013 Debono et al.; licensee BioMed Central Ltd

Childhood sexual abuse in patients with severe mental Illness: demographic, clinical and functional correlates.

OBJECTIVE: To use data from electronic health records (EHRs) to describe the demographic, clinical and functional correlates of childhood sexual abuse (CSA) in patients with severe mental illness (SMI), and compare their clinical outcomes (admissions and receipt of antipsychotic medications) to those of patients with no recorded history of CSA. METHODS: We applied a string-matching technique to clinical text records of 7,000 patients with SMI (non-organic psychotic disorders or bipolar disorder), identifying 619 (8.8%) patients with a recorded history of CSA. Data was extracted from both free-text and structured fields of patients' EHRs. RESULTS: Comorbid diagnoses of major depressive disorder, posttraumatic stress disorder and personality disorders were more prevalent in patients with CSA. Positive psychotic symptoms, depressed mood, self-harm, substance use and aggression were also more prevalent in this group, as were problems with relationships and living conditions. The odds of inpatient admissions were higher in patients with CSA than in those without (adjusted OR=1.95, 95% CI: 1.64-2.33), and they were more likely to have spent more than 10 days per year as inpatients (adjusted OR=1.32, 95% CI: 1.07-1.62). Patients with CSA were more likely to be prescribed antipsychotic medications (adjusted OR=2.48, 95% CI: 1.69-3.66), and be given over 75% of the maximum recommended daily dose (adjusted OR=1.72, 95% CI: 1.44-2.04). CONCLUSION: Data-driven approaches are a reliable, promising avenue for research on childhood trauma. Clinicians should be trained and skilled at identifying childhood adversity in patients with SMI, and addressing it as part of the care plan

Stability Analysis of Frame Slotted Aloha Protocol

Frame Slotted Aloha (FSA) protocol has been widely applied in Radio Frequency Identification (RFID) systems as the de facto standard in tag identification. However, very limited work has been done on the stability of FSA despite its fundamental importance both on the theoretical characterisation of FSA performance and its effective operation in practical systems. In order to bridge this gap, we devote this paper to investigating the stability properties of FSA by focusing on two physical layer models of practical importance, the models with single packet reception and multipacket reception capabilities. Technically, we model the FSA system backlog as a Markov chain with its states being backlog size at the beginning of each frame. The objective is to analyze the ergodicity of the Markov chain and demonstrate its properties in different regions, particularly the instability region. By employing drift analysis, we obtain the closed-form conditions for the stability of FSA and show that the stability region is maximised when the frame length equals the backlog size in the single packet reception model and when the ratio of the backlog size to frame length equals in order of magnitude the maximum multipacket reception capacity in the multipacket reception model. Furthermore, to characterise system behavior in the instability region, we mathematically demonstrate the existence of transience of the backlog Markov chain.Comment: 14 pages, submitted to IEEE Transaction on Information Theor

Explicit Formulae Showing the Effects of Texture on Acoustoelastic Coefficients

It is well known that crystallographic texture not only modifies the elastic constants of polycrystalline aggregates at (unstressed) natural states but also affects their acoustoelastic coefficients when the aggregates are stressed. While exact knowledge about the effects of texture on acoustoelastic coefficients has hitherto remained wanting, such effects are usually assumed to be negligible and are ignored in practical applications of acoustoelasticity (cf. [1] for example). Concerning this common practice, Thompson et al. [2] have urged caution: Care must be taken when [this] assumption is made since the influence of texture on acoustoelastic constants is stronger than its influence on elastic moduli or velocities

The role of primary healthcare professionals in oral cancer prevention and detection

AIM: To investigate current knowledge, examination habits and preventive practices of primary healthcare professionals in Scotland, with respect to oral cancer, and to determine any relevant training needs. SETTING: Primary care. METHOD: Questionnaires were sent to a random sample of 357 general medical practitioners (GMPs) and 331 dental practitioners throughout Scotland. Additionally, focus group research and interviews were conducted amongst primary healthcare team members. RESULTS: Whilst 58% of dental respondents reported examining regularly for signs of oral cancer, GMPs examined patients' mouths usually in response to a complaint of soreness. The majority of GMPs (85%) and dentists (63%) indicated that they felt less than confident in detecting oral cancer, with over 70% of GMPs identifying lack of training as an important barrier. Many practitioners were unclear concerning the relative importance of the presence of potentially malignant lesions in the oral cavity. A high proportion of the GMPs indicated that they should have a major role to play in oral cancer detection (66%) but many felt strongly that this should be primarily the remit of the dental team. CONCLUSION: The study revealed a need for continuing education programmes for primary care practitioners in oral cancer-related activities. This should aim to improve diagnostic skills and seek to increase practitioners' participation in preventive activities

Thermoelectric spin voltage in graphene

In recent years, new spin-dependent thermal effects have been discovered in ferromagnets, stimulating a growing interest in spin caloritronics, a field that exploits the interaction between spin and heat currents. Amongst the most intriguing phenomena is the spin Seebeck effect, in which a thermal gradient gives rise to spin currents that are detected through the inverse spin Hall effect. Non-magnetic materials such as graphene are also relevant for spin caloritronics, thanks to efficient spin transport, energy-dependent carrier mobility and unique density of states. Here, we propose and demonstrate that a carrier thermal gradient in a graphene lateral spin valve can lead to a large increase of the spin voltage near to the graphene charge neutrality point. Such an increase results from a thermoelectric spin voltage, which is analogous to the voltage in a thermocouple and that can be enhanced by the presence of hot carriers generated by an applied current. These results could prove crucial to drive graphene spintronic devices and, in particular, to sustain pure spin signals with thermal gradients and to tune the remote spin accumulation by varying the spin-injection bias

High-transition-temperature superconductivity in the absence of the magnetic-resonance mode

The fundamental mechanism that gives rise to high-transition-temperature (high-Tc) superconductivity in the copper oxide materials has been debated since the discovery of the phenomenon. Recent work has focussed on a sharp 'kink' in the kinetic energy spectra of the electrons as a possible signature of the force that creates the superconducting state. The kink has been related to a magnetic resonance and also to phonons. Here we report that infrared spectra of Bi2Sr2CaCu2O(8+d), (Bi-2212) show that this sharp feature can be separated from a broad background and, interestingly, weakens with doping before disappearing completely at a critical doping level of 0.23 holes per copper atom. Superconductivity is still strong in terms of the transition temperature (Tc approx 55 K), so our results rule out both the magnetic resonance peak and phonons as the principal cause of high-Tc superconductivity. The broad background, on the other hand, is a universal property of the copper oxygen plane and a good candidate for the 'glue' that binds the electrons.Comment: 4 pages, 3 figure

Multiscale friction in lubricant-surface systems for high performance transmissions under mild wear

The lubricant-surface system is complex in nature and can significantly affect the frictional performance of high-performance transmission systems. The complexity stems from the coupled mechanical and chemical phenomena that occur at the interfacial tooth conjunctions. A combined analytical and precision experimental approach is presented to analyse the salient parameters of the lubricant-surface system. A multiscale procedure comprising topographical measurement, pin-on-disc tribometry, atomic force microscopy in lateral force mode, X-ray photo-electron spectroscopy and continuum contact mechanics analysis under mixed non-Newtonian thermo-elastohydrodynamics is used to describe the formation of a tribo-film, as well as wear and frictional characteristics of the lubricant-surface system. The contribution of chemisorbed and physisorbed bonded tribo-film on the boundary coefficient of friction is ascertained at different physical scales. Therefore, the paper presents a novel multiscale analysis, promoting improved understanding of the complex interactions between mechanisms of friction, wear and surface chemistry

Generating Single Microwave Photons in a Circuit

Electromagnetic signals in circuits consist of discrete photons, though conventional voltage sources can only generate classical fields with a coherent superposition of many different photon numbers. While these classical signals can control and measure bits in a quantum computer (qubits), single photons can carry quantum information, enabling non-local quantum interactions, an important resource for scalable quantum computing. Here, we demonstrate an on-chip single photon source in a circuit quantum electrodynamics (QED) architecture, with a microwave transmission line cavity that collects the spontaneous emission of a single superconducting qubit with high efficiency. The photon source is triggered by a qubit rotation, as a photon is generated only when the qubit is excited. Tomography of both qubit and fluorescence photon shows that arbitrary qubit states can be mapped onto the photon state, demonstrating an ability to convert a stationary qubit into a flying qubit. Both the average power and voltage of the photon source are characterized to verify performance of the system. This single photon source is an important addition to a rapidly growing toolbox for quantum optics on a chip.Comment: 6 pages, 5 figures, hires version at http://www.eng.yale.edu/rslab/papers/single_photon_hires.pd