Decision-making in an emergency department: A nursing accountability model

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction Nurses that work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. Research objective The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. Research design Data were analysed, codified and triangulated using qualitative ethnographic content analysis. Participants and research context This research is set in a large emergency department in the Midlands area of England. Data was collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies Ethical considerations Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. Results The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations amongst the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. Discussion The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. Conclusion The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen

Revisiting the Stability of Quadratic Poincar\'e Gauge Gravity

Poincar\'e gauge theories provide an approach to gravity based on the gauging of the Poincar\'e group, whose homogeneous part generates curvature while the translational sector gives rise to torsion. In this note we revisit the stability of the widely studied quadratic theories within this framework. We analyse the presence of ghosts without fixing any background by obtaining the relevant interactions in an exact post-Riemannian expansion. We find that the axial sector of the theory exhibits ghostly couplings to the graviton sector that render the theory unstable. Remarkably, imposing the absence of these pathological couplings results in a theory where either the axial sector or the torsion trace becomes a ghost. We conclude that imposing ghost-freedom generically leads to a non-dynamical torsion. We analyse however two special choices of parameters that allow a dynamical scalar in the torsion and obtain the corresponding effective action where the dynamics of the scalar is apparent. These special cases are shown to be equivalent to a generalised Brans-Dicke theory and a Holst Lagrangian with a dynamical Barbero-Immirzi pseudoscalar field respectively. The two sectors can co-exist giving a bi-scalar theory. Finally, we discuss how the ghost nature of the vector sector can be avoided by including additional dimension four operators.Comment: 25 pages, 1 figure. More insight on the bi-scalar theory has been added, including its possible extensions and the coupling with fermions. A clarifying footnote on the Holst term has been introduced. Extended discussion. It matches the version published in EPJ

Ethical, legal and professional accountability in emergency nursing practice: an ethnographic observational study

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction Accountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses’ working conditions. Aim The aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice. Methods A qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis. Results The factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles’ application. Discussion The long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses’ working conditions need to be implemented to limit the workload to which an ED nurse is subjected to. Conclusion ED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making

Using multicomponent recycled electronic waste alloys to produce high entropy alloys

The amount of electronic waste (e-waste) recycled worldwide is less than 20% of the total amount produced. In a world where the need for critical and strategic metals is increasing almost exponentially, it is unacceptable that tons of these elements remain unrecycled. One of the causes of this low level of recycling is that recycling is based on an expensive and complex selective sorting of metals. Extracting all metals simultaneously is much simpler and if this were done, it would significantly increase the recycling rate. Meanwhile, it was demonstrated that high entropy alloys (HEAs), which are in great demand in applications where very high performance is required, can be made from mixtures of complex alloys, hence reducing their dependence on pure critical metals. Here, we show that it is possible to obtain competitive HEAs from complex alloy mixtures corresponding to typical electronic waste compositions, combining two needs of high interest in our society, namely: to increase the level of recycling of electronic waste and the possibility of developing high-performance HEAs without the need of using critical and/or strategic metals. To validate our hypothesis that e-waste can be used to produce competitive HEAs, we propose an alloy design strategy combining computational thermodynamics (CalPhaD) exploration of phase diagrams and phenomenological criteria for HEA design based on thermodynamic and structural parameters. A shortlist of selected compositions are then fabricated by arc melting ensuring compositional homogeneity of such complex alloys and, finally, characterised microstructurally, using electron microscopy and diffraction analysis, and mechanically, using hardness testing

Nonsingular and ghost-free infinite derivative gravity with torsion

We present the most general quadratic curvature action with torsion including infinite covariant derivatives and study its implications around the Minkowski background via the Palatini approach. Provided the torsion is solely given by the background axial field, the metric and torsion arc shown to decouple, and both of them can be made ghost and singularity free for a fermionic source

Foreigner? Want to Study in Spain? The Integration Process at Universities

AbstractThe student exchange programs being carried out at universities for over 50 years, have led to changes in the institutions, which had to adapt to accommodate these students. Despite those changes, the integration of foreign students not coming from the aforementioned exchange programs that come to our country to study at the University has been neglected.These students face many barriers (language, cultural and origin customs mainly), so a clear and detailed information would be highly desirable in order to facilitate the necessary arrangements This study aims to show the deficiencies in the integration process and hosting programs faced by a foreign student at University.The study is performed by means of an analysis of statistical data from the Polytechnic University of Madrid and the Civil Engineering School over the last 12 school years (1999 - 2000 to 2010 - 2011), as well as surveys and interviews with some of these students.The study is enhanced with the analysis of the measures and integration methods of the various minorities, which had been implemented by the foremost public universities in Spain, as well as other public and private universities abroad.It illustrates the existing backlog at the Spanish universities with regards to supporting the integration of diversity among foreign students, providing data concerning the growth of such population and its impact at the university, and on the institutions in particular.In an increasingly globalized world, we must understand and facilitate the integration of minorities at University, supplying them, from the first day, and before the enrollment process, the essential elements that will allow their adequate adaptation to the educational process at University. It concludes by identifying the main subjects that need to be tackled to endorse such integration

Accountability issues in an English emergency department: A nursing perspective

University Hospitals of Leicester NHS Trust University of Murcia, Spain The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Introduction: Nurses confront doubts about their accountability and how it affects their clinical practice daily in the complex environment of an emergency department. Therefore, nurses’ experiences can provide vital information about the decisions and dilemmas in clinical practice that affect both healthcare professionals and patients alike. Aim: The aim of this study was to explore the perceptions of nursing staff in an English emergency department in relation to their ethical, legal and professional accountability. Methods: Ethnographic content analysis was used to analyse 34 semi-structured interviews from registered nurses working in an emergency department. Results: There were five categories found during the coding process: nursing care, staff interactions, legal and professional accountability, decision-making process and ethics and values. Conclusion: Several issues related to nursing accountability were found, including the effects of nursing shortages and the reasoning behind multidiscipinary team conflicts. Different approaches of individual and institutional accountability, the evolution of Benner’s nursing model and nursing value progression was also identified as key issues. All these phenomena affect nursing accountability in different ways, so their comprehension is paramount to understand and influence them to benefit both patients and nurses

Thermoluminescence from europium doped gadolinium oxide aerosols

Poster presented at the International Roundtable on Advanced Wide Band Gap Materials for Radiation Detectors - MATRAD 2007, June 17 till June 20, 2007 in Sinaia, Romani

La amenaza futura de los UAV y nano-UAV en la Defensa Antiaérea

En los últimos años, se ha asistido a un aumento exponencial de la presencia de los UAV (Unmanned Aerial System), o drones, como se les conoce popularmente, tanto en el ámbito militar donde se han empleado en escenarios como la guerra de Afganistán que se inició en 2001 y en la cual probablemente se ha visto el inicio y expansión de su uso como en el civil, donde cada vez son más comunes. El presente trabajo pretende analizar el papel de la Defensa Antiaérea en relación a esta incipiente presencia en los cielos, teniendo en cuenta que no se ha dado hasta ahora el caso de enfrentarse dos fuerzas armadas de similar capacidad empleando los UAV. Así, se analizan estos sistemas, el papel de la Defensa Antiaérea moderna y se proponen como conclusiones una serie de medidas a adoptar para afrontar mejor esta creciente amenaza.<br /