Accounting for actions and omissions: a discourse analysis of student nurse accounts of responding to instances of poor care.

AIMS: To explore how nursing students account for decisions to report or not report poor care witnessed on placement and to examine the implications of findings for educators. BACKGROUND: Concern has been raised about the extent to which cases of poor care go unreported. Failure to report cases may have serious consequences for patient safety. DESIGN: Semistructured interviews were conducted with 13 undergraduate students at a UK university during 2013. They were asked to consider their response to episodes of poor practice witnessed on placement. METHODS: Data were transcribed verbatim and categorized according to whether or not students reported concerns. Cases were analysed in accordance with Potter and Wetherall's version of discourse analysis to identify the discursive strategies used to account for decisions to report or not report poor practice. RESULTS: Participants took care to present themselves in a positive light regardless of whether or not they had reported an episode of concern. Those who had reported tended to attribute their actions to internal factors such as moral strength and a commitment to a professional code. Those who had not or would not report concerns provided accounts which referred to external influences that prevented them from doing so or made reporting pointless. CONCLUSION: This study provides information about how students account for their actions and omissions in relation to the reporting of poor care. Findings suggest ways educators might increase reporting of concerns.

The Effects of Soil Acidity and Aluminium on the Root Systems and Shoot Growth of Lotus pedunculatus and Lupinus polyphyllus.

Lotus pedunculatus (lotus) and Lupinus polyphyllus (Russell lupin) persist in the upland grasslands of New Zealand, where soil acidity and associated aluminium (Al) toxicity impede conventional pasture legumes. This experiment investigated the response of lotus and Russell lupin to soil acidity and Al. The species were sown in 20 cm tall 1.2 L pots of acidic upland soil. A mass of 4.5 or 6.7 g lime (CaCO3)/L was added to either the top or bottom or both soil horizons (0-9 cm and 9-18 cm), resulting in six treatments across six randomised blocks in a glasshouse. The soil pH was 4.4, 4.9, and 5.4; the exchangeable Al concentrations were 24, 2.5, and 1.5 mg/kg for 0, 4.5, and 6.7 g lime/L. At 16 weeks post-sowing, the plants were divided into shoots and roots at 0-9 cm and 9-18 cm. Root morphology, shoot and root dry matter (DM), shoot nitrogen (N), and nodulation were measured. The total plant DM and shoot-to-root DM ratio were higher, and the shoot %N was lower for the lotus plants than the Russell lupin plants for the various lime rates (13.2 vs. 2.9 g plant-1, 5.6 vs. 1.6, and 2.4 vs. 3.3%, p < 0.05). No response to lime in terms of total DM or total root morphology parameters was exhibited in either species (p > 0.05). Root morphology adjustments in response to acidity between soil horizons were not observed. The results indicated that lotus and Russell lupin are tolerant to high soil acidity (pH 4.4-5.4) and exchangeable Al (1.5-24 mg kg-1), highlighting their considerable adaptation to grasslands with acidic soils.

Vocalization characteristics of North Atlantic right whale surface active groups in the calving habitat, southeastern United States.

Passive acoustic surveys were conducted to assess the vocal behavior of North Atlantic right whales (Eubalaena glacialis) in the designated critical calving habitat along the shallow coastal waters of southeastern United States. Underwater vocalizations were recorded using autonomous buoys deployed in close proximity to surface active groups (SAGs). Nine main vocalization types were identified with manual inspection of spectrograms, and standard acoustic descriptors were extracted. Classification trees were used to examine the distinguishing characteristics of calls and quantify their variability within the SAG vocal repertoire. The results show that descriptors of frequency, bandwidth, and spectral disorder are the most important parameters for partitioning the SAG repertoire, contrary to duration-related measures. The reported source levels and vocalization statistics provide sound production data vital to inform regional passive acoustic monitoring and conservation for this endangered species.

Impacts of Phosphogypsum, Soluble Fertilizer and Lime Amendment of Acid Soils on the Bioavailability of Phosphorus and Sulphur Under Lucerne (Medicago sativa).

Legumes play critical dual roles in grazed grassland ecosystems; providing nitrogen inputs and high-quality feed for grazing livestock. However, many species fail to persist in acidic, low fertility soils. A glasshouse study was conducted to investigate the response of lucerne (Medicago sativa) to phosphogypsum (PG), lime and soluble P + S fertilizer (PS) application to two soils. Phosphorus and sulphur were applied through either PG (0, 1, 3 and 9 t ha-1) or P + S fertilizer at equivalent rates to PG. Both PG and PS were applied with or without lime, which was applied at 2 t ha-1. Yield and nutrient uptake of the lucerne was measured, while the soil was analyzed for pH, Olsen P and exchangeable aluminum. Yield responses were significantly different between the two soils. Maximum yields and P and S uptakes were obtained under PG 9 t ha-1 combined with lime. Exchangeable Al decreased in both soils under 1 ha-1 of PG compared with the control. At the highest rate, Olsen P increased by 8 and 6 mg kg-1 for PG and by 6 and 11 mg kg-1 for PS compared with the control for Glenmore and Molesworth soils respectively. Phosphogypsum showed positive effects on P and S bioavailability.

Potential Pasture Nitrogen Concentrations and Uptake from Autumn or Spring Applied Cow Urine and DCD under Field Conditions.

Nitrogen (N) cycling and losses in grazed grassland are strongly driven by urine N deposition by grazing ruminants. The objective of this study was to quantify pasture N concentrations, yield and N uptake following autumn and spring deposition of cow urine and the effects of fine particle suspension (FPS) dicyandiamide (DCD). A field plot study was conducted on the Lincoln University dairy farm, Canterbury, New Zealand from May 2003 to May 2005. FPS DCD was applied to grazed pasture plots at 10 kg·ha(-1) in autumn and spring in addition to applied cow urine at a N loading rate of 1000 kg·N·ha(-1), with non-urine control plots. Pasture N ranged between 1.9 and 4.8% with higher concentrations from urine. Results indicated that urine consistently increased N concentrations for around 220 days post deposition (mid December/early summer) at which point concentrations dropped to background levels. In urine patches, pasture yield and annual N uptake were dramatically increased on average by 51% for autumn and 28% for spring applied urine, in both years, when DCD was applied. This field experiment provides strong evidence that annual pasture N uptake is more strongly influenced by high urine N deposition than pasture N concentrations. FPS DCD has the potential to result in very high N uptake in urine patches, even when they are autumn deposited.

When the business of sharing treatment decisions is not the same as shared decision making: A discourse analysis of decision sharing in general practice.

Although shared decision making (SDM) in general practice continues to be promoted as a highly desirable means of conducting consultations it is rarely observed in practice. The aim of this study is to identify the discursive features and conversational strategies particular to the negotiation and sharing of treatment decisions in order to understand why SDM is not yet embedded into routine practice. Consultations from Scottish general practices were examined using discourse analysis. Two themes were identified as key components for when the doctor and the patient were intent on sharing decisions: the generation of patient involvement using first-person pronouns, and successful and unsuccessful patient requesting practices. This article identifies a number of conversational activities found to be successful in supporting doctors' agendas and reducing their responsibility for decisions made. Doctor's use of 'partnership talk' was found to minimize resistance and worked to invite consensus rather than involvement. The information from this study provides new insight into the consultation process by identifying how treatment decisions are arrived at through highlighting the complexities involved. Notably, shared decision making does not happen with the ease implied by current models and appears to work to maintain a biomedical 'GP as expert' approach rather than one in which the patient is truly involved in partnership. We suggest that further research on the impact of conversational activities is likely to benefit our understanding of shared decision making and hence training in and the practice of SDM.