Mixed venous oxygen saturation monitoring revisited : thoughts for critical care nursing practice

Background Less invasive methods of determining cardiac output are now readily available. Using indicator dilution technique, for example has made it easier to continuously measure cardiac output because it uses the existing intra-arterial line. Therefore gone is the need for a pulmonary artery floatation catheter and with it the ability to measure left atrial and left ventricular work indices as well the ability to monitor and measure a mixed venous saturation (SvO2). Purpose The aim of this paper is to put forward the notion that SvO2 provides valuable information about oxygen consumption and venous reserve; important measures in the critically ill to ensure oxygen supply meets cellular demand. In an attempt to portray this, a simplified example of the septic patient is offered to highlight the changing pathophysiological sequelae of the inflammatory process and its importance for monitoring SvO2. Relevance to clinical practice SvO2 monitoring, it could be argued, provides the gold standard for assessing arterial and venous oxygen indices in the critically ill. For the bedside ICU nurse the plethora of information inherent in SvO2 monitoring could provide them with important data that will assist in averting potential problems with oxygen delivery and consumption. However, it has been suggested that central venous saturation (ScvO2) might be an attractive alternative to SvO2 because of its less invasiveness and ease of obtaining a sample for analysis. There are problems with this approach and these are to do with where the catheter tip is sited and the nature of the venous admixture at this site. Studies have shown that ScvO2 is less accurate than SvO2 and should not be used as a sole guiding variable for decision-making. These studies have demonstrated that there is an unacceptably wide range in variance between ScvO2 and SvO2 and this is dependent on the presenting disease, in some cases SvO2 will be significantly lower than ScvO2. Conclusion Whilst newer technologies have been developed to continuously measure cardiac output, SvO2 monitoring is still an important adjunct to clinical decision-making in the ICU. Given the information that it provides, seeking alternatives such as ScvO2 or blood samples obtained from femorally placed central venous lines, can unnecessarily lead to inappropriate treatment being given or withheld. Instead when using ScvO2, trending of this variable should provide clinical determinates that are useable for the bedside ICU nurse, remembering that in most conditions SvO2 will be approximately 16% lower.

Advancing practice in critical care : a model of knowledge integration

Aim The aim of this paper was to discuss the potential development of a conceptual model of knowledge integration pertinent to critical care nursing practice. A review of the literature identified that reflective practice appeared to be at the forefront of professional development. Background It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda. Some would suggest that advancing practice is focused on the core attributes of an individual’s practice, which then leads onto advanced practice status. However, advancing practice is more of a process than identifiable skills and as such is often negated when viewing the development of practitioners to the advanced practice level. For example, practice development initiatives can be seen as advancing practice for the masses, which ensures that practitioners are following the same level and practice of care. The question here is, are they developing individually? Relevance to clinical practice What this paper presents is that reflection may not be best suited to advancing practice if the individual practitioner does not have a sound knowledge base both theoretically and experientially. The knowledge integration model presented in this study uses multiple learning strategies that are focused in practice to develop practice, e.g. the use of work-based learning and clinical supervision. To demonstrate the models application, an exemplar of an issue from practice shows its relevance from a practical perspective. Conclusions In conclusion, further knowledge acquisition and its relationship with previously held theory and experience will enable individual practitioners to advance their own practice as well as being a resource for others.

The pathophysiology of emphysema : considerations for critical care nursing practice

Emphysema is caused by exposure to cigarette smoking as well as alpha1-antitrypsin deficiency. It has been estimated to cost the National Health Service (NHS) in excess of £800 million per year in related health care costs. The challenges for Critical Care nurses are those associated with dynamic hyperinflation, Auto-PEEP, malnutrition and the weaning from invasive and non-invasive mechanical ventilation. In this paper we consider the impact of the pathophysiology of emphysema, its effects on other body systems as well as the impact acute exacerbations have when patients are admitted to the Intensive Care Unit.

An examination of the critical resources and internet capabilities for leveraging global performance in international entrepreneurial firms

This PhD research investigates the critical resources and Internet capabilities utilized by firms for leveraging global performance in entrepreneurial firms. Firm resources have been identified as important firm assets, which contribute to the firm's competitive global position. The Internet is a critical resource for a new generation of small and medium sized enterprise (SME) in pursuing international opportunities. By facilitating international business, the Internet has the ability to increase the quality and speed of communications, lower transaction costs, and facilitate the development of networks. Despite the increasing numbers of firms utilizing the Internet to pursue international opportunities, limited research remains. Adopting multiple case study methodology and structural equation modelling, the research identified the firm-level resources, which coincide with capabilities in a model predicting how international performance in firms is achieved.

Re-reading the reading lesson : episodes in the history of reading pedagogy

Reading pedagogy is constantly an object of discussion and debate in contemporary policy and practice but is rarely a matter for historical inquiry. This paper reports from a recent study of the history of reading pedagogy in Australia and beyond. It focuses on a recurring figure in the historical record—the ‘reading lesson’. Presented as a distinctive trope, the reading lesson is traced in its regularity in and through the discourse of reading pedagogy, starting in 1930s Australia and moving back into 19th-century Europe, and with specific reference to the UK and the USA. Teaching reading is expressly identified as a moral project—something that, it can be argued, clearly continues into the present.

Digital Literacy and the Spaces of Academic Discourse

Digital literacy poses a particular challenge to the research-led university. Although these universities are often at the forefront of introducing digital literacy initiatives—such as e-learning platforms, technological infrastructure, and digital repositories—these applications of digital literacy tend to be more instrumental or functional than critical or creative. Certainly, this clash of cultures between the instrumental/functional and the critical/analytical is at the heart of debates over the uses of digital literacy in higher education. However, this simple equation of political forces with instrumentality and the corresponding equation of the university with a tradition of reflective thought that brings criticism to bear on instrumentality elide the fact that this conflict is more deeply rooted within the academy. This essay argues that, in fact, much of the resistance to critical uses of digital literacy comes from within the institution of the university itself. That is, the university is bound up in a scriptural economy that prioritises the printed word and that reinforces its power by way of a normative, political, and spatialised academic discourse. It is this print-based scriptural economy—in which this essay must acknowledge its own complicity—that a critical approach to digital literacy threatens to disrupt or lay bare.

Negotiating the creative and the critical : Paul Dawson’s creative writing and the new humanities

In the first Modern Language Association newsletter for 2006, renowned poetry critic and MLA President, Marjorie Perloff, remarked on the growing ascendency of Creative Writing within English Studies in North America. In her column, Perloff notes that "[i]n studying the English Job Information List (JIL) so as to advise my own students and others I know currently on the market, I noticed what struck me as a curious trend: there are, in 2005, almost three times as many positions in creative writing as in the study of twentieth-century literature" (3). The dominance of Creative Writing in the English Studies job list in turn reflects the growing student demand for undergraduate and postgraduate degrees in the field—over the past 20 years, BA and MA degrees in Creative Writing in North American tertiary institutions have quadrupled (3)...

Making quality teachers : the role of an explicit values-based pedagogy

There is little conjecture that quality teaching is essential to student achievement and well-being. Whilst much has been written about the importance of quality teaching, including the link to pre-service teacher education, to date there has been little investigation into specific pedagogical practices that can enhance quality teaching dimensions within a pre-service teacher education programme. This paper reports on a small-scale qualitative research study, undertaken in an Australian university, which linked the fields of quality teaching, pre-service teacher education and values education. The study followed the journey of five pre-service teacher education students as they undertook their second field experience unit where the focus was centred on the values-based pedagogy of Philosophy in the Classroom. The research findings, collected via interviews, demonstrated that an explicit values-based pedagogy can have a positive impact on the development of quality teaching dimensions. This new knowledge has potential for further research into examining the ways quality teaching dimensions are gained and practised by pre-service teacher education students and these findings and recommendations are discussed in this paper.

Developing a culture to support peer review of teaching in higher education

This presentation addresses issues related to leadership, academic development and scholarship of teaching and learning, and highlights research funded by the Australian Office of Learning and Teaching (OLT) designed to embed and sustain peer review of teaching within the culture of 5 Australian universities: Queensland University of Technology, University of Technology, Sydney, University of Adelaide, Curtin University, and Charles Darwin University. Peer review of teaching in higher education will be emphasised as a professional process for providing feedback on teaching and learning practice, which if sustained, can become an effective ongoing strategy for academic development (Barnard et al, 2011; Bell, 2005; Bolt and Atkinson, 2010; McGill & Beaty 2001, 1992; Kemmis & McTaggart, 2000). The research affirms that using developmental peer review models (Barnard et al, 2011; D'Andrea, 2002; Hammersley-Fletcher & Orsmond, 2004) can bring about successful implementation, especially when implemented within a distributive leadership framework (Spillane & Healey, 2010). The project’s aims and objectives were to develop leadership capacity and integrate peer review as a cultural practice in higher education. The research design was a two stage inquiry process over 2 years. The project began in July 2011 and encompassed a development and pilot phase followed by a cascade phase with questionnaire and focus group evaluation processes to support ongoing improvement and measures of outcome. Leadership development activities included locally delivered workshops complemented by the identification and support of champions. To optimise long term sustainability, the project was implemented through existing learning and teaching structures and processes within the respective partner universities. Research outcomes highlight the fundamentals of peer review of teaching and the broader contextual elements of integration, leadership and development, expressed as a conceptual model for embedding peer review of teaching within higher education. The research opens a communicative space about introduction of peer review that goes further than simply espousing its worth and introduction. The conceptual model highlights the importance of development of distributive leadership capacity, integration of policies and processes, and understanding the values, beliefs, assumptions and behaviors embedded in an organizational culture. The presentation overviews empirical findings that demonstrate progress to advance peer review requires an ‘across-the-board’ commitment to embed change, and inherently demands a process that co-creates connection across colleagues, discipline groups, and the university sector. Progress toward peer review of teaching as a cultural phenomenon can be achieved and has advantages for academic staff, scholarship, teaching evaluation and an organisation, if attention is given to strategies that influence the contexts and cultures of teaching practice. Peer review as a strategy to develop excellence in teaching is considered from a holistic perspective that by necessity encompasses all elements of an educational environment and has a focus on scholarship of teaching. The work is ongoing and has implication for policy, research, teaching development and student outcomes, and has potential application world-wide.

Tell me what you see : pre-service teachers' recognition of exemplary digital pedagogy

How do you identify "good" teaching practice in the complexity of a real classroom? How do you know that beginning teachers can recognise effective digital pedagogy when they see it? How can teacher educators see through their students’ eyes? The study in this paper has arisen from our interest in what pre-service teachers “see” when observing effective classroom practice and how this might reveal their own technological, pedagogical and content knowledge. We asked 104 pre-service teachers from Early Years, Primary and Secondary cohorts to watch and comment upon selected exemplary videos of teachers using ICT (information and communication technologies) in Science. The pre-service teachers recorded their observations using a simple PMI (plus, minus, interesting) matrix which were then coded using the SOLO Taxonomy to look for evidence of their familiarity with and judgements of digital pedagogies. From this, we determined that the majority of preservice teachers we surveyed were using a descriptive rather than a reflective strategy, that is, not extending beyond what was demonstrated in the teaching exemplar or differentiating between action and purpose. We also determined that this method warrants wider trialling as a means of evaluating students’ understandings of the complexity of the digital classroom.

Cyber security of networked critical infrastructures [Guest Editorial]

A new era of cyber warfare has appeared on the horizon with the discovery and detection of Stuxnet. Allegedly planned, designed, and created by the United States and Israel, Stuxnet is considered the first known cyber weapon to attack an adversary state. Stuxnet's discovery put a lot of attention on the outdated and obsolete security of critical infrastructure. It became very apparent that electronic devices that are used to control and operate critical infrastructure like programmable logic controllers (PLCs) or supervisory control and data acquisition (SCADA) systems lack very basic security and protection measures. Part of that is due to the fact that when these devices were designed, the idea of exposing them to the Internet was not in mind. However, now with this exposure, these devices and systems are considered easy prey to adversaries.

Recruiting career-change professionals as teachers: the challenge of socialization into teaching

In many countries there is a shortage of quality teachers in areas of science, technology, engineering and mathematics (STEM). One solution has been to encourage mid-career professionals in the area of STEM to become school teachers. The transition of mid-career professionals to science and mathematics teaching in schools is thus becoming a common phenomenon. The assumption exists that their experiences and enthusiasm for their subject matter will inspire more students to achieve greater outcomes in school and to pursue careers in the sciences. Although the experiences of beginning teachers have been extensively studied for over half a century, there has been little research on career-change teachers and the particular challenges that they face in becoming school teachers. These career-changers have constructed professional identities and are accustomed to working within a culture of collaboration and inquiry. In contrast school cultures are quite different and often teaching is a lonely solitary affair with little opportunity for collegial relationships aimed at knowledge building in the context of teaching. This research was a longitudinal study that followed 17 teachers from the commencement of teaching. Most of these teachers left professional careers to become teachers. Seven remained in teaching after three years.

Reflections from early career graduates of the exceptional teachers for disadvantaged schools project

This paper aims to explore the experiences of newly qualified teachers and their supervising principals who work in schools situated in various high-poverty areas of Queensland, Australia. It is informed by data collected in the context of an Australian teacher education program, Exceptional Teachers for Disadvantaged Schools (ETDS). Now in its third year, this program was designed to prepare highly skilled pre-service teachers to work in schools that have large numbers of students from disadvantaged or low socio-economic status (SES) backgrounds. Addressing the oft-stated need to prepare high-quality teachers for low SES schools, high-achieving undergraduate education students were invited to participate in two years of specialised curriculum to prepare them for the schools that need them the most, which are also the schools that are often difficult to staff. Pre-service teachers in this program do all their teaching practicum placements in challenging or complex schools. In 2011, some of this cohort did their practicum teaching in schools with large numbers of Indigenous students and several went on to teach in remote communities after graduation. These graduates and the leaders of the schools they work in are the primary informants for this paper.