Factors influencing student nurse decisions to report poor practice witnessed while on placement

Background: While it is commonly accepted that nursing care is generally of a good standard, it would be naïve to think that this is always the case. Over recent years concern about aspects of the quality of some nursing care has grown. In tandem with this, there is recognition that nurses do not always report poor practice. As future registrants, student nurses have a role to play in changing this culture. We know, however, relatively little about the factors that influence student decisions on whether or not to report. In the absence of a more nuanced understanding of this issue, we run the risk of assuming students will speak out simply because we say they should. Objectives: To explore influences on student decisions about whether or not to report poor clinical practice which is a result of deliberate action and which is witnessed while on placement. Methods: Qualitative interviews were conducted with thirteen pre-registration nursing students from the UK. Participants included both adult and mental health nurses with an age range from 20–47. Data were analysed to identify key themes. Category integrity and fit with data was confirmed by a team member following initial analysis. Results: Four themes emerged from the data. The first of these, ‘I had no choice’ described the personal and ethical drivers which influenced students to report. ‘Consequences for self’ and ‘Living with ambiguity’ provide an account of why some students struggle to report, while ‘Being prepared’ summarised arguments both for and against reporting concerns. Conclusion: While there is a drive to promote openness in health care settings and an expectation that staff will raise concerns about quality of care, the reality is that the decision to do this can be very difficult. This is certainly the case for some student nurses. Our results suggest ways in which educationalists might intervene to support students who witness poor practice to report

Becoming physical education: the ontological shift to complexity

In this paper, we present the view that an ontological shift to complexitythinking will be significant in the future of physical education (PE). Complexity thinking not only moves PE beyond long dominant modernist approaches but also offers the opportunity to integrate many of the postmodern perspectives that currently seek to frame PE. Four interconnected complexity commonalities, becoming, lived time, selforganisation and boundaries, are presented in an overarching frame to guide future PE developments in ways that are coherent, connected and emergent. PE is subsequently viewed as a complex phenomenon that is always in a non-linear, messy and never-ending process of becoming. Students, teachers and other stakeholders are also complex as their past, present and future experiences constantly merge in a lived time unity to create lifelong and life-wide PE journeys that are both personalised and holistic. Central to these personalised journeys is each stakeholder’s ability to self-organise and influence the trajectory of their pathways. Self-organisation, however, is not a relativist ‘anything goes’ phenomenon but a process that takes place within a multiplicity of boundaries. While boundaries may traditionally be viewed as divisive features, complexity thinking recognises that many boundaries are flexible and enable the creation of ‘boundary spaces’ in which ‘rich’ discussions can take place to develop more coherent, connected and emergent forms of PE. Transdisciplinary Inquiry (TDI) and Ecologically Informed Practice (EIP) are presented as perspectives that can help teachers, and others, create the ‘boundary spaces’ in which ways to plan and introduce complexity-informed forms of PE can be explored. The paper concludes by proposing that the challenge for PE in the future will be for practitioners to develop the adaptability, openness, confidence and self-organising skills that will be needed to make the most effective use of the ‘rich interactions’ that these ‘boundary spaces’ offer

Direct perturbation theory on the shift of Electron Spin Resonance

We formulate a direct and systematic perturbation theory on the shift of the main paramagnetic peak in Electron Spin Resonance, and derive a general expression up to second order. It is applied to one-dimensional XXZ and transverse Ising models in the high field limit, to obtain explicit results including the polarization dependence for arbitrary temperature.Comment: 5 pages (no figures) in REVTE

Cancer and systemic inflammation: treat the tumour and treat the host

Determinants of cancer progression and survival are multifactorial and host responses are increasingly appreciated to have a major role. Indeed, the development and maintenance of a systemic inflammatory response has been consistently observed to confer poorer outcome, in both early and advanced stage disease. For patients, cancer-associated symptoms are of particular importance resulting in a marked impact on day-to-day quality of life and are also associated with poorer outcome. These symptoms are now recognised to cluster with one another with anorexia, weight loss and physical function forming a recognised cluster whereas fatigue, pain and depression forming another. Importantly, it has become apparent that these symptom clusters are associated with presence of a systemic inflammatory response in the patient with cancer. Given the understanding of the above, there is now a need to intervene to moderate systemic inflammatory responses, where present. In this context the rationale for therapeutic intervention using nonselective anti-inflammatory agents is clear and compelling and likely to become a part of routine clinical practice in the near future. The published literature on therapeutic intervention using anti-inflammatory agents for cancer-associated symptoms was reviewed. There are important parallels with the development of useful treatments for the systemic inflammatory response in patients with rheumatological disease and cardiovascular disease

Statistics of lowest excitations in two dimensional Gaussian spin glasses

A detailed investigation of lowest excitations in two-dimensional Gaussian spin glasses is presented. We show the existence of a new zero-temperature exponent lambda describing the relative number of finite-volume excitations with respect to large-scale ones. This exponent yields the standard thermal exponent of droplet theory theta through the relation, theta=d(lambda-1). Our work provides a new way to measure the thermal exponent theta without any assumption about the procedure to generate typical low-lying excitations. We find clear evidence that theta < theta_{DW} where theta_{DW} is the thermal exponent obtained in domain-wall theory showing that MacMillan excitations are not typical.Comment: 4 pages, 3 figures, (v2) revised version, (v3) corrected typo

A simple abstraction of arrays and maps by program translation

We present an approach for the static analysis of programs handling arrays, with a Galois connection between the semantics of the array program and semantics of purely scalar operations. The simplest way to implement it is by automatic, syntactic transformation of the array program into a scalar program followed analysis of the scalar program with any static analysis technique (abstract interpretation, acceleration, predicate abstraction,.. .). The scalars invariants thus obtained are translated back onto the original program as universally quantified array invariants. We illustrate our approach on a variety of examples, leading to the " Dutch flag " algorithm

Preoperative systemic inflammation predicts postoperative infectious complications in patients undergoing curative resection for colorectal cancer

The presence of systemic inflammation before surgery, as evidenced by the glasgow prognostic score (mGPS), predicts poor long-term survival in colorectal cancer. The aim was to examine the relationship between the preoperative mGPS and the development of postoperative complications in patients undergoing potentially curative resection for colorectal cancer. Patients (n=455) who underwent potentially curative resections between 2003 and 2007 were assessed consecutively, and details were recorded in a database. The majority of patients presented for elective surgery (85%) were over the age of 65 years (70%), were male (58%), were deprived (53%), and had TNM stage I/II disease (61%), had preoperative haemoglobin (56%), white cell count (87%) and mGPS 0 (58%) in the normal range. After surgery, 86 (19%) patients developed a postoperative complication; 70 (81%) of which were infectious complications. On multivariate analysis, peritoneal soiling (P&#60;0.01), elevated preoperative white cell count (P&#60;0.05) and mGPS (P&#60;0.01) were independently associated with increased risk of developing a postoperative infection. In elective patients, only the mGPS (OR=1.75, 95% CI=1.17-2.63, P=0.007) was significantly associated with increased risk of developing a postoperative infection. Preoperative elevated mGPS predicts increased postoperative infectious complications in patients undergoing potentially curative resection for colorectal cancer

Using Flow Specifications of Parameterized Cache Coherence Protocols for Verifying Deadlock Freedom

We consider the problem of verifying deadlock freedom for symmetric cache coherence protocols. In particular, we focus on a specific form of deadlock which is useful for the cache coherence protocol domain and consistent with the internal definition of deadlock in the Murphi model checker: we refer to this deadlock as a system- wide deadlock (s-deadlock). In s-deadlock, the entire system gets blocked and is unable to make any transition. Cache coherence protocols consist of N symmetric cache agents, where N is an unbounded parameter; thus the verification of s-deadlock freedom is naturally a parameterized verification problem. Parametrized verification techniques work by using sound abstractions to reduce the unbounded model to a bounded model. Efficient abstractions which work well for industrial scale protocols typically bound the model by replacing the state of most of the agents by an abstract environment, while keeping just one or two agents as is. However, leveraging such efficient abstractions becomes a challenge for s-deadlock: a violation of s-deadlock is a state in which the transitions of all of the unbounded number of agents cannot occur and so a simple abstraction like the one above will not preserve this violation. In this work we address this challenge by presenting a technique which leverages high-level information about the protocols, in the form of message sequence dia- grams referred to as flows, for constructing invariants that are collectively stronger than s-deadlock. Efficient abstractions can be constructed to verify these invariants. We successfully verify the German and Flash protocols using our technique

Radar systems for the water resources mission. Volume 4: Appendices E-I

The use of a scanning antenna beam for a synthetic aperture system was examined. When the resolution required was modest, the radar did not use all the time the beam was passing a given point on the ground to build a synthetic aperture, so time was available to scan the beam to other positions and build several images at different ranges. The scanning synthetic-aperture radar (SCANSAR) could achieve swathwidths of well over 100 km with modest antenna size. Design considerations for a SCANSAR for hydrologic parameter observation are presented. Because of the high sensitivity to soil moisture at angles of incidence near vertical, a 7 to 22 deg swath was considered for that application. For snow and ice monitoring, a 22 to 37 deg scan was used. Frequencies from X-band to L-band were used in the design studies, but the proposed system operated in C-band at 4.75 GHz. It achieved an azimuth resolution of about 50 meters at all angles, with a range resolution varying from 150 meters at 7 deg to 31 meters at 37 deg. The antenna required an aperture of 3 x 4.16 meters, and the average transmitter power was under 2 watts