Addressing Moral Distress in Critical Care Nurses

Background: Moral distress can affect critical care nurses caring for complex patients. It can result in job dissatisfaction, loss of capacity for caring, and nurse turnover, resulting in a negative impact on quality care. Purpose: This project was completed to determine how moral distress impacts critical care nurses (adult and pediatric) and to implement improvement strategies to reduce moral distress, improve job satisfaction, and retention. Theoretical Framework: Nathaniel’s Theory of Moral Reckoning was the grounded theory used to show the application of the improvement interventions. Methods: Phase 1 was a cross-sectional design using the 26-item Hospital Ethical Climate Survey (HECS) and the 21-item Moral Distress Scale-Revised (MDS-R). Phase 2 consisted of a mixed-method design employing focus group interviews, interventions, and pre- and posttest. Results: Pediatric nurses reported lower mean moral distress composite scores 21.71 (15.47) as compared to the adult nurses 88.75 (64.7). For adult nurses, a strong correlation existed between ethical climate and moral distress (rs =-.62, n = 10, p = .49), with high levels of ethical climate associated with lower levels of moral distress. The cohort group identified personal and professional impact of moral distress with some differences between the pediatric and adult nurses related to the source of moral distress responses to suffering. The 3-month post survey showed a total moral distress score for one adult critical care nurse decreased from 158 to 74. The remaining three nurses’ scores were unchanged. All four nurses were not considering leaving their position now. All participants either agreed or strongly agreed the education and action plan reduced their moral distress

A brief history of the British Neuroscience Association

As the British Neuroscience Association commemorates 50 years of existence in 2018, this article recalls its founding as a discussion group, its establishment as the Brain Research Association, its transition to a professional society encompassing all aspects of neuroscience research, both clinical and non-clinical, and its re-branding as the British Neuroscience Association in the late 1990s. Neuroscience as a branch of life science has expanded hugely in the last 25 years and the British Neuroscience Association has adapted, frequently working with partner societies, to serve as an interdisciplinary hub for professionals working in this exciting and crucial field. The authors have attempted to highlight some key events in the Association’s history and acknowledge the contributions made by many people over half a century

Evolution: Complexity, uncertainty and innovation

Complexity science provides a general mathematical basis for evolutionary thinking. It makes us face the inherent, irreducible nature of uncertainty and the limits to knowledge and prediction. Complex, evolutionary systems work on the basis of on-going, continuous internal processes of exploration, experimentation and innovation at their underlying levels. This is acted upon by the level above, leading to a selection process on the lower levels and a probing of the stability of the level above. This could either be an organizational level above, or the potential market place. Models aimed at predicting system behaviour therefore consist of assumptions of constraints on the micro-level – and because of inertia or conformity may be approximately true for some unspecified time. However, systems without strong mechanisms of repression and conformity will evolve, innovate and change, creating new emergent structures, capabilities and characteristics. Systems with no individual freedom at their lower levels will have predictable behaviour in the short term – but will not survive in the long term. Creative, innovative, evolving systems, on the other hand, will more probably survive over longer times, but will not have predictable characteristics or behaviour. These minimal mechanisms are all that are required to explain (though not predict) the co-evolutionary processes occurring in markets, organizations, and indeed in emergent, evolutionary communities of practice. Some examples will be presented briefly

Improvements to the Measurement of Atmospheric Reactive Mercury, and Contributions to the Investigation of Reactive Mercury at Six Sampling Sites

Mercury (Hg) is a globally transported hazardous pollutant. In the atmosphere, reactive mercury (RM), composed of gaseous oxidized and particulate-bound Hg, comprises the minority of Hg fractions, but contributes significantly to wet and dry deposition. Unfortunately, the standard instrument used for the past twenty years has been shown to inaccurately measure atmospheric RM. Therefore, the University of Nevada, Reno – Reactive Mercury Active System (RMAS) was developed to improve measurements of RM concentrations, in addition to identification of the chemistry of RM compounds, which was previously impossible. The work presented in this thesis focused on investigating the impact of flow rates on RMAS RM collection and whether the RMAS cartridge that holds membranes collected RM. In addition, alternate surfaces for RM collection were tested. The results of this work are presented in Chapter 2. Chapter 3 summarizes contributions made to a multi-year field campaign aimed at collecting RM using the RMAS at: Amsterdam Island, Indian Ocean; Atlanta, GA; the Great Salt Lake, UT; Guadalupe Mountains National Park, TX; and Reno, NV and the adjacent Peavine Peak. Chapter 3 was focused on understanding the chemistry and concentrations of RM at locations with different ambient air chemistry. Lastly, in Chapter 4, the thesis work was summarized, and the direction of future work discussed

An Investigation of Partizan Misere Games

Combinatorial games are played under two different play conventions: normal play, where the last player to move wins, and \mis play, where the last player to move loses. Combinatorial games are also classified into impartial positions and partizan positions, where a position is impartial if both players have the same available moves and partizan otherwise. \Mis play games lack many of the useful calculational and theoretical properties of normal play games. Until Plambeck's indistinguishability quotient and \mis monoid theory were developed in 2004, research on \mis play games had stalled. This thesis investigates partizan combinatorial \mis play games, by taking Plambeck's indistinguishability and \mis monoid theory for impartial positions and extending it to partizan ones, as well as examining the difficulties in constructing a category of \mis play games in a similar manner to Joyal's category of normal play games. This thesis succeeds in finding an infinite set of positions which each have finite \mis monoid, examining conditions on positions for when $* + *$ is equivalent to 0, finding a set of positions which have Tweedledum-Tweedledee type strategy, and the two most important results of this thesis: giving necessary and sufficient conditions on a set of positions $\Upsilon$ such that the \mis monoid of $\Upsilon$ is the same as the \mis monoid of $*$ and giving a construction theorem which builds all positions $\xi$ such that the \mis monoid of $\xi$ is the same as the \mis monoid of $*$.Comment: PhD Thesi

Women Making Freedom: Rethinking Gender in Caribbean Intra-Regional Migration from a Curaçaoan Perspective

In recent decades, the number of scholarly publications on the feminization of migration has grown exponentially, as women increasingly migrate in the contemporary era of globalisation. Although migration is rooted in Caribbean history, very little attention has been paid to the autonomous migration of women in the past and they have been made invisible by sidelining gender in historiography. Yet, in similar ways to men, women in the Caribbean left their countries and migrated to seek employment elsewhere. The intra-migration movements of women from Curaçao to other Caribbean countries provides sufficient evidence that also women from a Dutch colony in the Caribbean participated independently from their males in these migration dynamics. After emancipation in 1863 in the Dutch colonies, a large group of people of African descent, both men and women remained at the bottom of the social hierarchy and used the demand for labor in other Caribbean countries to realize their aspirations. My paper, “Women Making Freedom: Rethinking Gender in Caribbean Intra-regional Migration from a Curaçaoan Perspective” draws on archival documents and some auto/biographies of Curaçaoan women who have participated in intra-Caribbean migrations in the 19th and 20th century. I will look at the experiences and concerns of these working-class women, migrating from one post-emancipation Caribbean society to another at a time when these societies were still struggling to deal with the legacy of slavery and colonialism. The paper also situates the migration of these women in the wider context of Caribbean women participating independently in migration movements in search of work and it will consider the implications for studying migration as a survival strategy for women in particular in post-emancipation Caribbean societies