4,991 research outputs found

    Talking about persons--thinking about patients: An ethnographic study in critical care.

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    BACKGROUND: Nursing involves caring for the 'whole person' and it is considered inappropriate for nurses to think or talk about patients in objectifying or dehumanising ways. Objectifying discourses can dominate within the arena of critical care, and critical care nurses can experience moral distress as they struggle to think about patients as persons. No previous study has examined the role played by 'impersonal' talk in the delivery of nursing care. This paper reports a study which examined the relationship between nursing practice and the way(s) in which critical care nurses think and talk about patients. OBJECTIVES: The study objectives were to (1) identify and characterise the ways in which critical care nurses think and talk about patients; and (2) describe patterns of nursing practice associated with these different ways of thinking. STUDY DESIGN: An ethnographic study was undertaken within one critical care unit in the United Kingdom. Data were collected over 8 months through 92h of participant observation and 13 interviews. Seven critical care nurses participated in the study. Data analysis adopted the perspective of linguistic ethnography. FINDINGS: Analysis of these data led to the identification of seven Discourses, each of which was characterised by a particular way of talking about patients, a particular way of thinking about patients, and a particular pattern of practice. Four of these seven Discourses were of particular significance because participants characterised it as 'impersonal' to think and talk about patients as 'routine work', as a 'body', as '(un)stable' or as a 'medical case'. Although participants frequently offered apologies or excuses for doing so, these 'impersonal' ways of thinking and talking were associated with practice that was essential to delivering safe effective care. CONCLUSIONS: Critical care practice requires nurses to think and talk about patients in many different ways, yet nurses are socialised to an ideal that they should always think and talk about patients as whole persons. This means that nurses can struggle to articulate and reflect upon aspects of their practice which require them to think and talk about patients in impersonal ways. This may be an important source of distress to critical care nurses and emotional exhaustion and burnout can arise from such dissonance between ideals and the reality of practice. Nursing leaders, scholars and policy makers need to recognise and legitimise the fact that nurses must think about patients in many ways, some of which may be considered impersonal

    The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study

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    publisher: Elsevier articletitle: The challenges in caring for morbidly obese patients in Intensive Care: A focused ethnographic study journaltitle: Australian Critical Care articlelink: http://dx.doi.org/10.1016/j.aucc.2017.02.070 content_type: article copyright: © 2017 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved

    Three-dimensional FE-EFGM adaptive coupling with application to nonlinear adaptive analysis

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    Three-dimensional problems with both material and geometrical nonlinearities are of practical importance in many engineering applications, e.g. geomechanics, metal forming and biomechanics. Traditionally, these problems are simulated using an adaptive finite element method (FEM). However, the FEM faces many challenges in modeling these problems, such as mesh distortion and selection of a robust refinement algorithm. Adaptive meshless methods are a more recent technique for modeling these problems and can overcome the inherent mesh based drawbacks of the FEM but are computationally expensive. To take advantage of the good features of both methods, in the method proposed in this paper, initially the whole of the problem domain is modeled using the FEM. During an analysis those elements which violate a predefined error measure are automatically converted to a meshless zone. This zone can be further refined by adding nodes, overcoming computationally expensive FE remeshing. Therefore an appropriate coupling between the FE and the meshless zone is vital for the proposed formulation. One of the most widely used meshless methods, the element-free Galerkin method (EFGM), is used in this research. Maximum entropy shape functions are used instead of the conventional moving least squares based formulations'. These shape functions posses a weak Kronecker delta property at the boundaries of the problem domain, which allows the essential boundary conditions to be imposed directly and also helps to avoid the use of a transition region in the coupling between the FE and the EFG regions. Total Lagrangian formulation is preferred over the updated Lagrangian formulation for modeling finite deformation due to its computational efficiency. The well-established error estimation procedure of Zienkiewicz-Zhu is used in the FE region to determine the elements requiring conversion to the EFGM. The Chung and Belytschko error estimator is used in the EFG region for further adaptive refinement. Numerical examples are presented to demonstrate the performance of the current approach in thre
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