Sustaining a “culture of silence” in the neonatal intensive care unit during nonemergency situations: A grounded theory on ensuring adherence to behavioral modification to reduce noise levels

The aim of this study was to generate a substantive theory explaining how the staff in a resource-limited neonatal intensive care unit (NICU) of a developing nation manage to ensure adherence to behavioral modification components of a noise reduction protocol (NsRP) during nonemergency situations. The study was conducted after implementation of an NsRP in a level III NICU of south India. The normal routine of the NICU is highly dynamic because of various categories of staff conducting clinical rounds followed by care-giving activities. This is unpredictably interspersed with very noisy emergency management of neonates who suddenly fall sick. In-depth interviews were conducted with 36 staff members of the NICU (20 staff nurses, six nursing aides, and 10 physicians). Group discussions were conducted with 20 staff nurses and six nursing aides. Data analysis was done in line with the reformulated grounded theory approach, which was based on inductive examination of textual information. The results of the analysis showed that the main concern was to ensure adherence to behavioral modification components of the NsRP. This was addressed by using strategies to “sustain a culture of silence in NICU during nonemergency situations” (core category). The main strategies employed were building awareness momentum, causing awareness percolation, developing a sense of ownership, expansion of caring practices, evolution of adherence, and displaying performance indicators. The “culture of silence” reconditions the existing staff and conditions new staff members joining the NICU. During emergency situations, a “noisy culture” prevailed because of pragmatic neglect of behavioral modification when life support overrode all other concerns. In addition to this, the process of operant conditioning should be formally conducted once every 18 months. The results of this study may be adapted to create similar strategies and establish context specific NsRPs in NICUs with resource constraints

The influence of external factors on bacteriophages—review

The ability of bacteriophages to survive under unfavorable conditions is highly diversified. We summarize the influence of different external physical and chemical factors, such as temperature, acidity, and ions, on phage persistence. The relationships between a phage’s morphology and its survival abilities suggested by some authors are also discussed. A better understanding of the complex problem of phage sensitivity to external factors may be useful not only for those interested in pharmaceutical and agricultural applications of bacteriophages, but also for others working with phages

Track D Social Science, Human Rights and Political Science

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138414/1/jia218442.pd

A conceptual view of internationalization strategies under dual institutional pressures for legitimacy and conformity

Internacionalizar as operações requer que as empresas multinacionais (EMNs) desenvolvam estratégias capazes de lidar, simultaneamente, com as pressões institucionais externas, para a legitimidade, e as pressões institucionais internas, para a conformidade. Neste artigo conceitual e baseado na literatura de teoria institucional em negócios internacionais, desenvolve-se um conjunto de proposições teóricas sobre quais as estratégias de entrada nos mercados externos seguidas pelas EMNs face aos ambientes institucionais. Com foco predominante no ambiente institucional externo e nas diferenças de desenvolvimento institucional, também aborda a relevância de considerar o ambiente interno. As estratégias de entrada tendem a ser baseadas em modos de baixo envolvimento e em parcerias, como joint ventures, para entrar em países institucionalmente imaturos ou institucionalmente mais distantes. As aquisições e as parcerias podem ser usadas se as pressões institucionais forem menores. Conclui-se com uma discussão geral e o apontamento de questões para pesquisas futuras.info:eu-repo/semantics/publishedVersio