PROFESSIONAL LIABILITY OF AMATEURS: THE CONTEXT OF SPORTS COACHING

The developing intersection between the law of negligence and sports coaching in the UK provides a profoundly distinctive context, as compared to that of the more traditional learned professions, in which to critically examine the issue of professional liability. More specifically, detailed consideration of the Bolam test in the context of sports coaching, where the majority of coaches are volunteers, reinforces the Bolam doctrine as a control mechanism designed to protect both claimants and defendants alike. Importantly, a fuller analysis of related jurisprudence, even in instances where defendant coaches lack a formal qualification, and/or may not have engaged in considered and reasoned decision-making, reveals the potential for the Bolam test to operate as a quasi-defence, thereby safeguarding coaches from negligence liability. Nonetheless, in discharging this heightened standard of care incumbent upon them, coaches must ensure that the coaching practices adopted are regular, approved, and capable of withstanding robust and logical scrutiny. Ultimately, this article’s analysis of the principles of professional liability, in the specific circumstances of sports coaching, should prove to be of appreciably wider interest and utility for practitioners specialising in personal injury law.

DESCRIBING SLEEP AND SEDATION PRACTICES IN THE ICU: A MULTINATIONAL SURVEY

Introduction Sleep disturbances are common in critically ill patients treated in the intensive care unit (ICU) with the potential for serious consequences and long-term effects on health outcomes and patient morbidity.
Objectives Our aim was to describe sleep management and sedation practices of adult ICUs in ten countries and to evaluate roles and responsibilities of the ICU staff in relation to key sleep and sedation decisions.
Methods A multicenter, self-administered survey sent to nurse managers of adult ICUs across 10 countries. The questionnaire comprised four domains: sleep characteristics of the critically ill; sleep and sedation practices; non-pharmacological and pharmacological interventions used to improve sleep; and the autonomy and influence of nurses on sleeping practices in the ICU.
Results Overall response rate was 66% (range 32% UK to 100% Cyprus), providing data from 522 ICUs. In all countries, the most frequent patient characteristic perceived to identify sleep was lying quietly with closed eyes (N=409, 78%) (range 92% Denmark to 36% Italy). The most commonly used sedation scale was the Richmond Agitation-Sedation Score (RASS) (N=220, 42%) (range 81% UK to 0% Denmark, Cyprus where most ICUs used the Ramsay score). In most ICUs, selection of sleep medication (N=265, 51%) and assessment of effect (N=309, 59%) was performed by physicians and nurses based on collaborative discussion. In a minority of ICUs (N=161, 31%), decisions and assessments were made by physicians alone. The most commonly used (in all countries) non-pharmacological intervention to promote sleep was reducing ICU staff noise (N=473, 91%) (range 100% Denmark, Norway to 78% Canada). Only 95 ICUs (18%) used earplugs on a frequent basis (range 0% Greece, Cyprus, Denmark to 57% Sweden). Propofol was the drug used most commonly for sedation (N=359, 69%) (range 96% Sweden to 29% Canada). Chloral hydrate was used by only 63 (12%) ICUs (range 0% Greece, Cyprus, Denmark, Italy to 56% Germany). Sedation scales were used on a routine basis by 77% of the 522 ICUs. Participants scored nursing autonomy for sleep and sedation management as moderate; median score of 5 (scale of 0 to 10), range 7 (Canada, Greece, Sweden) to 4 (Norway, Poland). Nursing influence on sleep and sedation decisions was perceived considerable; median score 8, range 9 (Denmark) to 5 (Poland).
Conclusions We found considerable across country variation in sleep promotion and sedation management practices though most have adopted a sedation scale as recommended in professional society guidelines. Most ICUs in all countries used a range of pharmacological and non-pharmacological interventions to promote sleep. Most units reported inter-professional decision-making with nurses perceived to have substantial influence on sleep/sedation decisions.

Sister Practices: Non-Normative Experiences of Time and Technology

This chapter summarises some of the learning from a material practice that sits in a sisterly manner next to architecture. Drawing on feminist writing and the experiences of women in professional life more generally, the chapter will examine how mainstream understanding of time and technology limit the engagement of those people in society who do not fit given norms. The chapter argues that when we examine such concepts in more detail and expand them to reflect diverse experiences those very same concepts offer new potentials and innovative openings for the progression of disciplines such as architecture.