Exploring Moral Distress and Reflective Debriefing as a Potential Intervention Among Intensive Care Unit Nurses

Moral distress is recognized in the literature as a significant problem for nurses working in the intensive care unit (ICU). Moral distress occurs when one knows the right course of action but is unable to follow it due to team or organizational constraints. Moral distress may lead to physical and psychological symptoms resulting in burnout, job attrition, and a negative impact on patient care. While interventions for reducing moral distress among ICU nurses are limited in the literature, one potentially promising approach is reflective debriefing. This Doctor of Nursing Practice (DNP) scholarly project aimed to explore the intensity, frequency, and root causes of moral distress among registered nurses in an adult ICU setting and the feasibility of reflective debriefing as a potential intervention. Using the knowledge to action framework as a guide for project development, this exploratory project utilized a valid and reliable survey to assess the level and root causes of moral distress among a sample of 42 ICU nurses at the project site. The results indicated a moderate level of moral distress with 33% (n = 14) of nurses indicating they were considering vacating their current position due to this issue. Root causes of moral distress were primarily related to aggressive end-of-life treatment decisions. An evidence-based debriefing guide was developed and implemented over a total of 10 sessions attended by 15 nurses. Barriers to participation in reflective debriefing at the project site were attributed to heavy workloads and high patient acuity. Findings from this project might influence support iv mechanisms for nurses at the personal, team, and organizational levels at the project site and more broadly in the critical care setting

Smoke signals: The decline of brand identity predicts reduced smoking behaviour following the introduction of plain packaging

This study tests a social identity based mechanism for the effectiveness of plain tobacco packaging legislation, introduced in Australia in December 2012, to reduce cigarette smoking. 178 Australian smokers rated their sense of identification with fellow smokers of their brand, positive brand stereotypes, quitting behaviours and intentions, and smoking intensity, both before and seven months after the policy change. Mediation analyses showed that smokers, especially those who initially identified strongly with their brand, experienced a significant decrease in their brand identity following the introduction of plain packaging and this was associated with lower smoking behaviours and increased intentions to quit. The findings provide the first quantitative evidence that brand identities may help maintain smoking behaviour, and suggest the role of social-psychological processes in the effectiveness of public health policy

Parramatta 2035: Vibrant, Sustainable, Global

This Review, prepared at the request of the NSW Premier, tests the proposition that Greater Parramatta can become a ‘global city’ by 2035. Parramatta, in the past five years, has been the focus of intensive and accelerated urban regeneration. Equally, it has been the recent beneficiary of substantial public infrastructure investments. Ensuring these positive developments work to the city’s benefit, particularly against liveability and sustainability benchmarks is an emphasis of the Review. The city’s elevation into a ‘global’ cohort is conditional on the preservation and enhancement of these attributes, particularly in fundamental areas like housing affordability, cultural expression, and connectivity. Recognising the investment and talent attraction properties of these elements is a vitally important and, ideally, distinctive element of Parramatta’s current and future character. The Review identifies four priorities where government should now focus its efforts for this region over the next decade: 1. Greater Parramatta needs a Strategic Plan and better cross-government cooperation and investment in the region; 2. The development of the Greater Parramatta region needs to balance the goals of liveability and growth and better manage the unequal impacts of change; 3. Greater Parramatta’s economic future needs to be secured through preserving and investing in the region’s industrial and urban services land; and, 4. Sustainability needs to be a priority to ensure Greater Parramatta’s successful transformation into a resilient global city-region. The Review concludes that Parramatta will become a ‘global’ city, and notes that the real question is one of what type of global city it chooses to become. The Review makes twelve recommendations framed thematically across three priorities: 1. Strategic Planning and Governance; 2. Planning and Infrastructure Priorities; and, 3. Liveability and Sustainability

Acceptability of human papillomavirus self-sampling for cervical-cancer screening in under-screened Māori and Pasifika women: a pilot study.

AIM: To assess whether self-sampling for cervical-cancer screening is acceptable to New Zealand women. METHODS: Māori, Pacific and Asian un- or under-screened women aged 30-69 years were asked to: 1) examine three self-sampling devices; 2) complete a questionnaire on demographics and experiences with the devices; and 3) take a self-sample. Samples were tested 'off-label' using the cobas® 4800 human papillomavirus (HPV) test (Roche Diagnostics NZ). RESULTS: Thirty-one Pacific, 12 Māori, nine Asian and four women of other ethnicities participated (mean age, 39.5 years). Before trying any devices, 78% indicated a preference to self-sample, compared to 22% who preferred a physician-collected sample (PCS). After trying a device (HerSwab™, 91%; Delphi Screener™, 14%; cobas Swab, 13%; 12.5% used >1 device), fewer women (66%) preferred to self-sample next time, fewer (16%) preferred a PCS, while 18% expressed no preference. One of 32 samples with valid results (35 were tested) was positive for HPV 'other' oncogenic types. CONCLUSIONS: This was the first New Zealand study to invite women, including Māori women, to take a self-sample for cervical-cancer screening. The pilot study suggests that un- and under-screened women generally find self-sampling acceptable and all sample types are suitable for use with the cobas HPV test

Having a lot of a good thing: multiple important group memberships as a source of self-esteem.

Copyright: © 2015 Jetten et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are creditedMembership in important social groups can promote a positive identity. We propose and test an identity resource model in which personal self-esteem is boosted by membership in additional important social groups. Belonging to multiple important group memberships predicts personal self-esteem in children (Study 1a), older adults (Study 1b), and former residents of a homeless shelter (Study 1c). Study 2 shows that the effects of multiple important group memberships on personal self-esteem are not reducible to number of interpersonal ties. Studies 3a and 3b provide longitudinal evidence that multiple important group memberships predict personal self-esteem over time. Studies 4 and 5 show that collective self-esteem mediates this effect, suggesting that membership in multiple important groups boosts personal self-esteem because people take pride in, and derive meaning from, important group memberships. Discussion focuses on when and why important group memberships act as a social resource that fuels personal self-esteem.This study was supported by 1. Australian Research Council Future Fellowship (FT110100238) awarded to Jolanda Jetten (see http://www.arc.gov.au) 2. Australian Research Council Linkage Grant (LP110200437) to Jolanda Jetten and Genevieve Dingle (see http://www.arc.gov.au) 3. support from the Canadian Institute for Advanced Research Social Interactions, Identity and Well-Being Program to Nyla Branscombe, S. Alexander Haslam, and Catherine Haslam (see http://www.cifar.ca)

Functional crosstalk between the cohesin loader and chromatin remodelers.

[EN]The cohesin complex participates in many structural and functional aspects of genome organization. Cohesin recruitment onto chromosomes requires nucleosome-free DNA and the Scc2-Scc4 cohesin loader complex that catalyzes topological cohesin loading. Additionally, the cohesin loader facilitates promoter nucleosome clearance in a yet unknown way, and it recognizes chromatin receptors such as the RSC chromatin remodeler. Here, we explore the cohesin loader-RSC interaction. Amongst multi-pronged contacts by Scc2 and Scc4, we find that Scc4 contacts a conserved patch on the RSC ATPase motor module. The cohesin loader directly stimulates in vitro nucleosome sliding by RSC, providing an explanation how it facilitates promoter nucleosome clearance. Furthermore, we observe cohesin loader interactions with a wide range of chromatin remodelers. Our results provide mechanistic insight into how the cohesin loader recognizes, as well as influences, the chromatin landscape, with implications for our understanding of human developmental disorders including Cornelia de Lange and Coffin-Siris syndromes

Family identification is a protective resource for people with eating disorders because it ameliorates feelings of loneliness

Families play an important role in eating disorder recovery. Recently, it has been suggested that they can ameliorate the loneliness and social isolation associated with an eating disorder. However, the psychological mechanisms through which this occurs have yet to be systematically explored. Utilising the Social Identity Approach to Health, we explore whether identification with one’s family group positively predicts health and wellbeing in people with eating disorders due to its capacity to reduce feelings of loneliness. We investigate this in two studies (N=82; N=234), one of which was conducted in the early stages of the COVID-19 pandemic. In both studies, we demonstrated that family identification protects health. This was apparent in participants reporting fewer and less severe ED symptoms, and in the context of the COVID-19 pandemic, reduced eating disorder-related impact and reduced anxiety. In both studies, these benefits were attributable to the protective role of family identification against loneliness. Our findings provide a framework for understanding in general why family is so important in treatment, including in the case of adults. It also supports the focus in treatment on the family as a group rather than as a collection of interpersonal relationships

Factors influencing wellbeing in young people during COVID-19: A survey with 6291 young people in Wales.

COVID-19 infection and the resultant restrictions has impacted all aspects of life across the world. This study explores factors that promote or support wellbeing for young people during the pandemic, how they differ by age, using a self-reported online survey with those aged 8-25 in Wales between September 2020 and February 2021. Open-ended responses were analysed via thematic analysis to provide further context. A total of 6,291 responses were obtained from 81 education settings across Wales (including primary and secondary schools as well as sixth form, colleges and universities). Wellbeing was highest in primary school children and boys and lowest in those who were at secondary school children, who were girls and, those who preferred not to give a gender. Among primary school children, higher wellbeing was seen for those who played with lots of others (rather than alone), were of Asian ethnicity (OR 2.17, 95% CI: 1.26 to 4.3), had a safe play area (OR: 2.4, 95% CI: 1.67 to 2.56) and had more sleep. To support their wellbeing young people reported they would like to be able to play with their friends more. Among secondary school children those who were of mixed ethnicity reported lower wellbeing (OR: 5.14, 95% CI: 1.68 to 15.79). To support their wellbeing they reported they would like more support with mental health (due to anxiety and pressure to achieve when learning online). This study found self-reported wellbeing differed by gender, ethnicity and deprivation and found younger children report the need for play and to see friends to support wellbeing but older children/young people wanted more support with anxiety and educational pressures