No longer eating their young, but eating their own: Developing capacity to decrease lateral aggression among nurses and leaders

Nursing is generally known as a profession of caring. The public identifies these professionals as one of the most trusted roles in a healthcare setting. Despite this, many behaviours contradict this paradigm. These uncivil behaviours may be overt or subtle, but they are contributing to a psychologically unsafe environment where nursing instability and increased turnover threaten the ability to provide competent care for current and future patients. The nursing literature often refers to the term, eating their young, to summarize a harmful concept where experienced nurses neglect, betray, or belittle junior nurses who are in need of support from their more experienced peers. Many stressors at micro, meso, and macro levels have led to the resurgence of lateral aggression in the nursing profession. These actions have permeated to novice nurses, who now act as perpetrators engaging in this cannibalistic behaviour. This creates psychologically unsafe environments and acts as a deterrent for nurses staying in a specialty area. In view of its costly health-related repercussions, the prevention of lateral aggression is crucial to conserve nurse well-being and safeguard the provision of competent nursing care into the future. A blended learning pathway is proposed for nurses and leaders to recognize, respond, and address lateral aggression in action on adult surgical units. Kotter’s 8-step change model, combined with CQI methodology, is used to guide a change implementation plan. Workforce metrics such as turnover rates, overtime usage, absenteeism, sick time, and safety occurrence reporting will serve as indicators of success

Between maps and weather girls:the meteorology in the Jornal Nacional and Rural Notícias

Este artigo, resultado da etapa piloto da pesquisa, compara os quadros da previsão do tempo de dois telejornais brasileiros das Organizações Globo (o do Jornal Nacional, canal aberto, e o do Rural Notícias, canal fechado), procurando analisar seus formatos, funções aparentes, formatação, a imagem corporal construída de suas apresentadoras e o público-alvo de cada jornal. A previsão aparece com várias funções, sendo dominantes a ênfase no cotidiano e lazer e a ênfase do vínculo com a produção rural em sentido amplo. Há, também, uma clara mistura entre informação meteorológica e entretenimento. Todavia, as representações sociais do corpo na sociedade brasileira e sua presença no espaço da meteorologia dos telejornais em questão são temas deste estudo.This article, resulting from the research pilot, contrasts the weather forecast board of two Brazilian newscasts from Globo Organizations (Jornal Nacional, broadcast by an open channel, and Rural Notícias, by paid channel), analysing its formats, seeming function, the built-up bodily image of their anchorwomen and the target audience of each newscast. The weather forecast is shown as having several meanings, the emphasis being on everyday life and leasure and on the broad meaning of the agricultural production. There is also a clear mixture between weather information and entertainment. However, the social representations of the human body in Brazilian society and its presence in the newscasts weather reports in question are the subjects of this study

Nosokomiale Infektionen, Antibiotikaeinsatz und multiresistente Erreger (MRE) in Langzeitpflegeeinrichtungen im Rhein-Main-Gebiet

Nosokomiale Infektionen und multiresistente Erreger stellen ein zunehmendes Problem in Krankenhäusern dar. Obwohl diese Problematik mittlerweile auch die Altenpfle-geheime erreicht hat, ist die Studienlage zur Prävalenz nosokomialer Infektionen und multiresistenter Erreger in Langzeitpflegeeinrichtungen unzureichend. Um dem entge-genzuwirken, wurden im Rahmen dieser Studie aktuelle Punktprävalenzen zum Vor-kommen nosokomialer Infektionen und multiresistenter Erreger in Altenpflegeheimen im Rhein-Main-Gebiet 2013 ermittelt. Insgesamt nahmen 29 Altenpflegeheime aus dem Rhein-Main-Gebiet mit 2606 Be-wohnern an dieser Studie teil. Mit Hilfe der etablierten HALT-Fragebögen (Anlage 2) wurden im Rahmen des HALT-2-Projektes Bewohnercharakteristika und Antibiotika-einsatz in den Altenpflegeheimen dokumentiert und zusätzlich, anhand der modi-fizierten McGeer-Kriterien, alle nosokomialen Infektionen erfasst. Zusätzlich dazu wurden in dieser Studie alle Bewohner, die dem schriftlich einwilligten, auf multiresistente Erreger (MRSA, ESBL/MRGN und VRE) untersucht. Insgesamt be-teiligten sich 690 Bewohner aus 26 Altenpflegeheimen an dieser weiterführenden Diagnostik. Hierzu wurden Abstriche aus Nase, Rachen und/oder der Analregion genommen und diese im „Institut für Mikrobiologie und Krankenhaushygiene“ der Universität Frankfurt am Main auf MRSA, ESBL/MRGN und VRE untersucht. Die Datenerfassung in den Pflegeeinrichtungen erfolgte zwischen April und Juli 2013. Ziel dieser Studie war die Erhebung aktueller Punktprävalenzen zu nosokomialen Infektionen und Antibiotikaeinsatz in Pflegeeinrichtungen im Rhein-Main-Gebiet. Zudem wurde die Prävalenz der MRSA-, ESBL-/MRGN- und VRE-Besiedlung bei Bewohnern von Langzeitpflegeeinrichtungen im Rhein-Main-Gebiet ermittelt und anhand der dokumentierten Bewohnercharakteristika (inkl. „medical devices“, Haut-barriereverletzungen, anamnestische Daten) wurden schließlich Risikofaktoren für eine MRE-Kolonisation sowie für nosokomiale Infektionen diagnostiziert. Die Prävalenz nosokomialer Infektionen in Langzeitpflegeeinrichtungen im Rhein-Main-Gebiet in dieser Studie lag bei 2,5%. Harnwegsinfektionen waren mit einem Anteil von 44,8% aller Infektionen die am häufigsten vorkommende Infektionsart, gefolgt von Hautinfektionen mit 29,8%. Atemwegsinfektionen (9%) und gastro-intestinale Infektionen (4,5%) kamen deutlich seltener vor. Die Prävalenz des Antibiotikaeinsatzes lag bei 1,4%. Die am häufigsten eingenom-menen Antibiotika waren andere Beta-Laktame sowie Chinolone (je 27,8% aller Ant-ibiotika). Penicilline wurden eher selten eingesetzt (2,8% aller Antibiotika). Zusammen-fassend lässt sich sagen, dass der Antibiotikaeinsatz in Langzeitpflegeeinrichtungen im Rhein-Main-Gebiet als vergleichsweise gering einzustufen ist. Dafür wurden häufig Breitspektrumantibiotika (v.a. Cephalosporine und Fluorchinolone) verwendet, welche einen hohen Resistenzdruck aufweisen. Die in dieser Studie ermittelte Prävalenz von MRSA in Langzeitpflegeeinrichtungen im Rhein-Main-Gebiet lag bei 6,5%. Die Prävalenz von ESBL und insbes. 3MRGN in Pflegeeinrichtungen im Rhein-Main-Gebiet war mit 17,8% (ESBL) respektive 12,3% (3MRGN) unerwartet hoch. Insbesondere der hohe Anteil an 3MRGN wurde so bislang noch in keiner Studie beschrieben. Die Prävalenz von VRE war mit 0,4% sehr niedrig. Zusammenfassend zeigt sich eine hohe, jedoch stagnierende MRSA-Prävalenz sowie eine sehr hohe ESBL-Prävalenz (insb. 3MRGN). 4MRGN wurden im Rahmen dieser Untersuchung nicht gefunden. VRE stellt derzeit kein großes Problem dar. Als Risikofaktoren für eine MRE-Kolonisation stellten sich die klassischen, aus der Literatur bekannten, Risikofaktoren dar. Eine Harnwegskatheterisierung (OR 4,228), die Versorgung mit einer PEG (OR 2,746) sowie eine Antibiotikatherapie (OR 2,610) innerhalb der letzten 3 Monate wurden als signifikante Risikofaktoren für eine MRSA-Kolonisation ermittelt. Eine ESBL-Kolonisation war signifikant lediglich mit dem Vorhandensein eines Harnwegskatheters (OR 1,962) assoziiert. Als signifikante Risikofaktoren für eine Harnwegsinfektion wurden Harnwegskatheter (OR 6,7965) sowie männliches Geschlecht (OR 2,6890) diagnostiziert. Da Männer we-sentlich häufiger mit einem Harnwegskatheter versorgt waren als Frauen, müssen diese beiden Risikofaktoren jedoch kombiniert betrachtet werden. Als signifikante Risiko-faktoren für Hautinfektionen stellten sich Gefäßkatheter (OR 15,0702), Dekubiti (OR 9,4621), andere Wunden (OR 18,5909) sowie eine MRSA-Besiedlung (OR 5,9442) dar.Nosocomial infections and multidrug-resistant organisms (MDRO) are an increasing problem in hospital care. Although this complex of problems has meanwhile reached nursing homes, data on the current prevalence of MDRO and nosocomial infections in long-term care facilities (LTCFs) are rare. To counter this deficit, this study determined carriage rates of MDRO and nosocomial infections in LTCF residents in the German Rhine-Main region in 2013. A total of 29 LTCFs from the Rhine-Main region with 2606 inhabitants participated in this study. Using the well-established HALT questionnaire, characteristics of the in-habitants (e.g. sex, age, health characteristics…) and antibiotic treatment in the LTCFs were registered and additionally, according to the McGeer criteria, all nosocomial in-fections were recorded. Furthermore, all inhabitants who agreed to having swabs from nose, throaht and/or perineum, were analyzed for MDRO-colonization (MRSA, ESBL and VRE). A total of 690 inhabitants from 26 LTCFs took part in this continuative diagnostics. The swabs were tested in the „Institute for Medical Microbiology and In-fection Control“ from the university of Frankfurt for MRSA, ESBL/MRGN and VRE. The data acquisition in the LTCFs lasted from April to July 2013. The aim of our study was to asses the current prevalence of nosocomial infections, antibiotic treatment and MDRO (MRSA, ESBL/MRGN and VRE) in LTCFs in the Rhine-Main district in Germany. Analyzing the determined data, risk factors for MDRO-colonization and nosocomial infections were identified. The prevalence of nosocomial infections in LTCFs in the Rhine-Main-district in this study was 2,5%. Urinary tract infections (UTI) were the most frequent infections (44,8%), followed by skin infections (29,8%). Respiratory infections (9%) and gastro-intestinal infections (4,5%) were scarce. The prevalence of antibiotic treatment was 1,4%. The most frequently reported anti-biotics were „other beta-lactams“ and Chinolone (each with 27,8%). Penicillins were used more scarcely (2,8%). Summing up, antibiotic treatment in LTCFs in the Rhine-Main district is comparatively low. In return, a high amount of broad-spectrum anti-biotics with a high resistance pressure were used (especially Cephalosporines and Fluor-chinolones). The prevalence of MRSA in this study was 6,5%. The ESBL- and in particular the 3MRGN-prevalences were unexpected high, reaching 17,8% (ESBL) respectively 12,3% (3MRGN). Especially the high amount of 3MRGN has not been described in any other study yet. The prevalence of VRE in the studied LTCFs was very low (0,4%). Summing up, our study revealed a high but stagnating MRSA-prevalence and a much higher prevalence for ESBL/MRGN carriage, whereas VRE prevalence was very low in the participating LTCFs. 4MRGN have, as yet, not been detected in the residents in our studies. Significant risk factors for a MRSA-colonization identified in this study proved to be urinary catheters (OR 4,228), percutaneous endoscopic gastrostomy tubes (OR 2,746) and an antibiotic therapy during the last three months (OR 2,610). The odds ratios for ESBL/MRGN carriage were significantly increased merely by having a urinary catheter (OR 1,962). Urinary tract infections proved to be significantly associated with urinary catheters (OR 6,7965) and male gender (OR 2,6890). Given that male inhabitants were more frequently supplied with a urinary tract catheter than females, these two risk factors can only be regarded in combination. Skin infections in contrast were significantly associated with vascular catheters (OR 15,0702), decubiti (OR 9,4621), „other“ types of wounds (OR 18,5909) and MRSA-carriage (OR 5,9442)

The agile strategies in IT Governance: Towards a framework of agile IT Governance in the banking industry

Digital transformation has changed corporate reality and, with that, firms’ IT environments and IT governance (ITG). As such, the perspective of ITG has shifted from the design of a relatively stable, closed and controllable system of a self-sufficient enterprise to a relatively fluid, open, agile and transformational system of networked co-adaptive entities. Related to this paradigm shift in ITG, this paper aims to clarify how the concept of an effective ITG framework has changed in terms of the demand for agility in organizations. Thus, this study conducted 33 qualitative interviews with executives and senior managers from the banking industry in Germany, Switzerland and Austria. Analysis of the interviews focused on the formation of categories and the assignment of individual text parts (codings) to these categories to allow for a quantitative evaluation of the codings per category. Regarding traditional and agile ITG dimensions, 22 traditional and 25 agile dimensions in terms of structures, processes and relational mechanisms were identified. Moreover, agile strategies within the agile ITG construct and ten ITG patterns were identified from the interview data. The data show relevant perspectives on the implementation of traditional and new ITG dimensions and highlight ambidextrous aspects in ITG in the German-speaking banking industry

“STUDI LABORATORIUM PENGARUH PENAMBAHAN SPERSENE TERHADAP LUMPUR DASAR BENTONITE PT. SUD CHEMIE DENGAN ADDITIVE K-PAM YANG TERKONTAMINASI GYPSUM.”

Pada operasi pemboran adakalanya terjadi kontaminasi pada lumpur pemboran yang kita gunakan, salah satunya adalah kontaminasi oleh Gypsum (CaSO4). Kontaminasi Gypsum (CaSO4) akan mengakibatkan terjadinya kerusakan pada lumpur pemboran dengan berubahnya sifat-sifat fisiknya, seperti kenaikkan yield point, gel strength, volume filtrate, mud cake dan juga plastic viscosity, selain itu juga dapat menurunkan pH lumpur. Berubahnya sifat-sifat fisik dari lumpur pemboran tersebut menyebabkan tidak sesuai lagi dengan standar API 13 A sehingga perlu dilakukan perbaikkan (treatment) pada lumpur pemboran tersebut. Dalam penelitian ini menggunakan lumpur dasar dengan bentonite PT. SUD CHEMIE yang ditambahkan dengan additive K-PAM sebesar 0,6 ppb, kemudian dikontaminasi dengan Gypsum (CaSO4) dengan variasi penambahan 0.5 ppb sampai 5 ppb. Setelah diketahui efek dari kontaminasi Gypsum (CaSO4) maka dilakukan treatment terhadap lumpur yang terkontaminasi Gypsum (CaSO4) tersebut dengan menambahkan additive Spersene dengan konsentrasi dari 3 ppb sampai 7 ppb. Penambahan dengan Spersene mengakibatkan penurunan pada beberapa sifat fisik lumpur, diantaranya yield point, gel strength, volume filtrate, mud cake, dan juga harga plastic viscosity. Dari hasil percobaan terhadap lumpur yang terkontaminasi Gypsum (CaSO4) 2.5 ppb maka penambahan dengan Spersene yang paling efektif adalah dengan konsentrasi 5.0 ppb

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge

Enfermeiras em rede: Desenho comunicativo de gestão de comunidades

Relatamos, nesse artigo, um processo de construção de uma comunidade em rede de enfermeiros realizado no Canadá, paí­s que enfrenta crescentes problemas no sistema de saúde, relacionados tanto a questões de financiamento como de gestão. A comunidade foi implementada com base no desenho comunicativo de gestão em rede, uma abordagem de pesquisa-ação inspirada na tradição do design participativo, com o objetivo de desenvolver novas maneiras de se discutir práticas e de transformá-las. Em seguida, apresentamos os fundamentos da teoria comunicativa da ecologia dos sentidos que serviu como base para a análise do processo. Descrevemos a metodologia, explorando as relações entre tecnologia, redação colaborativa e práticas profissionais de enfermagem. Finalmente, discutimos as contribuições potenciais da abordagem para pesquisas integrando saúde, educação e comunicação

Reactivating TP53 signaling by the novel MDM2 inhibitor DS-3032b as a therapeutic option for high-risk neuroblastoma

Fewer than 50% of patients with high-risk neuroblastoma survive five years after diagnosis with current treatment protocols. Molecular targeted therapies are expected to improve survival. Although MDM2 has been validated as a promising target in preclinical models, no MDM2 inhibitors have yet entered clinical trials for neuroblastoma patients. Toxic side effects, poor bioavailability and low efficacy of the available MDM2 inhibitors that have entered phase I/II trials drive the development of novel MDM2 inhibitors with an improved risk-benefit profile. We investigated the effect of the novel MDM2 small molecular inhibitor, DS-3032b, on viability, proliferation, senescence, migration, cell cycle arrest and apoptosis in a panel of six neuroblastoma cell lines with different TP53 and MYCN genetic backgrounds, and assessed efficacy in a murine subcutaneous model for high-risk neuroblastoma. Re-analysis of existing expression data from 476 primary neuroblastomas showed that high-level MDM2 expression correlated with poor patient survival. DS-3032b treatment enhanced TP53 target gene expression and induced G1 cell cycle arrest, senescence and apoptosis. CRISPR-mediated MDM2 knockout in neuroblastoma cells mimicked DS-3032b treatment. TP53 signaling was selectively activated by DS-3032b in neuroblastoma cells with wildtype TP53, regardless of the presence of MYCN amplification, but was significantly reduced by TP53 mutations or expression of a dominant-negative TP53 mutant. Oral DS-3032b administration inhibited xenograft tumor growth and prolonged mouse survival. Our in vitro and in vivo data demonstrate that DS-3032b reactivates TP53 signaling even in the presence of MYCN amplification in neuroblastoma cells, to reduce proliferative capacity and cause cytotoxicity