Nurses' critical event risk assessments : a judgement analysis

Aims. To explore and explain nurses' use of readily available clinical information when deciding whether a patient is at risk of a critical event.

Background. Half of inpatients who suffer a cardiac arrest have documented but unacted upon clinical signs of deterioration in the 24 hours prior to the event. Nurses appear to be both misinterpreting and mismanaging the nursing-knowledge 'basics' such as heart rate, respiratory rate and oxygenation. Whilst many medical interventions originate from nurses, up to 26% of nurses' responses to abnormal signs result in delays of between one and three hours.

Methods. A double system judgement analysis using Brunswik's lens model of cognition was undertaken with 245 Dutch, UK, Canadian and Australian acute care nurses. Nurses were asked to judge the likelihood of a critical event, 'at-risk' status, and whether they would intervene in response to 50 computer-presented clinical scenarios in which data on heart rate, systolic blood pressure, urine output, oxygen saturation, conscious level and oxygenation support were varied. Nurses were also presented with a protocol recommendation and also placed under time pressure for some of the scenarios. The ecological criterion was the predicted level of risk from the Modified Early Warning Score assessments of 232 UK acute care inpatients.

Results. Despite receiving identical information, nurses varied considerably in their risk assessments. The differences can be partly explained by variability in weightings given to information. Time and protocol recommendations were given more weighting than clinical information for key dichotomous choices such as classifying a patient as 'at risk' and deciding to intervene. Nurses' weighting of cues did not mirror the same information's contribution to risk in real patients. Nurses synthesized information in non-linear ways that contributed little to decisional accuracy. The low-moderate achievement (Ra) statistics suggests that nurses' assessments of risk were largely inaccurate; these assessments were applied consistently among 'patients' (scenarios). Critical care experience was statistically associated with estimates of risk, but not with the decision to intervene.

Conclusion. Nurses overestimated the risk and the need to intervene in simulated paper patients at risk of a critical event. This average response masked considerable variation in risk predictions, the need for action and the weighting afforded to the information they had available to them. Nurses did not make use of the linear reasoning required for accurate risk predictions in this task. They also failed to employ any unique knowledge that could be shown to make them more accurate. The influence of time pressure and protocol recommendations depended on the kind of judgement faced suggesting then that knowing more about the types of decisions nurses face may influence information use.

Relevance to clinical practice. Practice developers and educators need to pay attention to the quality of nurses' clinical experience as well as the quantity when developing judgement expertise in nurses. Intuitive unaided decision making in the assessment of risk may not be as accurate as supported decision making. Practice developers and educators should consider teaching nurses normative rules for revising probabilities (even subjective ones) such as Bayes' rule for diagnostic or assessment judgements and also that linear ways of thinking, in which decision support may help, may be useful for many choices that nurses face. Nursing needs to separate the rhetoric of 'holism' and 'expertise' from the science of predictive validity, accuracy and competence in judgement and decision making.

Renegade judgement : a study of madness in medicine and literature

Explores socio-historical understandings and treatments of madness, examining literary works alongside contemporary medical texts. Incorporating notions of scientific objectivity, individual subjectivity and social totality, the thesis shows conceptual overlaps between art and science, identifying continuities and conflicts between fictional, clinical and cultural investigations into madness.

Representation and judgement : 'privileged' Jews in Holocaust writing and film

This thesis analyses the ways in which moral judgements of so-called privileged Jews are constructed in Holocaust representations. ‘Privileged’ Jews include those prisoners in the camps and ghettos who held positions which gave them access to material and other benefits. Subject to extreme levels of coercion, these victims were compelled to act in ways that have often been judged as both self-serving and harmful to fellow inmates. Such controversial figures constitute an intrinsically important, frequently misunderstood and hastily judged facet of the Holocaust. Scholars have neglected the problem of judgement in relation to ‘privileged’ Jews; nonetheless, Holocaust texts frequently portray these liminal figures.

Of crucial importance to the thesis is Primo Levi’s paradigmatic essay entitled ‘The Grey Zone,’ which directly engages with the complex and sensitive issue of ‘privileged’ Jews. Levi argues that due to the extreme ethical dilemmas that ‘privileged’ Jews confronted, any judgement of these victims needs to be suspended. However, if, as Levi suggests, judgement is at times impossible, the thesis challenges Levi’s assumption by contending that representations of ‘privileged’ Jews inevitably take a moral position. In this way, the thesis conceptualises judgement as a ‘limit’ of representation. Indeed, it is shown that Levi himself cannot abstain from judging those for whom he argues judgement should be suspended.

The thesis takes Levi’s concept of the ‘grey zone’ as a point of departure in order to examine the problems of judgement and representation in relation to ‘privileged’ Jews. Analysis focuses on Raul Hilberg’s influential historical work and examples of documentary and fiction films. The thesis examines how Hilberg and several filmmakers employ conventions as a means of conveying judgement. It is argued that self-reflexive representations of ‘privileged’ Jews in film, particularly fictional dramatisation, have the potential to provide a nuanced representation of ‘privileged’ Jews, which engages with Levi’s ideas by questioning the possibility of judgement.

Confronting 'choiceless choices' in Holocaust videotestimonies : judgement, 'privileged' Jews, and the role of the interviewer

'Privileged' Jews include those prisoners in the camps and ghettos who held positions which gave them access to material and other benefits. Subject to extreme levels of coercion, these victims were compelled to act in ways that have been judged as both self-serving and harmful to fellow inmates. Such situations, which exemplify what influential theorist Lawrence Langer terms 'choiceless choices', are the chief concern of Primo Levi's paradigmatic essay on the 'grey zone'. In light of these key conceptualizations of the ethical dilemmas of Holocaust victims, the paper analyses the representation of 'privileged' Jews in several videotestimonies recorded at the Jewish Holocaust Museum and Research Centre (JHMRC) in Melbourne, Australia. It will be shown that judgements of victims in extremis cause considerable problems for attempts to testify to the complex situations and experiences of 'privileged' Jews. The role of the interviewer is a crucial factor in this, particularly when interviewers are themselves Holocaust survivors. The paper reveals that while it might be argued that moral evaluations of 'privileged' Jews should be suspended, judgements are often imposed on Holocaust testimonies in various ways and have a significant impact on their content.

Judgement, reflexivitiy and interdisiciplinarity : reframing construction management education

A core skill of the construction management professional is decision making. Disciplinary content knowledge provides the basis for effective decision making, but is largely insufficient in contexts where projects demand a responsive and flexible approach to scenarios as they evolve and change. As Beckett and Hager suggest, ‘professional practice requires a much richer set of phenomena – a capacity to make judgements, sensitivity to intuition and an awareness of the purposes of the actions are all involved ‘(2002: 12). This paper begins by exploring judgement to develop a conceptual model for initiating and developing decision making skills for construction management professionals. The capacity to respond to change in a structured and self aware manner is examined through the concept of reflexivity, a concept borrowed from sociology. Reflexivity is an individual’s capacity to be aware, responsive and adaptability to constant changing and evolving environments. Coupled with this is the challenge for all built environment professionals in the need to integrate knowledge and processes from various specialist knowledge domains, particularly design domains. The conceptual model is then refined by synthesising concepts from interdisciplinary research.

The aim of this paper is to describe a framework to analyse and review current undergraduate and postgraduate coursework programs offerings from Deakin University in the School of Architecture and Building. Following Boud and Falchikov (2007) this framework starts with practice, that is, the actual ‘doing’ of construction management as the basis for shaping curriculum development.

The role of assessment in the development of judgement

This paper introduces an integrated assessment model developed within a project management discipline stream in a Construction Management course. Following Boud and Falchikov (2007) this model starts with practice, that is, the actual ‘doing’ of project management as the basis for shaping assessment that equips students to learn for the rest of their lives. Practice is understood as a holistic conception of what professionals do in particular contexts, and a theoretical construct that provides a method of framing ways in which we can investigate the world (Schatzki, 2001). This approach opens the way for considerations of assessment that engage with, and cultivate, certain kinds of professional learning and identity formation including the development of judgement. Integral to the model is the non-sequential nature of assessment activities, evolving team formation and ongoing self and communal reflection. The paper concludes that the use of an authentic and integrated assessment model creates a compelling learning environment that contributes meaningfully to the development of skills, knowledge and identities for future professional learning.

Unconscionable conduct : an evolving moral judgement

Statutory unconscionable conduct has been a controversial component of Australia's consumer laws since well before the first provision was introduced in 1986. Nevertheless, it has survived numerous reviews and has expanded beyond its early focus on consumers to provide small business - and, more recently, any business other than a listed company - statutory protection against unconscionable conduct occurring in trade or commerce.

Technophilia, neo-Luddism, eDependency and the judgement of Thamus

Purpose – The purpose of this paper is to reflect on society's relationship with technology and particularly our increasing dependence on electronic technology – so-called eDependency. The paper argues that technology is not neutral and we must engage with the moral issues that arise from our relationship with it.

Design/methodology/approach – Society's relationship with technology is examined through the lens of Socrates' consideration of the technology of writing. It identifies “technophilia” as a major theme in society and “neo-Luddism” as the Socrates-like examination of the benefits of technology.

Findings – While rejecting both technology determinism and technology presentism the paper argues technology is not neutral and does afford social change within a particular social ecology. The authors suggest that ultimately the use of all technology, including the technology underpinning eDependency, leads to important moral questions which deserve considered debate. The paper concludes by arguing that the Information Systems (IS) discipline should take the mantle of King Thamus and that the study of these issues should become a key concern for the discipline.

Originality/value – In an age of technophilia, this paper calls considered debate on the moral issues that arise from our relationship with technology, how it is appropriated, to whose benefit, and how we change it and will be changed by it.

Screening women’s complicity in the holocaust : the problems of judgement and representation

This essay analyses the representation of female perpetrators in Holocaust fiction films, particularly in relation to the persecution of prisoners in the Nazi camps. The screening of women in general, and female perpetrators in particular, is shown to be problematic due to their frequent marginalisation and the gendered, voyeuristic ways in which women's bodies are often objectified in Holocaust films. While the actions of female perpetrators and their depiction in films pose acute problems of judgement and representation that need to be acknowledged, it is argued that films have the potential to effectively explore the issue of women's complicity in the Holocaust.

A just judgement? Considerations on Ronald Srigley’s Camus’ Critique of Modernity

This paper responds critically to Ronald Srigley’s groundbreaking 2011 study Albert Camus’ Critique of Modernity. Srigley’s book reasserts Camus’ credentials as a deeply serious thinker, whose literary and philosophical oeuvre was dedicated to rethinking modernity on the basis of critical reassessments of theWest’s entire premodern heritage. Yet we challenge whether Camus was ever, even in his final writings, so uncompromisingly anti-modern as Srigley contends. Srigley’s attempt to present Camus as committed to a return to the Greeks, on the basis of a total critique of modernity as deleteriously post-Christian, forces him to occlude important distinctions in Camus’ thought: those between unity and totality, rebellion and revolution. By contrast, we compare Camus’ defence of modern rebellion with Blumenberg’s argument in The Legitimacy of the Modern Age: finding justification for this rebellion in the deep problem faced by Christian theology of resolving the ‘problem of evil’. Finally, we suggest that Srigley overplays the extent of Camus’ ‘Hellenic’ critique of the Christian heritage (notably its ethical commitment to protecting the weak), in contrast to Christian theodicy and eschatology, which serve to rationalize avoidable suffering.

Narratives of judgement: representations of 'privileged' Jews in Holocaust documentaries

Auschwitz survivor Primo Levi’s highly influential essay, “The Grey Zone”, explores the taboo issue of “privileged” Jews, those prisoners who were forced to cooperate with their Nazi captors in order to prolong their lives or the lives of their families. Levi argues that moral evaluations of privileged Jews should be suspended; however, judgements of these liminal figures have permeated representations of victims’ experiences. Taking Levi’s reflections on the “grey zone” as a point of departure, I analyse the ways in which a number of Holocaust documentary narratives construct problematic judgements of privileged Jews; nonetheless, it will be shown that some films engage with the issue in a nuanced manner. While Levi singles out the medium of film as particularly predisposed to simplistic judgements, I argue that documentary film has considerable potential to offer a complex representation of the extreme ethical dilemmas that privileged Jews faced.