The importance of reliable information exchange in emergency practices: a misunderstanding that was uncovered before it was too late

Background: Many medical emergency practices are regulated by written procedures that normally provide reliable guidelines for action. In some cases, however, the consequences of following rule-based instructions can have unintended negative consequences. The article discusses a case - described on a type level - where the consequences of following a rule formulation could have been fatal. Case presentation: A weak and elderly patient has cardiac arrest, and a Do Not Resuscitate (DNR) clause is written in the patient’s medical record. Paramedics at the scene cannot see that the patient’s general appearance match conditions which would indicate the DNR clause, so they start cardiopulmonary resuscitation (CPR), and the patient survives. This turns out to be a crucial decision. The DNR clause is from an earlier bout with serious disease from which the patient has recovered, against all odds, and someone has forgotten to remove the clause from the medical record. Analysis: In order to be able to interpret the validity of written guidelines, paramedics and other health workers need to develop personal skills that transcend the ability simply to follow written instructions. Within traditional virtue ethics, personal judgment is conceived of as crucial for being able to make ‘good’ autonomous decisions. Virtue ethical analyses, decision-making abilities and non-technical communication skills are important as conceptual tools when health workers need to make difficult clinical decisions. Conclusion: The case study accentuates the significance of prudent judgment in medical practice. In the case described, the consequence of trusting the written advance directive could have been fatal, but the point is general: for the purpose of achieving excellent organizational performance, it is insufficient for health workers to rely uncritically on rules and procedures. Even the clearest rule formulations must be interpreted contextually in order to determine ethically correct behavior and avoid potential negative consequences that are not in the patient’s best interests

Using Twitter to Deliver 4-H Show Announcements

Twitter, a free social media tool, can be used to help run a large Extension event. In Minnesota, beef and dairy show committees and 4-H participants are using real-time tweets delivered to participants\u27 cell phones to keep state fair livestock shows running smoothly

Windfall Justice: Sentences at the Mercy of Hypertechnicality

Once upon a time (a time not so remote as to be beyond the memories of many of us who still toil in the vineyards of justice), the severity of a criminal sentence was determined largely at the whim of the trial judge, who was guided only by vague considerations of suitability. Non-premeditated murder, for example, might be punished by anything from probation to forty years in prison. A parole board exercised a similarly subjective power to temper the term with early release. Then, about a quarter century ago, the legislature created a commission to establish sentencing “guidelines,” said to be “advisory,” to assist trial judges in devising sentences that would provide greater uniformity than had emerged under the earlier system. This resulted in classification of offenses according to severity which, cross-referenced to the defendant\u27s criminal record, yielded a “presumptive” sentence. Now, in the case of the murderer mentioned above, instead of a range of zero to forty years, the scope would be 299-313 months. The range of the judge\u27s discretion, in other words, was abruptly pruned from forty years to fourteen months

The Mongolian's peoples republic, 1924-1928, and the right deviation

The thesis examines the history of the MPR between 1924 and 1928, establishes a chronology of events and identifies the personalities involved. It describes the creation of political structures after Soviet models; the transfer of the Mongolian economy from the Chinese to the Soviet system; the growth of secular education; and the attempt to subject the organization and economic power of the Buddhist church to state control. These developments were strongly influenced by the Mongols' desire to remain independent of China and to assume the form and characteristics of powerful nation-states. However the heavy demands of allegiance to the USSR and the Comintern distorted native aspirations and compelled Mongols to give up ideas of Pan-Mongolism, Buddhist reform and an independent foreign policy. Until the end of 1926 modernization and the integration of the MPR into the Soviet system was gradual but from 1927 the Comintern ordered stricter measures of class discrimination, harsher religious policies and a more rapid construction of state capitalism. Some Mongolian leaders believed the demands unsuitable to Mongolian conditions. The Comintern fomented differences among the leadership and in 1928 most former MPRP leaders were ousted on the charge of Right Deviation. The USSR's deteriorating foreign relationships and Stalin's plan for the rapid industrialization of the USSR were root causes of this development. Unquestioning loyalty of the MPR to the USSR was required for strategic reasons. Cooperative and state forms of capitalism would facilitate the transfer of more Mongolian products to the Siberian industries. The thesis draws the conclusion that the MPRP submitted to Comintern demands in 1928 through conviction, coercion and because there was no alternative ally prepared to guarantee Mongolian independence. It also points to the experience of the MPR as a suitable development model for nomadic, pre-industrial societies. The MPR may also be compared with other states traditionally linked with China but now closely associated with the USSR

Art and Radical Interpretation

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Management and Conflict Resolution: Conceptual Tools for Securing Cooperation and Organizational Performance

In theories of conflict management, managers’ conflict resolution skills have often been understood as their relational attitudes and ability to communicate, but choices of conflict resolution strategies in organizational management should also depend on the types of conflicts managers face. Understanding how a complex conflict situation involves one or several conflict types is a matter of understanding the deep structure of the conflict. Knowledge of such deep structure is a key to realizing what the conflict is about and how it should be resolved. The chapter uses conflict theory to distinguish between six conflict types that are especially important from an organizational perspective: interpretation conflicts, argumentation conflicts, value conflicts, interest conflicts, role conflicts and personal conflicts. After having clarified their signifcance in an organizational context, the chapter elucidates how knowledge of the conflict types and how they are logically related to each other can be used in managers’ conflict resolution practices. The last part of the chapter uses the conflict types to develop a model for practical conflict resolution in management. The model can be used as a tool for analyzing conflict situations—to gain a deeper and more systematic understanding of how the situations should be resolved in accordance with the best interest of the organization

Wittgenstein’s Theory of Conceptual Competence and Virtue Analyses of Ethical Dilemmas in Nursing Practice

The article discusses Ludwig Wittgenstein’s theory of conceptual competence within the area of nursing ethics. Wittgenstein’s analysis shares fundamental assumptions with virtue approaches to ethical dilemmas in caring practice but is at the same time crucially different. The main difference is that while virtue theories have focused on psychological attitudes like compassion and empathy, Wittgenstein focuses on a person’s understanding of concepts like good and wrong. According to Wittgenstein, an ethical competence in nursing is not equivalent to knowledge of moral principles that are understood independently of contexts of application. But Wittgenstein is also opposed to the view that it is contextual knowledge that provides the normative basis for caring. For Wittgenstein, an ethical competence is essentially a preconception awareness of how caring concepts apply. According to this analysis, nurses should address ethical dilemmas in patient interaction by focusing on their understanding of ethical concepts in the context of interaction. Case studies are used to clarify this and other practical implications of Wittgenstein’s position

System Thinking in Serious Games

Many game designers and academics have pointed out that games are systems (Gee, 2007; Salen & Zimmerman, 2004). So, what would be more natural than using System Science or System Thinking to understand and develop them? That is, in short, what this PhD thesis is about, and is stated in the main research question: “How can System Thinking be used to understand, design, develop, and document the process of Serious Games development?” The PhD thesis discusses Serious Game development specifically for learning and training. However, that does not mean the results are not usable for entertainment games, it is just not the focus of this thesis. System Thinking aims to identify, explore, and understand complexity in systems, and uses System Analysis and System Dynamics to do so. This gives System Thinking a place in Serious Game design throughout the design, implementation, and runtime phase of the game. The research also discusses how psychology can be integrated in this design, and what pedagogics should be used to implement the System Thinking into the game design. The research is conducted in three courses given to students at the Game School in HINN, Norway. The courses are well-established and have been running since 2006. The courses are revised every year, and new areas of System Thinking are included. The PhD thesis includes eight articles about these projects. Four of these are articles published in journals and are to be considered as part of the PhD thesis. The other four are conference articles and are to be considered as background information. The PhD thesis not only discusses what has been done so far, but also suggests areas of potential that can be developed in the years to come