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 Background It could be argued that advancing practice in critical care has been superseded by the advanced practice agenda.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.

From expert to tasks, expert nursing practice redefined?

Aim The aim of this paper was to explore the concept of expertise in nursing from the perspective of how it relates to current driving forces in health care in which it discusses the potential barriers to acceptance of nursing expertise in a climate in which quantification of value and cost containment run high on agendas. Background Expert nursing practice can be argued to be central to high quality, holistic, individualized patient care. However, changes in government policy which have led to the inception of comprehensive guidelines or protocols of care are in danger of relegating the ‘expert nurse’ to being an icon of the past. Indeed, it could be argued that expert nurses are an expensive commodity within the nursing workforce. Consequently, with this change to the use of clinical guidelines, it calls into question how expert nursing practice will develop within this framework of care. Method The article critically reviews the evidence related to the role of the Expert Nurse in an attempt to identify the key concepts and ideas, and how the inception of care protocols has implications for their role. Conclusion Nursing expertise which focuses on the provision of individualized, holistic care and is based largely on intuitive decision making cannot, should not be reduced to being articulated in positivist terms. However, the dominant power and decision-making focus in health care means that nurses must be confident in articulating the value of a concept which may be outside the scope of knowledge of those with whom they are debating. Relevance to clinical practice The principles of abduction or fuzzy logic may be useful in assisting nurses to explain in terms which others can comprehend, the value of nursing expertise.

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.

Advancing Nursing Practice in Pain Management

This book showcases the development and evaluation of innovative examples of pain management initiatives by advanced practitioners. It considers each service development or community initiative both in terms of advanced practice nursing and pain management. There is a wide range of examples of innovation in pain management included - from the introduction of ketamine use in one trust, to wider issues around meeting the needs of pain management in the community. The book considers issues including use of research, education and interprofessional working in the advanced practitioner role. Each chapter looks at development of the service, challenges of implementation, evaluation of the service's success and justifying the importance of the advanced nurse in the service's achievements.

Introduction to Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advanced practice The context of pain management: definitions and prevalence Advancing practice in pain management Bringing together advanced practice and pain management Conclusions References

New Knowledge for Advancing Practice in Pain Management

This chapter contains sections titled: Introduction Advancing practice in pain management Conclusions References

Circles of care : should community development redefine the practice of palliative care?

Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. The patient centred model of care has limitations when there is a fundamental lack of integrated community policy, development and resourcing. Within this article, we propose a model of care which identifies a person with an illness at the centre of a network which includes inner and outer networks, communities and service delivery organisations. All of these are underpinned by policy development, supporting the overall structure. Adoption of this model would allow individuals, communities, service delivery organisations and policy makers to work together to provide end of life care that enhances value and meaning for people at end of life, both patients and communities alike.

Statutory right of user - its impact in practice?

Scenario 1 A buys a two storey commercial building built along the only street frontage to the property. Vehicles cannot reach the rear of the property as the building extends across the entire width of the land. A bought the building with full knowledge that vehicular access to the rest of the property had been compromised by a desire to obtain maximum street frontage for the building which was occupied by a commercial tenant. On street parking is scarce in the surrounding area. A (to the knowledge of the adjoining owner B) constructs a carpark at the rear of the building. The employees of A’s tenant have been using the carpark obtaining access via a driveway on B’s land. To formalise this arrangement, A seeks a right of way for vehicles to travel down B’s driveway to access the carpark...

Competition Hertz : the culture and practice of car audio competitions

The present paper explores extreme car audio systems and the culture and practices that surround car audio competitions. I begin by examining whether, and how, car audio can be thought of as a 'music scene' and in what ways the culture and practice of car audio may fit within post-subcultural discourses. Following this, I offer a description of car audio competitions, revealing some of the practices that define this aspect of car audio scenes. In particular, I concentrate on sound pressure level (SPL) competitions and some of the interesting aspects of the SPL scene. Finally, I briefly examine how the powerful effects (and affects) of bass frequencies are an important part of the attraction of loud car audio systems and how car audio systems contribute to the territorializing of urban spaces.

Bug reproduction : a collaborative practice within software maintenance activities

Software development settings provide a great opportunity for CSCW researchers to study collaborative work. In this paper, we explore a specific work practice called bug reproduction that is a part of the software bug-fixing process. Bug re-production is a highly collaborative process by which software developers attempt to locally replicate the ‘environment’ within which a bug was originally encountered. Customers, who encounter bugs in their everyday use of systems, play an important role in bug reproduction as they provide useful information to developers, in the form of steps for reproduction, software screenshots, trace logs, and other ways to describe a problem. Bug reproduction, however, poses major hurdles in software maintenance as it is often challenging to replicate the contextual aspects that are at play at the customers’ end. To study the bug reproduction process from a human-centered perspective, we carried out an ethnographic study at a multinational engineering company. Using semi-structured interviews, a questionnaire and half-a-day observation of sixteen software developers working on different software maintenance projects, we studied bug reproduction. In this pa-per, we present a holistic view of bug reproduction practices from a real-world set-ting and discuss implications for designing tools to address the challenges developers face during bug reproduction.

Portrait of the artist as a feminist, practice-led researcher

Becoming a researcher, like any process of cultural initiation, is a complicated negotiation of processes and identity. While it is tempting to imagine that a researcher is just 'one who researches', the reality is far more complex and can be thought of as a journey rather than a sudden change of role. In practice-led research there is often a final and difficult assessment that needs to be made of that journey, and this requires the collation and integration of seemingly schizophrenic elements into one coherent body of findings. This paper attempts to outline the underlying “system of methods used in a particular area of study or activity” that have defined my research journey. It discusses the various elements that have informed and directed this enquiry, which include, but are not limited to: practice-led research, reflexivity, and post/academic writing, all underpinned by a feminist approach.

Mentoring : improving transition to practice

Nurse graduates indicate the transition from student of nursing to registered nurse (RN) is a difficult conversion. This impending change of role and accompanying higher expectations placed upon newly graduating RNs causes concern for students as their Bachelor of Nursing program nears completion. A career mentor scheme is suggested as a way to better prepare final year students for this transition. Evaluations indicate the positive impact the scheme has made on both mentors and mentees as it has enhanced their career development.

Medium and mode : relationships between visual experience and perception in an installation arts practice

Working primarily within the natural landscape, this practice-led research project explored connections between the artist's visual and perceptual experience of a journey or place while simultaneously emphasizing the capacity for digital media to create a perceptual dissonance. By exploring concepts of time, viewpoint, duration of sequences and the manipulation of traditional constructs of stop-frame animation, the practical work created a cognitive awareness of the elements of the journey through optical sensations. The work allowed an opportunity to reflect on the nature of visual experience and its mediation through images. The project recontextualized the selected mediums of still photography, animation and projection within contemporary display modes of multiple screen installations by analysing relationships between the experienced and the perceived. The resulting works added to current discourse on the interstices between still and moving imagery in a digital world.