Nursing and midwifery students' encounters with poor clinical practice:a systematic review

The aim of this paper was to systematically review evidence about nursing and midwifery students’ encounters with poor clinical care.We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students’ encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis.N=14 papers met inclusion criteria; study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction; ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice; iii) a range of influencing factors impact the likelihood of reporting; iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students.Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so

Accounting for actions and omissions:a discourse analysis of student nurse accounts of responding to instances of poor care

Aims: To explore how nursing students account for decisions to report or not report poor care witnessed on placement and to examine the implications of findings for educators. Background: Concern has been raised about the extent to which cases of poor care go unreported. Failure to report cases may have serious consequences for patient safety. Design: Semi structured interviews were conducted with 13 under graduate students at a UK university during 2013. They were asked to consider their response to episodes of poor practice witnessed on placement. Methods: Data were transcribed verbatim and categorized according to whether or not students reported concerns. Cases were analysed in accordance with Potter and Wetherall’s version of discourse analysis to identify the discursive strategies used to account for decisions to report or not report poor practice. Results: Participants took care to present themselves in a positive light regardless of whether or not they had reported an episode of concern. Those who had reported tended to attribute their actions to internal factors such as moral strength and a commitment to a professional code. Those who had not or would not report concerns provided accounts which referred to external influences that prevented them from doing so or made reporting pointless. Conclusion: This study provides information about how students account for their actions and omissions in relation to the reporting of poor care. Findings suggest ways educators might increase reporting of concerns

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

Ocean heat uptake processes: a model intercomparison

We compare the quasi-equilibrium heat balances, as well as their responses to 4×CO2 perturbation, among three global climate models with the aim to identify and explain inter-model differences in ocean heat uptake (OHU) processes. We find that, in quasi-equilibrium, convective and mixed layer processes, as well as eddy-related processes, cause cooling of the subsurface ocean. The cooling is balanced by warming caused by advective and diapycnally diffusive processes. We also find that in the CO2-perturbed climates the largest contribution to OHU comes from changes in vertical mixing processes and the mean circulation, particularly in the extra-tropics, caused both by changes in wind forcing, and by changes in high-latitude buoyancy forcing. There is a substantial warming in the tropics, a significant part of which occurs because of changes in horizontal advection in extra-tropics. Diapycnal diffusion makes only a weak contribution to the OHU, mainly in the tropics, due to increased stratification. There are important qualitative differences in the contribution of eddy-induced advection and isopycnal diffusion to the OHU among the models. The former is related to the different values of the coefficients used in the corresponding scheme. The latter is related to the different tapering formulations of the isopycnal diffusion scheme. These differences affect the OHU in the deep ocean, which is substantial in two of the models, the dominant region of deep warming being the Southern Ocean. However, most of the OHU takes place above 2000 m, and the three models are quantitatively similar in their global OHU efficiency and its breakdown among processes and as a function of latitude

The influence of eddy parameterizations on the transport of the Antarctic Circumpolar Current in coupled climate models

The transport of the Antarctic Circumpolar Current (ACC) varies strongly across the coupled GCMs (general circulation models) used for the IPCC AR4. This note shows that a large fraction of this across-model variance can be explained by relating it to the parameterization of eddy-induced transports. In the majority of models this parameterization is based on the study by Gent and McWilliams (1990). The main parameter is the quasi-Stokes diffusivity kappa (often referred to less accurately as ’’thickness diffusion’’). The ACC transport and the meridional density gradient both correlate strongly with kappa across those models where kappa is a prescribed constant. In contrast, there is no correlation with the isopycnal diffusivity jiso across the models. The sensitivity of the ACC transport to kappa is larger than to the zonal wind stress maximum. Experiments with the fast GCM FAMOUS show that changing kappa directly affects the ACC transport by changing the density structure throughout the water column. Our results suggest that this limits the role of the wind stress magnitude in setting the ACC transport in FAMOUS. The sensitivities of the ACC and the meridional density gradient are very similar across the AR4 GCMs (for those models where kappa is a prescribed constant) and among the FAMOUS experiments. The strong sensitivity of the ACC transport to kappa needs careful assessment in climate models

Strong exciton-photon coupling with colloidal nanoplatelets in an open microcavity

Colloidal semiconductor nanoplatelets exhibit quantum size effects due to their thickness of only few monolayers, together with strong optical band-edge transitions facilitated by large lateral extensions. In this article we demonstrate room temperature strong coupling of the light and heavy hole exciton transitions of CdSe nanoplatelets with the photonic modes of an open planar microcavity. Vacuum Rabi splittings of $66 \pm 1$ meV and $58 \pm 1$ meV are observed for the heavy and light hole excitons respectively, together with a polariton-mediated hybridisation of both transitions. By measuring the concentration of platelets in the film we compute the transition dipole moment of a nanoplatelet exciton to be $\mu = (575 \pm 110)$ D. The large oscillator strength and fluorescence quantum yield of semiconductor nanoplatelets provide a perspective towards novel photonic devices, combining polaritonic and spinoptronic effects.Comment: 9 pages, 4 figure

Reading Skill in Adult Survivors of Childhood Brain Tumor: A Theory-Based Neurocognitive Model

Objective: This study investigated the relationship between word reading and white matter (WM) integrity within a neuroanatomical-based reading system comparing adult survivors of childhood brain tumors and controls. It was predicted that the association between WM integrity and word reading would be mediated by processing speed, and this indirect effect would be moderated by group. Method: Thirty-seven adult survivors of childhood brain tumor and typically developing adults participated (age M=24.19±4.51 years, 62% female). DTI Tractography identified the WM tract for three of the reading system connections: inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), and parietotemporal-occipitotemporal connection (PT-OT). Results:Fractional anisotropy values (FA) of the PT-OT tract were significantly correlated with word reading in survivors and controls (r=.45, .58, respectively; p Conclusion: Results suggest the tracts emerging from the occipitotemporal area are a critical component of the reading system in adults. The finding that processing speed was the mechanism by which WM was associated with reading in survivors is in alignment with the developmental cascade model. Current findings bolster the existing theory-based models of reading using innovative diffusion tensor imaging and moderated mediation statistical neurodevelopmental model, establishing the role of processing speed and specific WM pathway integrity in word reading skill

The UK quality and outcomes framework pay-for-performance scheme and spirometry: rewarding quality or just quantity? A cross-sectional study in Rotherham, UK

Background: Accurate spirometry is important in the management of COPD. The UK Quality and Outcomes Framework pay-for-performance scheme for general practitioners includes spirometry related indicators within its COPD domain. It is not known whether high achievement against QOF spirometry indicators is associated with spirometry to BTS standards. Methods: Data were obtained from the records of 3,217 patients randomly sampled from 5,649 patients with COPD in 38 general practices in Rotherham, UK. Severity of airflow obstruction was categorised by FEV1 (% predicted) according to NICE guidelines. This was compared with clinician recorded COPD severity. The proportion of patients whose spirometry met BTS standards was calculated in each practice using a random sub-sample of 761 patients. The Spearman rank correlation between practice level QOF spirometry achievement and performance against BTS spirometry standards was calculated. Results: Spirometry as assessed by clinical records was to BTS standards in 31% of cases (range at practice level 0% to 74%). The categorisation of airflow obstruction according to the most recent spirometry results did not agree well with the clinical categorisation of COPD recorded in the notes (Cohen's kappa = 0.34, 0.30 - 0.38). 12% of patients on COPD registers had FEV1 (% predicted) results recorded that did not support the diagnosis of COPD. There was no association between quality, as measured by adherence to BTS spirometry standards, and either QOF COPD9 achievement (Spearman's rho = -0.11), or QOF COPD10 achievement (rho = 0.01). Conclusion: The UK Quality and Outcomes Framework currently assesses the quantity, but not the quality of spirometry