Understanding nurses’ decision-making when managing weaning from mechanical ventilation: a study of novice and experienced critical care nurses in Scotland and Greece.

Aim and objectives To examine how nurses collect and use cues from respiratory assessment to inform their decisions as they wean patients from ventilatory support. Background Prompt and accurate identification of the patient's ability to sustain reduction of ventilatory support has the potential to increase the likelihood of successful weaning. Nurses' information processing during the weaning from mechanical ventilation has not been well-described. Design A descriptive ethnographic study exploring critical care nurses' decision-making processes when weaning mechanically ventilated patients from ventilatory support in the real setting. Methods Novice and expert Scottish and Greek nurses from two tertiary intensive care units were observed in real practice of weaning mechanical ventilation and were invited to participate in reflective interviews near the end of their shift. Data were analysed thematically using concept maps based on information processing theory. Ethics approval and informed consent were obtained. Results Scottish and Greek critical care nurses acquired patient-centred objective physiological and subjective information from respiratory assessment and previous knowledge of the patient, which they clustered around seven concepts descriptive of the patient's ability to wean. Less experienced nurses required more encounters of cues to attain the concepts with certainty. Subjective criteria were intuitively derived from previous knowledge of patients' responses to changes of ventilatory support. All nurses used focusing decision-making strategies to select and group cues in order to categorise information with certainty and reduce the mental strain of the decision task. Conclusions Nurses used patient-centred information to make a judgment about the patients' ability to wean. Decision-making strategies that involve categorisation of patient-centred information can be taught in bespoke educational programmes for mechanical ventilation and weaning. Relevance to clinical practice Advanced clinical reasoning skills and accurate detection of cues in respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation

Rethinking the digital divide: from philanthropy to isonomia..

The digital divide has been, at least until very recently, a major theme in policy as well as interdisciplinary academic circles across the world, as well as at a collective global level, as attested by the World Summit on the Information Society. Numerous research papers and volumes have attempted to conceptualise the digital divide and to offer reasoned prescriptive and normative responses. What has been lacking in many of these studies, it is submitted, is a rigorous negotiation of moral and political philosophy, the result being a failure to situate the digital divide - or rather, more widely, information imbalances - in a holistic understanding of social structures of power and wealth. In practice, prescriptive offerings have been little more than philanthropic in tendency, whether private or corporate philanthropy. Instead, a theory of distributive justice is required, one that recovers the tradition of emancipatory, democratic struggle. This much has been said before. What is new here, however, is that the paper suggests a specific formula, the Rawls-Tawney theorem, as a solution at the level of analytical moral-political philosophy. Building on the work of John Rawls and R. H. Tawney, this avoids both the Charybdis of Marxism and the Scylla of liberalism. It delineates some of the details of the meaning of social justice in the information age. Promulgating a conception of isonomia, which while egalitarian eschews arithmetic equality (the equality of misery), the paper hopes to contribute to the emerging ideal of communicative justice in the media-saturated, post-industrial epoch.

Novel information sharing syntax for data sharing between police and community partners, using role-based security.

The exchange of information between the police and community partners forms a central aspect of effective community service provision. In the context of policing, a robust and timely communications mechanism is required between police agencies and community partner domains, including: Primary healthcare (such as a Family Physician or a General Practitioner); Secondary healthcare (such as hospitals); Social Services; Education; and Fire and Rescue services. Investigations into high-profile cases such as the Victoria Climbié murder in 2000, the murders of Holly Wells and Jessica Chapman in 2002, and, more recently, the death of baby Peter Connelly through child abuse in 2007, highlight the requirement for a robust information-sharing framework. This paper presents a novel syntax that supports information-sharing requests, within strict data-sharing policy definitions. Such requests may form the basis for any information-sharing agreement that can exist between the police and their community partners. It defines a role-based architecture, with partner domains, with a syntax for the effective and efficient information sharing, using SPoC (Single Point-of-Contact) agents to control in-formation exchange. The application of policy definitions using rules within these SPoCs is inspired by network firewall rules and thus define information exchange permissions. These rules can be imple-mented by software filtering agents that act as information gateways between partner domains. Roles are exposed from each domain to give the rights to exchange information as defined within the policy definition. This work involves collaboration with the Scottish Police, as part of the Scottish Institute for Policing Research (SIPR), and aims to improve the safety of individuals by reducing risks to the community using enhanced information-sharing mechanisms.