The implementation of a guideline of care for patients with a Sengstaken-Blakemore tube in situ in a general intensive care unit using transitional change theory

The use of the Sengstaken–Blakemore tube as a life-saving treatment for bleeding oesophageal varices is slowly becoming the least preferred method possibly due to the potential complications associated with its placement. Nursing practice pertaining to the care of this patient group appears ad hoc and reliant on local knowledge and experience as opposed to recognised evidence of best practice. Therefore, this paper focuses on the application of Lewin's transitional change theory used to introduce a change in nursing practice with the application of a guideline to enhance the care of patients with a Sengstaken–Blakemore tube in situ within a general intensive care unit. This method identified some of the complexities surrounding the change process including the driving and restraining forces that must be harnessed and minimised in order for the adoption of change to be successful.

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.

Defining the expert ICU nurse

This paper explores the concept of expertise in intensive care nursing practice from the perspective of its relationship to the current driving forces in healthcare. 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. It argues that nursing expertise which focuses on the provision of individualised, holistic care and which is based largely on intuitive decision-making cannot and should not be reduced to being articulated in positivist terms. The principles of abduction or fuzzy logic, derived from computer science, may be useful in assisting nurses to explain in terms, which others can comprehend, the value of nursing expertise.

Vertical dynamic interaction of trains and rail steel bridges

Rail steel bridges are vulnerable to high impact forces due to the passage of trains; unfortunately the determination of these transient impact forces is not straightforward as these are affected by a large number of parameters, including the wagon design, the wheel-rail contact and the design parameters of the bridge deck and track, as well as the operational parameters – wheel load and speed. To determine these impact forces, a detailed rail train-track/bridge dynamic interaction model has been developed, which includes a comprehensive train model using multi-body dynamics approach and a flexible track/bridge model using Euler– Bernoulli beam theory. Single and multi-span bridges have been modelled to examine their dynamic characteristics. From the single span bridge, the train critical speed is determined; the minimum distance of two peak loadings is found to affect the train critical speed. The impact factor and the dynamic characteristics are discussed.

Reflexive Dwelling: The body as representation of wall

In a play-within-a-play, the Mechanicals' production within William Shakespeare's A Midsummer Night's Dream, the character Snout announces his transformation to play the character of Wall. Snout's portrayal of Wall is both comical and menacing as he represents the forces that separate the lovers Pyramus and Thisbe. Wall becomes a subject in a manner no different from the lovers that he separates; his influence on their situation is brought to life. The unbecoming nature of walls to demarcate, separate, intimidate, influence and control is a relationship most can relate to in their experiences with architecture. It is in these moments that architecture leaps from the sphere of object into the realm of subject; where we might be involved in some intense struggle with the placement of a wall, the wall that might separate us from a lover, justice, freedom, power or privacy. This study investigates how this struggle is portrayed through the human body as representation of walls in performance.

Digital Literacy and the Spaces of Academic Discourse

Digital literacy poses a particular challenge to the research-led university. Although these universities are often at the forefront of introducing digital literacy initiatives—such as e-learning platforms, technological infrastructure, and digital repositories—these applications of digital literacy tend to be more instrumental or functional than critical or creative. Certainly, this clash of cultures between the instrumental/functional and the critical/analytical is at the heart of debates over the uses of digital literacy in higher education. However, this simple equation of political forces with instrumentality and the corresponding equation of the university with a tradition of reflective thought that brings criticism to bear on instrumentality elide the fact that this conflict is more deeply rooted within the academy. This essay argues that, in fact, much of the resistance to critical uses of digital literacy comes from within the institution of the university itself. That is, the university is bound up in a scriptural economy that prioritises the printed word and that reinforces its power by way of a normative, political, and spatialised academic discourse. It is this print-based scriptural economy—in which this essay must acknowledge its own complicity—that a critical approach to digital literacy threatens to disrupt or lay bare.