Obstacles to compassion-giving among nursing and midwifery managers: an international study

Aim: To explore nursing and midwifery managers’ views regarding obstacles to compassion-giving across country cultures. Background: The benefit of compassionate leadership is being advocated, but despite the fact that healthcare is invariably conducted within culturally diverse workplaces, the interconnection of culture, compassion and leadership is rarely addressed. Furthermore, evidence on how cultural factors hinder the expression of compassion among nursing and midwifery managers is lacking. Methods: Cross-sectional, exploratory, international online survey involving 1 217 participants from 17 countries. Managers’ responses on open-ended questions related to barriers for providing compassion were entered and thematically analysed through NVivo. Results: Three key themes related to compassion-giving obstacles emerged across countries: 1. related to the managers’ personal characteristics and experiences; 2. system-related; 3. staff-related. Conclusions: Obstacles to compassion-giving among managers vary across countries. An understanding of the variations across countries and cultures of what impedes compassion to flourish in healthcare is important. Implications for nursing practice and policy: Nursing mangers should wisely use their power by adopting leadership styles that promote culturally competent and compassionate workplaces with respect for human rights. Policymakers should identify training and mentoring needs to enable the development of managers’ practical wisdom. Appropriate national and international policies should facilitate the establishment of standards and guidelines for compassionate leadership, in the face of distorted organisational cultures and system-related obstacles to compassion-giving

Enactment of compassionate leadership by nursing and midwifery managers: results from an international online survey

Aim To explore the views of an international sample of nursing and midwifery managers concerning attributes that they associate with compassionate management. Method A cross- sectional online survey. Using a snowballing sampling method, 1217 responses were collected from nursing and midwifery managers in 17 countries. A total of complete 933 responses to a question related to which actions and behaviours indicated that a manager was exercising compassionate leadership were analysed for this paper. First, content analysis of the responses was conducted, and second, a relative distribution of the identified themes for the overall sample and for each participating country was calculated. Results Six main themes were identified describing the attributes of a compassionate leader: (1) Virtuous support, (2) Communication, (3) Personal virtues of the manager, (4) Participatory communication, (5) Growth/flourishing/ nurturing and (6) Team cohesion. The first three themes mentioned above collectively accounted for 63% of the responses, and can therefore be considered to be the most important characteristics of compassionate management behaviour. Conclusion The key indicators of compassionate management in nursing and midwifery which were identified emphasise approachability, active and sensitive listening, sympathetic responses to staff members’ difficulties (especially concerning child and other caring responsibilities), active support of and advocacy for the staff team and active problem solving and conflict resolution. While there were differences between the countries’ views on compassionate healthcare management, some themes were widely represented among different countries’ responses, which suggest key indicators of compassionate management that apply across culture

The importance of being a compassionate leader: the views of nursing and midwifery managers from around the world

Introduction: Despite the importance of compassionate leadership in health care, many of the existing publications do not account for the effect of culture. The aim of this study is to explore the views of nursing and midwifery managers from different countries in relation to the definition, advantages, and importance of compassion. Methodology: A cross-sectional, descriptive, exploratory online survey was conducted across 17 countries, containing both closed and open-ended questions. Data from N = 1,217 respondents were analyzed using a directed hybrid approach focusing only on qualitative questions related to compassion-giving. Results: Four overarching themes capture the study’s results: (1) definition of compassion, (2) advantages and importance of compassion for managers, (3) advantages and importance of compassion for staff and the workplace, and (4) culturally competent and compassionate leadership. Discussion: Innovative research agendas should pursue further local qualitative empirical research to inform models of culturally competent and compassionate leadership helping mangers navigate multiple pressures and be able to transculturally resonate with their staff and patients

Obstacles to compassion-giving among nursing and midwifery managers: an international study

Aim: To explore nursing and midwifery managers’ views regarding obstacles to compassion-giving across country cultures. Background: The benefit of compassionate leadership is being advocated, but despite the fact that health care is invariably conducted within culturally diverse workplaces, the interconnection of culture, compassion and leadership is rarely addressed. Furthermore, evidence on how cultural factors hinder the expression of compassion among nursing and midwifery managers is lacking. Methods: Cross-sectional, exploratory, international online survey involving 1 217 participants from 17 countries. Managers’ responses on open-ended questions related to barriers for providing compassion were entered and thematically analysed through NVivo. Results: Three key themes related to compassion-giving obstacles emerged across countries: 1. related to the managers’ personal characteristics and experiences; 2. system-related; and 3. staff-related. Conclusions: Obstacles to compassion-giving among managers vary across countries. An understanding of the variations across countries and cultures of what impedes compassion to flourish in health care is important. Implications for nursing practice and policy: Nursing mangers should wisely use their power by adopting leadership styles that promote culturally competent and compassionate workplaces with respect for human rights. Policymakers should identify training and mentoring needs to enable the development of managers’ practical wisdom. Appropriate national and international policies should facilitate the establishment of standards and guidelines for compassionate leadership, in the face of distorted organizational cultures and system-related obstacles to compassion-giving

Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to 300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m 2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

One-step, low temperature synthesis of reduced graphene oxide decorated with ZnO nanocrystals using galvanized iron steel scrap

Production of a ZnO-rGO composite, using a novel one-pot method consisting in continuously flowing argon into a GO aqueous suspension heated at 80 C, in the presence of galvanized iron steel scrap is presented. FTIR shows the complete disappearance of GO functional groups and only the C=C band remained, indicating extensive GO reduction. Raman spectra indicated sp2 character increase after reaction and the presence of the E2h mode of ZnO. SEM showed submicron crystals identified by XRD as ZnO in the hexagonal phase, while TEM images indicate ZnO nanoparticles decorate mainly the rGO borders. Optical band gap of 3.5 eV corresponding to ZnO, and optical transitions at 4.1 and 5.5 eV related with n → π and π → π∗ were observed. Electrochemical characterization by cyclic voltammetry shows an specific capacitance of 4.7 F g-1 at a scan rate of 5 mVs-1, which drops to ca. 0.8 F g-1 at 200 mVs-1. By electrochemical impedance spectroscopy, the relaxation time was ca. 5 ms. The proposed mechanism for the materials' synthesis includes Zn dissolution from scrap, galvanic displacement of oxygen moieties at the GO sheet, Zn deposition onto the carbon surface, and further oxidation and growth of ZnO nanocrystals.</p

Structural damage in graphene oxide coatings onto Nb substrates upon laser irradiation

In this work graphene oxide (GO) coatings were obtained on Nb substrates by electrophoretic deposition (EPD), using a ramp of stepped potential and variable deposition time, to evaluate the feasibility as a protective coating against the exposition to a 20 W Yb laser (1070 nm). Laser irradiation constitutes a first approximation to the potential damage by local high heat loads that could occur in a Tokamak-type fusion reactor. GO coatings can act as the first barrier against exposure to the fusion reactor plasma, but the coating may experience local high heat loads and simultaneous exposure to energetic particles. The GO/Nb coatings were irradiated with different laser power-frequency settings. With X-ray photoelectron spectroscopy, the bonding evolution of the coatings was followed for each deposition time. Scanning electron microscopy was used to evaluate the coating morphology before and after laser irradiation, whereas Raman spectroscopy was used to evaluate the structural evolution of GO coatings, crystallinity, and disorder in the graphene oxide. An increase of the crystallite size due to sp2 restoration was observed for the films prepared up to 10 s/V. Atomic force microscopy was used to study the film morphology and to estimate the film thickness by comparing the z-offset between the substrate and coating topography images. Film thickness reduces from ca. 280 nm to 100 nm with the increase in the time at each voltage step. Coating tolerance against laser-induced damage was observed up to 34% of the full laser power, where the coating was damaged and local metal melting was observed. The coating damage occurs between 4.9 × 108 MW/m2 and 2.5 × 109 MW/m2 and higher power levels triggered the occurrence of melting in the metallic substrate. The reduction in laser damage is attributed to the enhanced thermal dissipation by the sp2 dominion as the crystallite size increases. GO coatings prepared by electrophoresis are shown to be promising to protect nuclear components against damage for high heat loads.</p

One-step, low temperature synthesis of reduced graphene oxide decorated with ZnO nanocrystals using galvanized iron steel scrap

Production of a ZnO–rGO composite, using a novel one-pot method consisting in continuously flowing argon into a GO aqueous suspension heated at 80 °C, in the presence of galvanized iron steel scrap is presented. FTIR shows the complete disappearance of GO functional groups and only the C=C band remained, indicating extensive GO reduction. Raman spectra indicated sp ^2 character increase after reaction and the presence of the E _2h mode of ZnO. SEM showed submicron crystals identified by XRD as ZnO in the hexagonal phase, while TEM images indicate ZnO nanoparticles decorate mainly the rGO borders. Optical band gap of 3.5 eV corresponding to ZnO, and optical transitions at 4.1 and 5.5 eV related with n →  π and π  →  π * were observed. Electrochemical characterization by cyclic voltammetry shows an specific capacitance of 4.7 F g ^−1 at a scan rate of 5 mVs ^−1 , which drops to ca. 0.8 F g ^−1 at 200 mVs ^−1 . By electrochemical impedance spectroscopy, the relaxation time was ca. 5 ms. The proposed mechanism for the materials‘ synthesis includes Zn dissolution from scrap, galvanic displacement of oxygen moieties at the GO sheet, Zn deposition onto the carbon surface, and further oxidation and growth of ZnO nanocrystals

International research in graphene-oxide based materials for net-zero energy, military and aeronautic applications catalysed by Tamaulipas, Mexico: A Mini Review

Graphene oxide, as a nanoscopic platform for functional materials, has been extensively studied for several applications. The present Mini Review stresses the collaborative research in graphene-oxide materials pivoted from the Group of Materials and Technologies for Energy, Health, and Environment at an Instituto Politecnico Nacional unit in Tamaulipas, in Northeastern Mexico, with Mexican, Turkish, and British collaborators. This review covers the recent works on photovoltaic and photocatalytic materials, coatings for thermonuclear reactors, and composites and metamaterials for military and aeronautic applications.</p