Patient safety, ethics and whistleblowing : a nursing response to the events at the Campbelltown and Camden Hospitals

In November 2002, in what stands as one of the most significant whistleblowing cases in the history of the Australian health care system, four nurses went public with concerns they had about the management of clinical incidents and patient safety at two hospitals in Sydney, New South Wales. The handling of this case and its aftermath raises important moral questions concerning the nature of whistleblowing in health care domains and the possible implications for the patient safety and quality of care movement in Australia. This paper presents an overview of the case, the moral risks associated with whistleblowing, and some lessons learned.<br /

The politics of resistance to workplace cultural diversity education for health service providers : an Australian study

This qualitative study has as its focus an exploration of health service providers\u27 perceptions and experiences of the processes and implications of delivering workplace cultural diversity education for staff. Data were obtained from conducting in-depth individual and focus group interviews with a purposeful sample of 137 healthcare professionals, recruited from over 17 different organizational sites. Participants included cultural diversity educators, ethnic liaison officers, health service managers, nurses, health interpreters, allied health professionals, and community-based ethnic welfare organization personnel working in or with select metropolitan health services in Victoria, Australia. Analysis of the data revealed that workplace cultural diversity education in healthcare is a significant site of resistance and struggle. \u27Resistance\u27 was expressed in several forms including: the problematization of resources and staff availability to attend cultural diversity education forums; indifferent failure to recognize cultural imperatives in healthcare; deliberate refusal to recognize cultural imperatives in healthcare; selective recognition of cultural imperatives in healthcare (\u27facts sheets\u27 only); and the angry rejection of cultural imperatives in healthcare. \u27Struggle\u27, in turn, largely involved cultural diversity educators having to constantly \u27cajole and convince\u27 (and even manipulate) staff to attend cultural diversity education forums and using a \u27velvet glove and iron fist\u27 approach to teaching staff who remained resolute in their resistance when participating in educational forums. An important implication of this study is that the politics of workplace cultural diversity education - and the \u27politics of resistance\u27 to such programs - need to be better recognized and understood if the status quo is to be successfully challenged and changed. The need for critical debate and further comparative research on the subject are also highlighted. <br /

Key milestones in the operationalisation of professional nursing ethics in Australia: a brief historical overview

Objective To provide a brief historical overview of the achievement of key milestones in the development of mechanisms for operationalising professional nursing ethics in Australia; examples of such milestones include: the publication of the first Australian text on nursing ethics (1989), the provision of the first Australian national distance education course on nursing ethics for registered nurses (1990), the adoption of the first code of ethics for Australian nurses (1993), and the commissioning of the first regular column on nursing ethics by the Australian Nurses Journal (2008). Setting Australian nursing ethics. Primary argument An historical perspective on the achievement of key milestones in the development of mechanisms for operationalising professional nursing ethics in Australia has been poorly documented. As a consequence an authentic &lsquo;Australian voice&rsquo; is missing in global discourses on the history and development of nursing ethics as a field of inquiry. Compared with other countries, the achievement of key milestones pertinent to the operationalisation of nursing ethics in Australia has been relatively slow. Even so, over the past three decades an Australian perspective on nursing ethics has gained a notable voice in the international arena with Australian nursing scholars now making a significant contribution to the field. Conclusion Nursing ethics in Australia remains a &lsquo;work in progress&rsquo;. Although significant achievements have been made in the last three decades, the ongoing development of mechanisms for advancing nursing ethics in Australia would benefit from the development and implementation of a strategic agenda of collaborative, internationally comparative, cross disciplinary scholarship, research and critique

Health care provider and consumer understandings of cultural safety and cultural competency in health care : an Australian study

There is increasing recognition in Australia that racial and ethnic minority groups experience significant disparities in health and health care compared with the average population and that the Australian health care system needs to be more responsive to the health and care needs of these groups. The paper presents the findings of a year long study that explored what providers and recipients of health care know and understand about the nature and implications of providing culturally safe and competent health care to minority racial and ethnic groups in Victoria, Australia. Analysis of the data obtained from interviewing 145 participants recruited from over 17 different organizational sites revealed a paucity of knowledge and understanding of this issue and the need for a new approach to redress the status quo.<br /

A Deep Look at the Emission-Line Nebula in Abell 2597

The close correlation between cooling flows and emission-line nebulae in clusters of galaxies has been recognized for over a decade and a half, but the physical reason for this connection remains unclear. Here we present deep optical spectra of the nebula in Abell 2597, one of the nearest strong cooling-flow clusters. These spectra reveal the density, temperature, and metal abundances of the line-emitting gas. The abundances are roughly half-solar, and dust produces an extinction of at least a magnitude in V. The absence of [O III] 4363 emission rules out shocks as a major ionizing mechanism, and the weakness of He II 4686 rules out a hard ionizing source, such as an active galactic nucleus or cooling intracluster gas. Hot stars are therefore the best candidate for producing the ionization. However, even the hottest O stars cannot power a nebula as hot as the one we see. Some other nonionizing source of heat appears to contribute a comparable amount of power. We show that the energy flux from a confining medium can become important when the ionization level of a nebula drops to the low levels seen in cooling-flow nebulae. We suggest that this kind of phenomenon, in which energy fluxes from the surrounding medium augment photoelectric heating, might be the common feature underlying the diverse group of objects classified as LINERS.Comment: 33 Latex pages, including 16 Postscript figures, to appear in 1997 September 1 Astrophysical Journa

Assuaging death anxiety in older overseas-born Australians of culturally and linguistically diverse backgrounds hospitalised for end-of-life care

BACKGROUND: Death anxiety is a known phenomenon in older people of culturally and linguistically diverse backgrounds (CALD) hospitalised for end-of-life (EOL) care . Little is known about how nurses assuage death anxiety in this population. AIMS: To investigate strategies used by nurses to assuage death anxiety and facilitate a good death in older CALD Australians hospitalised for EOL care. METHODS: Advanced as a qualitative descriptive inquiry, a purposeful sample of 22 nurses was recruited from four Victorian healthcare services. Interviews were transcribed verbatim and analysed using thematic analysis processes. FINDINGS: Nurses used three key strategies: recognising death anxiety; delineating its dimensions; and initiating conventional nursingcaring behaviours to help contain it. Contrary to expectations, cultural similarities rather than differences were found in the strategies used. CONCLUSIONS: Nursing strategies for recognising, delineating, and managing death anxiety in older CALD people hospitalised at the EOL is an important component of quality EOL care

Nursing strategies for engaging families of older immigrants hospitalized for end-of-life care: an Australian study

BACKGROUND: Engaging with families of older non-English-speaking background (NESB) immigrants hospitalized for end-of-life (EOL) care can be challenging, especially when their cultures, lifeways, and family decision-making processes are unfamiliar to the nurses caring for them. Despite the recognized importance of family engagement when providing EOL care, the issue of ethnic minority family engagement has received little attention in the field. AIM: To explore and describe the strategies nurses use to facilitate engagement with families of older immigrant NESB patients hospitalized for EOL care. METHODS: A qualitative descriptive approach was used. Data were collected via in-depth interviews conducted with 22 registered nurses recruited from 4 Australian health services. FINDINGS: Using thematic analysis processes, 5 key strategies were identified: listening and understanding families, encouraging family members to speak first, dealing with angst, redressing naive views about the dying process, and managing intergenerational differences. Underpinning these strategies was a profound &quot;will to engage&quot; with the families and their cultural worldviews. CONCLUSION: Further cross-cultural comparative research is required to inform evidence-based policies, practice, and education on this issue

The mTORC1 inhibitor everolimus prevents and treats Eμ-Myc lymphoma by restoring oncogene-induced senescence

MYC deregulation is common in human cancer. IG-MYC translocations that are modeled in EμMyc mice occur in almost all cases of Burkitt lymphoma as well as in other B-cell lymphoproliferative disorders. Deregulated expression of MYC results in increased mTOR complex 1 (mTORC1) signaling. As tumors with mTORC1 activation are sensitive to mTORC1 inhibition, we used everolimus, a potent and specific mTORC1 inhibitor, to test the requirement for mTORC1 in the initiation and maintenance of EμMyc lymphoma. Everolimus selectively cleared premalignant B cells from the bone marrow and spleen, restored a normal pattern of B-cell differentiation, and strongly protected against lymphoma development. Established EμMyc lymphoma also regressed after everolimus therapy. Therapeutic response correlated with a cellular senescence phenotype and induction of p53 activity. Therefore, mTORC1-dependent evasion of senescence is critical for cellular transformation and tumor maintenance by MYC in B lymphocytes