Mixed venous oxygen saturation monitoring revisited : thoughts for critical care nursing practice

Background Less invasive methods of determining cardiac output are now readily available. Using indicator dilution technique, for example has made it easier to continuously measure cardiac output because it uses the existing intra-arterial line. Therefore gone is the need for a pulmonary artery floatation catheter and with it the ability to measure left atrial and left ventricular work indices as well the ability to monitor and measure a mixed venous saturation (SvO2). Purpose The aim of this paper is to put forward the notion that SvO2 provides valuable information about oxygen consumption and venous reserve; important measures in the critically ill to ensure oxygen supply meets cellular demand. In an attempt to portray this, a simplified example of the septic patient is offered to highlight the changing pathophysiological sequelae of the inflammatory process and its importance for monitoring SvO2. Relevance to clinical practice SvO2 monitoring, it could be argued, provides the gold standard for assessing arterial and venous oxygen indices in the critically ill. For the bedside ICU nurse the plethora of information inherent in SvO2 monitoring could provide them with important data that will assist in averting potential problems with oxygen delivery and consumption. However, it has been suggested that central venous saturation (ScvO2) might be an attractive alternative to SvO2 because of its less invasiveness and ease of obtaining a sample for analysis. There are problems with this approach and these are to do with where the catheter tip is sited and the nature of the venous admixture at this site. Studies have shown that ScvO2 is less accurate than SvO2 and should not be used as a sole guiding variable for decision-making. These studies have demonstrated that there is an unacceptably wide range in variance between ScvO2 and SvO2 and this is dependent on the presenting disease, in some cases SvO2 will be significantly lower than ScvO2. Conclusion Whilst newer technologies have been developed to continuously measure cardiac output, SvO2 monitoring is still an important adjunct to clinical decision-making in the ICU. Given the information that it provides, seeking alternatives such as ScvO2 or blood samples obtained from femorally placed central venous lines, can unnecessarily lead to inappropriate treatment being given or withheld. Instead when using ScvO2, trending of this variable should provide clinical determinates that are useable for the bedside ICU nurse, remembering that in most conditions SvO2 will be approximately 16% lower.

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.

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.

Thinking as if you are another : drama, persuasive language and pretexts

Using Shaun Tan’s picture book Rules of Summer (2013) as a pretext, this practical session will explore how primary teachers can engage middle and upper primary students in drama-based activities that support student learning and assessment outcomes in both English and The Arts (with a particular emphasis on drama and media arts). The session will explore notions of persuasive text (written and oral), points of view, devised storytelling and embodied learning.

An examination of the critical resources and internet capabilities for leveraging global performance in international entrepreneurial firms

This PhD research investigates the critical resources and Internet capabilities utilized by firms for leveraging global performance in entrepreneurial firms. Firm resources have been identified as important firm assets, which contribute to the firm's competitive global position. The Internet is a critical resource for a new generation of small and medium sized enterprise (SME) in pursuing international opportunities. By facilitating international business, the Internet has the ability to increase the quality and speed of communications, lower transaction costs, and facilitate the development of networks. Despite the increasing numbers of firms utilizing the Internet to pursue international opportunities, limited research remains. Adopting multiple case study methodology and structural equation modelling, the research identified the firm-level resources, which coincide with capabilities in a model predicting how international performance in firms is achieved.

"The Stratified Record upon Which We Set Our Feet" : The Spatial Turn and the Multilayering of History, Geography, and Geology

In Thomas Mann’s tetralogy of the 1930s and 1940s, Joseph and His Brothers, the narrator declares history is not only “that which has happened and that which goes on happening in time,” but it is also “the stratified record upon which we set our feet, the ground beneath us.” By opening up history to its spatial, geographical, and geological dimensions Mann both predicts and encapsulates the twentieth-century’s “spatial turn,” a critical shift that divested geography of its largely passive role as history’s “stage” and brought to the fore intersections between the humanities and the earth sciences. In this paper, I draw out the relationships between history, narrative, geography, and geology revealed by this spatial turn and the questions these pose for thinking about the disciplinary relationship between geography and the humanities. As Mann’s statement exemplifies, the spatial turn itself has often been captured most strikingly in fiction, and I would argue nowhere more so than in Graham Swift’s Waterland (1983) and Anne Michaels’s Fugitive Pieces (1996), both of which present space, place, and landscape as having a palpable influence on history and memory. The geographical/geological line that runs through both Waterland and Fugitive Pieces continues through Tim Robinson’s non-fictional, two-volume “topographical” history Stones of Aran. Robinson’s Stones of Aran—which is not history, not geography, and not literature, and yet is all three—constructs an imaginative geography that renders inseparable geography, geology, history, memory, and the act of writing.

Negotiating the creative and the critical : Paul Dawson’s creative writing and the new humanities

In the first Modern Language Association newsletter for 2006, renowned poetry critic and MLA President, Marjorie Perloff, remarked on the growing ascendency of Creative Writing within English Studies in North America. In her column, Perloff notes that "[i]n studying the English Job Information List (JIL) so as to advise my own students and others I know currently on the market, I noticed what struck me as a curious trend: there are, in 2005, almost three times as many positions in creative writing as in the study of twentieth-century literature" (3). The dominance of Creative Writing in the English Studies job list in turn reflects the growing student demand for undergraduate and postgraduate degrees in the field—over the past 20 years, BA and MA degrees in Creative Writing in North American tertiary institutions have quadrupled (3)...

Cyber security of networked critical infrastructures [Guest Editorial]

A new era of cyber warfare has appeared on the horizon with the discovery and detection of Stuxnet. Allegedly planned, designed, and created by the United States and Israel, Stuxnet is considered the first known cyber weapon to attack an adversary state. Stuxnet's discovery put a lot of attention on the outdated and obsolete security of critical infrastructure. It became very apparent that electronic devices that are used to control and operate critical infrastructure like programmable logic controllers (PLCs) or supervisory control and data acquisition (SCADA) systems lack very basic security and protection measures. Part of that is due to the fact that when these devices were designed, the idea of exposing them to the Internet was not in mind. However, now with this exposure, these devices and systems are considered easy prey to adversaries.

We have a lot to learn yet : a postcolonial lens in health promotion

Health promotion progresses a social justice and empowerment agenda and thus emphasises working with people to increase their control over their health. Certainly, Australia has experienced much success in this endeavour and is internationally recognised as a leader. However, health promotion has failed Indigenous Australians; a fact that is echoed in the health outcomes that ironically provide us with the “moral imperative” to act. Further investigation has also revealed health promotion’s foundation in colonial imaginings. Thus, this paper calls for the culture of health promotion to be examined as a risk factor for poor Indigenous health. To complement this call, this paper presents findings of an ethnographic study of Indigenous health promotion practice, undertaken from a postcolonial and critical whiteness framework. These findings provide a narrative of strength and innovative approaches, highlighting the value of Indigenous knowledge. These findings also contradict the biomedical tendency to construct culture as illness-producing. More broadly, this study’s findings entail important lessons for health promotion to consider, if it is to move beyond the rhetoric, to truly increase people’s control over their health.

Literacy in the Middle Years : Learning from Collaborative Classroom Research

Literacy in the Middle Years: Learning from Collaborative Classroom Research, showcases teachers' innovative literacy work across the curriculum. Classroom practice, teacher thinking and collaborative research are highlighted in ways of working with new curricula and rapidly changing literacy modes and platforms. Connections with place, critical engagement with digital literacies, using polymedia with EAL/D learners, and subject-specific literacies are detailed in teachers' stories of practice. Teacher wellbeing, for a sustainable workforce, underpins the case studies, aimed at equipping 'change ready' teachers with positive examples of literacy approaches and inquiry in practice.

Sustainable development as a meta-context for engineering education

At the end of the first decade of the twenty-first century, there is unprecedented awareness of the need for a transformation in development, to meet the needs of the present while also preserving the ability of future generations to meet their own needs. However, within engineering, educators still tend to regard such development as an ‘aspect’ of engineering rather than an overarching meta-context, with ad hoc and highly variable references to topics. Furthermore, within a milieu of interpretations there can appear to be conflicting needs for achieving sustainable development, which can be confusing for students and educators alike. Different articulations of sustainable development can create dilemmas around conflicting needs for designers and researchers, at the level of specific designs and (sub-) disciplinary analysis. Hence sustainability issues need to be addressed at a meta-level using a whole of system approach, so that decisions regarding these dilemmas can be made. With this appreciation, and in light of curriculum renewal challenges that also exist in engineering education, this paper considers how educators might take the next step to move from sustainable development being an interesting ‘aspect’ of the curriculum, to sustainable development as a meta-context for curriculum renewal. It is concluded that capacity building for such strategic considerations is critical in engineering education.

Critical reflections on the use of participatory methodologies to build evaluation capacities in international development organisations

There has been a greater focus on strengthening evaluation capacity building (ECB) within development organisations in recent years. This can be attributed in part to the growing appreciation of the value of participatory and collaborative forms of evaluation. Evaluation is increasingly seen as an ongoing learning process and an important means of strengthening capacity and improving organisational performance (Horton et al., 2003:7). While there are many benefits of using participatory methodologies in ECB projects, our experiences and a review of the literature in this area highlight the many challenges, issues and contradictions that can affect the success of such ECB efforts. We discuss these issues, drawing on our learnings from the ongoing participatory action research (PAR) project 'Assessing Communication for Social Change’ (AC4SC). This four year project, which began in 2007, is a collaboration between communication and development academics and evaluation specialists from two Australian universities and communication for development practitioners and monitoring and evaluation (M&E) staff in the NGO Equal Access Nepal (EAN). The aim is to develop, implement, and evaluate a participatory methodology for assessing the social change impacts of community radio programs produced by EAN. It builds on previous projects that used ethnographic action research (EAR) methodology (Tacchi et al., 2007).

Critical reflections on the use of participatory methodologies to build evaluation capacities in international development organisations

"In this chapter the authors present a critique of Participatory Evaluation as worked in development projects, in this case, in Nepal. The article works between established claims that Participatory Evaluation builds capacity at programmatic and organisational levels, and the specific experiences of these claims in the authors’ current work. They highlight the need to address key difficulties such as high turn-over of staff and resulting loss of capacity to engage in Participatory Evaluation, and the difficulty of communication between academic as compared with local practical wisdoms. A key issue is the challenge of addressing the inevitable issues of power inequities that such approaches encounter. While Participatory Evaluation has been around for some time, it has only enjoyed more widespread recognition of its value in comparatively recent times, with its uptake in international development environments. To this extent, the practice is still in its early stages of development, and Jo, June and Michael’s work contributes to strengthening and more comprehensively understanding it. With regard to the meta-theme of this publication, this chapter is an example of how context not only influences the methodology to be used and the praxis of how it is to be used, but contributes to early explication of the core nature of an emerging methodology."