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

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

Identification Of Mitotically Competent SOX2+ Cells In White Matter Of Normal Human Adult Brain

SOX2 expression is linked to the undifferentiated state of stem cells in mammalian neurogenic niches. While its expression has been reported in the adult human subventricular zone (SVZ), to date it has not been detected in adult human white matter. Here we describe a population of SOX2+ cells from the white matter of the adult human temporal lobe, which proliferate and express glial markers in vitro

Physical Demands of Top-class Soccer Assistant Refereeing During High-standard Matches

This study examined the physical demands experienced by top-class assistant referees during high-standard football matches. Computerized match analyses and heart rate recordings were performed on 18 international assistant referees during the FIFA Confederations Cup 2005. Total distance covered averaged 5752+/-554 m, of which 34% was covered at a high-intensity (>13 km.h (-1)). Sidewards movements represented 30% of total match distance. Both total distance (r=0.67; P<0.01) and high-intensity activities (r=0.52; P<0.05) were related to the displacements of the ball in the same match. The distance covered by high-speed running in this tournament was 255% greater (P<0.001) than that covered during the under-17 World Championship 2003. Mean heart rate during the game was 140+/-11 b.min (-1) (78+/-4% HR (max)). Mean heart rate during a 5-min interval of the match was related in part (r=0.31; P<0.001) to the amount of high-intensity activities performed within the same match-period. The results of this study show that the physical demands imposed on assistant referees are influenced by the movements of the ball and the standard of the competition

Estudio comparativo de equipos fijos de pedestal y su aplicación en la detección del tráfico incontrolado de material radiactivo en aeropuertos

En este trabajo se analiza la respuesta de tres equipos comerciales, diseñados para detectar el tráfico ilícito o el desplazamiento involuntario de material radiactivo en aeropuertos cuando es transportado por los pasajeros. Se han comparado tres instrumentos fijos de pedestal: el equipo APM de Bicron, el equipo GR-606 de Exploranium y el equipo FHT-1372 de Thermo Eberline. En esta evaluación inicial, realizada en el Laboratorio de Ingeniería Nuclear de la Escuela de Caminos, Canales y Puertos, se observó que el equipo FHT-1372 presentó una respuesta de detección más rápida, sensible y permitió la medida de tasa de dosis total y tasa de dosis artificial. Este equipo fue instalado en la salida de la aduana de pasajeros del aeropuerto internacional de Barajas durante un periodo operativo de 108 días en el año 2002 y pasaron un total de 1.339.931 personas. Este periodo se dividió en 5 sesiones para poder establecer los niveles de investigación adecuados para detectar una posible incidencia de material radiactivo, que finalmente se fijaron en 110 nSv/h para la tasa de dosis total y 25 nSv/h para la tasa de dosis artificial. Durante dicho periodo se detectaron 39 posibles incidencias por encima del límite de investigación establecido para las diferentes sesiones, 5 de ellas con un valor 10 veces superior al fondo ambiental de la sala donde se instaló el equipo (alrededor de 90 nSv/h) y ninguna superó el nivel de 100 μSv/h a 1 m de distancia que la Organización Internacional de la Energía Atómica (OIEA) establece como límite para el transporte lícito de material radiactivo

Histological assessment of a novel de-epithelialization method for connective tissue grafts harvested from the palate. An experimental study in cadavers

Objectives This study aims to compare the histological outcomes of three distinct de-epithelialization methods used in (connective tissue grafts) CTG harvested from the palate. Materials and methods An experimental study using nine cadaver head specimens was carried out to compare 3 different de-epithelialization techniques for CTG. Eighteen samples were randomly allocated to three study groups: bone scraper, diamond bur and extraoral removal with a scalpel. The main outcome variable was the graft surface percentage without epithelium remains. Additionally, the time employed, and the graft thickness were also measured. Results Sixteen CTGs were analyzed. The extraoral scalpel group presented a total surface area with no epithelium of 58.84% (22.68) and a mean de-epithelialization time of 3.7 min; the intraoral diamond bur group had 88.24% (41.3) of the surface with no epithelium and took 1.455 min, and the intraoral bone scraper showed 97.98% (5.99) of surface without epithelium and a mean time of 0.815 min (P < 0.05). Histological analysis showed significant differences between the bone scraper and the extraoral group (P = 0.009). Conclusion The de-epithelialization technique with a bone scraper seems to be the most effective and fastest de-epithelialization technique for CTG. These findings need to be confirmed in future clinical studies with larger samples. Clinical relevance The use of bone scrapers, could be a simple, effective and fast technique to de-epithelialize connective tissue grafts harvested from the palatal area for both novice and experienced surgeons

Logarithmical hopping encoding: a low computational complexity algorithm for image compression

LHE (logarithmical hopping encoding) is a computationally efficient image compression algorithm that exploits the Weber–Fechner law to encode the error between colour component predictions and the actual value of such components. More concretely, for each pixel, luminance and chrominance predictions are calculated as a function of the surrounding pixels and then the error between the predictions and the actual values are logarithmically quantised. The main advantage of LHE is that although it is capable of achieving a low-bit rate encoding with high quality results in terms of peak signal-to-noise ratio (PSNR) and image quality metrics with full-reference (FSIM) and non-reference (blind/referenceless image spatial quality evaluator), its time complexity is O( n) and its memory complexity is O(1). Furthermore, an enhanced version of the algorithm is proposed, where the output codes provided by the logarithmical quantiser are used in a pre-processing stage to estimate the perceptual relevance of the image blocks. This allows the algorithm to downsample the blocks with low perceptual relevance, thus improving the compression rate. The performance of LHE is especially remarkable when the bit per pixel rate is low, showing much better quality, in terms of PSNR and FSIM, than JPEG and slightly lower quality than JPEG-2000 but being more computationally efficient

Use of gonadotropins in ovarian stimulation in Spain: Delphi consensus

Ovarian stimulation; In vitro fertilisation; Poor responderEstimulació ovàrica; Fecundació in vitro; Resposta pobreEstimulación ovárica; Fecundación in vitro; Respuesta pobreTwo-round Delphi study carried out in Spain. Three theme-based blocks were set out: 1) Patient profiles: therapeutic goal and parameters to be analysed according to POSEIDON patient profiles; 2) Ovarian stimulation protocols with antagonists: monotherapy (FSH) vs combined therapy (FSH + LH/HMG); 3) Safety and effectiveness of the devices. The antral follicle count and the anti-Müllerian hormone level were considered indicators that can be used to predict ovarian response. More than 80% of the participants agreed that FSH monotherapy is the recommended regimen in normal/hyper-responsive patients of < 35 years of age; that 150–300 IU is the dose to be used in ovarian stimulation in monotherapy depending on clinical parameters; and that FSH monotherapy improves patients’ comfort compared to two combined drugs. It was unanimously considered that the type of device used by the patient influences the comfort of the treatment.This project has been funded by Gedeon Richter. The sponsor took no part in designing, implementing, interpreting or writing the document. All the authors have accepted the participation in the group and give their consent for the publication of the document

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