Nurse managers' experience with ethical issues in six government hospitals in Malaysia: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Nurse managers have the burden of experiencing frequent ethical issues related to both their managerial and nursing care duties, according to previous international studies. However, no such study was published in Malaysia. The purpose of this study was to explore nurse managers' experience with ethical issues in six government hospitals in Malaysia including learning about the way they dealt with the issues.</p> <p>Methods</p> <p>A cross-sectional study was conducted in August-September, 2010 involving 417 (69.2%) of total 603 nurse managers in the six Malaysian government hospitals. Data were collected using three-part self-administered questionnaire. Part I was regarding participants' demographics. Part II was about the frequency and areas of management where ethical issues were experienced, and scoring of the importance of 11 pre-identified ethical issues. Part III asked how they dealt with ethical issues in general; ways to deal with the 11 pre-identified ethical issues, and perceived stress level. Data were analyzed using descriptive statistics, cross-tabulations and Pearson's Chi-square.</p> <p>Results</p> <p>A total of 397 (95.2%) participants experienced ethical issues and 47.2% experienced them on weekly to daily basis. Experiencing ethical issues were not associated with areas of practice. Top area of management where ethical issues were encountered was "staff management", but "patient care" related ethical issues were rated as most important. Majority would "discuss with other nurses" in dealing generally with the issues. For pre-identified ethical issues regarding "patient care", "discuss with doctors" was preferred. Only 18.1% referred issues to "ethics committees" and 53.0% to the code of ethics.</p> <p>Conclusions</p> <p>Nurse managers, regardless of their areas of practice, frequently experienced ethical issues. For dealing with these, team-approach needs to be emphasized. Proper understanding of the code of ethics is needed to provide basis for reasoning.</p

La adhesión de las enfermeras al Método Canguro: subvención para la administración del cuidado de enfermería

;;OBJETIVO:;; construir um modelo teórico explicativo acerca da adesão das enfermeiras ao Método Canguru na Unidade de Terapia Intensiva Neonatal, a partir dos significados e interações para a gerência do cuidado.;;;;MÉTODO:;; pesquisa qualitativa, guiada pelo referencial da Grounded Theory. Foram entrevistadas oito enfermeiras de uma Unidade de Terapia Intensiva Neonatal da cidade do Rio de Janeiro. A análise comparativa dos dados percorreu as etapas de codificação aberta, axial e seletiva, sendo construído um modelo teórico do tipo condicional-causal.;;;;RESULTADOS:;; emergiram quatro categorias principais que compuseram o paradigma de análise: Vestindo a camisa do Método Canguru; Trabalhando com a complexidade do Método Canguru; Encontrando (des)motivação para aplicar o Método Canguru; e Deparando-se com os desafios para a adesão e aplicação do Método Canguru.;;;;CONCLUSÕES:;; o fenômeno central revelou que cada enfermeira e profissional da equipe possui um papel de multiplicador de valores e práticas que podem ou não ser construtivas, influenciando potencialmente na (des)continuidade do Método Canguru na Unidade de Terapia Intensiva Neonatal. Os achados podem ser utilizados para o delineamento de estratégias gerenciais que ultrapassem os cursos e treinamentos e garantam o fortalecimento do modelo assistencial.;;;;OBJECTIVE:;; construct an explanatory theoretical model about nurses' adherence to the Kangaroo Care Method at the Neonatal Intensive Care Unit, based on the meanings and interactions for care management.;;;;METHOD:;; qualitative research, based on the reference framework of the Grounded Theory. Eight nurses were interviewed at a Neonatal Intensive Care Unit in the city of Rio de Janeiro. The comparative analysis of the data comprised the phases of open, axial and selective coding. A theoretical conditional-causal model was constructed.;;;;RESULTS:;; four main categories emerged that composed the analytic paradigm: Giving one's best to the Kangaroo Method; Working with the complexity of the Kangaroo Method; Finding (de)motivation to apply the Kangaroo Method; and Facing the challenges for the adherence to and application of the Kangaroo Method.;;;;CONCLUSIONS:;; the central phenomenon revealed that each nurse and team professional has a role of multiplying values and practices that may or may not be constructive, potentially influencing the (dis)continuity of the Kangaroo Method at the Neonatal Intensive Care Unit. The findings can be used to outline management strategies that go beyond the courses and training and guarantee the strengthening of the care model.;;;;OBJETIVO:;; construir un modelo teórico explicativo acerca de la adhesión de las enfermeras al Método Canguro en la Unidad de Terapia Intensiva Neonatal, a partir de los significados e interacciones para la administración del cuidado.;;;;MÉTODO:;; investigación cualitativa, guiada por el referencial de la Grounded Theory. Fueron entrevistadas ocho enfermeras de una Unidad de Terapia Intensiva Neonatal de la ciudad de Rio de Janeiro. El análisis comparativo de los datos recorrió las etapas de codificación abierta, axial y selectiva, siendo construido un modelo teórico del tipo condicional-causal.;;;;RESULTADOS:;; surgieron cuatro categorías principales que compusieron los paradigmas del análisis: Vistiendo la camisa del Método Canguro; Trabajando con la complejidad del Método Canguro; Encontrando (des)motivación para aplicar el Método Canguro; y Encontrando los desafíos para la adhesión y aplicación del Método Canguro.;;;;CONCLUSIONES:;; el fenómeno central reveló que cada enfermera y profesional del equipo posee un papel de multiplicador de valores y prácticas que pueden o no ser constructivas, influenciando potencialmente en la (des)continuidad del Método Canguro en la Unidad de Terapia Intensiva Neonatal. Los hallazgos pueden ser utilizados para el delineamiento de estrategias de administración que sobrepasen los cursos y entrenamientos y garanticen el fortalecimiento del modelo asistencial.;

Genome Characteristics of a Novel Phage from Bacillus thuringiensis Showing High Similarity with Phage from Bacillus cereus

Bacillus thuringiensis is an important entomopathogenic bacterium belongs to the Bacillus cereus group, which also includes B. anthracis and B. cereus. Several genomes of phages originating from this group had been sequenced, but no genome of Siphoviridae phage from B. thuringiensis has been reported. We recently sequenced and analyzed the genome of a novel phage, BtCS33, from a B. thuringiensis strain, subsp. kurstaki CS33, and compared the gneome of this phage to other phages of the B. cereus group. BtCS33 was the first Siphoviridae phage among the sequenced B. thuringiensis phages. It produced small, turbid plaques on bacterial plates and had a narrow host range. BtCS33 possessed a linear, double-stranded DNA genome of 41,992 bp with 57 putative open reading frames (ORFs). It had a typical genome structure consisting of three modules: the “late” region, the “lysogeny-lysis” region and the “early” region. BtCS33 exhibited high similarity with several phages, B. cereus phage Wβ and some variants of Wβ, in genome organization and the amino acid sequences of structural proteins. There were two ORFs, ORF22 and ORF35, in the genome of BtCS33 that were also found in the genomes of B. cereus phage Wβ and may be involved in regulating sporulation of the host cell. Based on these observations and analysis of phylogenetic trees, we deduced that B. thuringiensis phage BtCS33 and B. cereus phage Wβ may have a common distant ancestor

Regulation of Signaling at Regions of Cell-Cell Contact by Endoplasmic Reticulum-Bound Protein-Tyrosine Phosphatase 1B

Protein-tyrosine phosphatase 1B (PTP1B) is a ubiquitously expressed PTP that is anchored to the endoplasmic reticulum (ER). PTP1B dephosphorylates activated receptor tyrosine kinases after endocytosis, as they transit past the ER. However, PTP1B also can access some plasma membrane (PM)-bound substrates at points of cell-cell contact. To explore how PTP1B interacts with such substrates, we utilized quantitative cellular imaging approaches and mathematical modeling of protein mobility. We find that the ER network comes in close proximity to the PM at apparently specialized regions of cell-cell contact, enabling PTP1B to engage substrate(s) at these sites. Studies using PTP1B mutants show that the ER anchor plays an important role in restricting its interactions with PM substrates mainly to regions of cell-cell contact. In addition, treatment with PTP1B inhibitor leads to increased tyrosine phosphorylation of EphA2, a PTP1B substrate, specifically at regions of cell-cell contact. Collectively, our results identify PM-proximal sub-regions of the ER as important sites of cellular signaling regulation by PTP1B

Hacking into bacterial biofilms: a new therapeutic challenge

Microbiologists have extensively worked during the past decade on a particular phase of the bacterial cell cycle known as biofilm, in which single-celled individuals gather together to form a sedentary but dynamic community within a complex structure, displaying spatial and functional heterogeneity. In response to the perception of environmental signals by sensing systems, appropriate responses are triggered, leading to biofilm formation. This process involves various molecular systems that enable bacteria to identify appropriate surfaces on which to anchor themselves, to stick to those surfaces and to each other, to construct multicellular communities several hundreds of micrometers thick, and to detach from the community. The biofilm microbial community is a unique, highly competitive, and crowded environment facilitating microevolutionary processes and horizontal gene transfer between distantly related microorganisms. It is governed by social rules, based on the production and use of "public" goods, with actors and recipients. Biofilms constitute a unique shield against external aggressions, including drug treatment and immune reactions. Biofilm-associated infections in humans have therefore generated major problems for the diagnosis and treatment of diseases. Improvements in our understanding of biofilms have led to innovative research designed to interfere with this process

Leadership in Nursing: Analysis of the Process of Choosing The Heads

The process of choosing heads can be strategic to achieve desired results in nursing care. This study presents an exploratory and descriptive research that aims to analyze the process of choosing heads for the ward, in the nursing area of a teaching hospital in Porto Alegre. Data was collected from registered nurses, technicians and nursing auxiliaries through a semi-structured interview technique and free choice of words. Three theme categories emerged from content analysis: process of choosing heads, managerial competences of the head-to-be and team articulation. Leadership was the word most frequently associated with the process of choosing heads. The consultation process for the choice of the leader also contributes to the success of the manager, as it makes the team members feel co-responsible for the results achieved and legitimizes the head-to-be in their group.El proceso de elección de dirigentes se reviste de importancia estratégica para el alcance de los resultados deseados en el cuidado de enfermería. Este estudio presenta una investigación exploratoria descriptiva, con el objetivo de analizar el proceso de elección de jefes de unidad, en el área de enfermería de un hospital de enseñanza, habiendo recolectado datos con enfermeros, técnicos y auxiliares de enfermería, mediante entrevista semiestructurada y evocación libre de palabras. Del análisis de contenido, emergieron tres categorías temáticas: 1) proceso de elección de jefes, 2) competencias administrativas del futuro jefe y, 3) articulación del equipo. La palabra liderazgo fue la más frecuentemente asociada al proceso de elección de jefes. El proceso de consulta para la elección de jefes contribuye para el éxito de la administración, ya que responsabiliza a los miembros del equipo por los resultados alcanzados y otorga legitimidad al futuro jefe del grupo.O processo de escolha de dirigentes reveste-se de importância estratégica para o alcance dos resultados desejados do cuidado de enfermagem. Este estudo apresenta pesquisa exploratória, descritiva, com o objetivo de analisar o processo de escolha de chefias de unidade, na área de enfermagem de um hospital de ensino, tendo-se coletado dados com enfermeiros, técnicos e auxiliares de enfermagem, mediante entrevista semiestruturada e evocação livre de palavras. Da análise de conteúdo, emergiram três categorias temáticas: processo de escolha de chefias, competências gerenciais do futuro chefe e articulação da equipe. Liderança compreendeu a palavra mais frequentemente associada ao processo de escolha de chefia. O processo consultivo para a escolha dos chefes contribui para o sucesso da gestão, pois corresponsabiliza os membros da equipe pelos resultados alcançados e legitima o futuro chefe em seu grupo