Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius

BACKGROUND: The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system. METHODS: A force field analysis in terms of the driving forces had shown that there was dissatisfaction with the traditional method of handover which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The restraining forces identified were a fear of accountability, lack of confidence and that this change would lead to more work. A 3 – step planned change model consisting of unfreezing, moving and refreezing was used to guide us through the change process. Resistance to change was managed by creating a climate of open communication where stakeholders were allowed to voice opinions, share concerns, insights, and ideas thereby actively participating in decision making. RESULTS: An evaluation had shown that this process was successfully implemented to the satisfaction of patients, and staff in general. CONCLUSION: This successful change should encourage other nurses to become more proactive in identifying areas for change management in order to improve our health care system

Mercury and selenium loading in mountaintop mining impacted alkaline streams and riparian food webs

Coal is naturally enriched in trace elements, including mercury (Hg) and selenium (Se).Alkaline mine drainage from mountaintop mining valley fill (MTM-VF)—the dominant form of surface coal mining in Appalachia, USA—releases large quantities of Se into streams draining mined catchments, resulting in elevated bioaccumulation of Se in aquatic and riparian organisms. Yet, the release of Hg into these streams from MTM-VF has not yet been studied. We measured total Hg, methylmercury (MeHg), and Se in stream water, sediment, biofilm, cranefly larvae, and riparian spiders in alkaline streams (pH range 6.9–8.4) across a mining gradient (0–98% watershed mined) in central Appalachia. Hg concentrations ranged from below detection limit (BDL)-6.9 ng/L in unfiltered water, BDL-0.05 lg/g in bulk sediment, 0.016–0.098 lg/g in biofilm, 0.038–0.11 lg/g in cranefly larvae, and 0.046–0.25 lg/g in riparian spiders. In contrast to Se, we found that Hg concentrations in all environmental compartments were not related to the proportion of the watershed mined, suggesting that Hg is not being released from, nor bioaccumulating within, MTM-VF watersheds. We also did not find clear evidence for a reduction in Hg methylation or bioaccumulation under elevated Se concentrations: water, sediment, biofilm, and riparian spiders exhibited no relationship between Hg and Se; only cranefly larvae exhibited a negative relationship (p = 0.0002,r2 = 0.42). We suggest that the type of surface mining matrix rock, with resultant alkaline or acid mine drainage, is important for the speciation, mobility, and bioaccumulation of trace elements within watersheds affected by mining activities

Role of ALD Al2O3 surface passivation on the performance of p-type Cu2O thin film transistors

High-performance p-type oxide thin film transistors (TFTs) have great potential for many semiconductor applications. However, these devices typically suffer from low hole mobility and high off-state currents. We fabricated p-type TFTs with a phase-pure polycrystalline Cu2O semiconductor channel grown by atomic layer deposition (ALD). The TFT switching characteristics were improved by applying a thin ALD Al2O3 passivation layer on the Cu2O channel, followed by vacuum annealing at 300 C. Detailed characterisation by TEM-EDX and XPS shows that the surface of Cu2O is reduced following Al2O3 deposition and indicates the formation of 1-2 nm thick CuAlO2 interfacial layer. This, together with field-effect passivation caused by the high negative fixed charge of the ALD Al2O3, leads to an improvement in the TFT performance by reducing the density of deep trap states as well as by reducing the accumulation of electrons in the semiconducting layer in the device off-state