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

Using an Outdoor Learning Space to Teach Sustainability and Material Processes in HE product Design.

The world is facing environmental changes that are increasingly affecting how we think about manufacturing, the consumption of products and use of resources. Within the HE product design community, thinking and designing sustainability’ has evolved to become a natural part of the curriculum. Paradoxical as the rise in awareness of sustainability increases there is growing concern within HE product design of the loss of workshop facilities and as a consequence a demise in teaching traditional object-making skills and material experimentation. We suggest the loss of workshops and tangible ‘learning by making skills’ also creates a lost opportunity for a rich learning resource to address sustainable thinking, design and manufacture ‘praxis’ within HE design education. Furthermore, as learning spaces are frequently discussed in design research, there seems to be little focus on how the use of an outdoor environment might influence learning outcomes particularly with regard to material teaching and sustainability. This 'case study' of two jewellery workshops, used outdoor learning spaces to explore both its impact on learning outcomes and to introduce some key principles of sustainable working methodologies and practices. Academics and students mainly from Norway and Scotland collaborated on this international research project. Participants made models from disposable packaging materials, which were cast in tin, in the sand on a local beach, using found timber to create a heat source for melting the metal. This approach of using traditional making skills, materials and nature was found to be a relevant contribution to a sustainable discourse.