This study explored workplace interactions of Australian nurses in regional acute care hospitals through an examination of nurses' experiences and perceptions of workplace behaviour.
This research is ...informed by Social Worlds Theory and is the qualitative component of an overarching mixed methods sequential explanatory study.
Between January and March 2019, data were collected from 13 nursing informants from different occupational levels and roles, who engaged in semi-structured, in-depth, face-to-face interviews. Data analysis was guided by Straussian grounded theory to identify the core category and subcategories.
Theoretical saturation occurred after 13 interviews. The core category identified is A conflicted tribe under pressure, which is comprised of five interrelated subcategories: Belonging to the tribe; 'It's a living hell'; Zero tolerance-'it's a joke'; Conflicted priorities; Shifting the cultural norm.
This study provides valuable insight into the nursing social world and the organizational constraints in which nurses work. Although the inclination for an individual to exhibit negative behaviours cannot be dismissed, this behaviour can either be facilitated or impeded by organizational influences.
By considering the nurses' experiences of negative workplace behaviour and identifying the symptoms of a struggling system, nurse leaders can work to find and implement strategies to mitigate negative behaviour and create respectful workplace behaviours.
This study involved registered nurse participants and there was no patient or public contribution.
Study registration Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).
The polymorphic nature of the cytochrome P450 (CYP) genes affects individual drug response and adverse reactions to a great extent. This variation includes copy number variants (CNV), missense ...mutations, insertions and deletions, and mutations affecting gene expression and activity of mainly CYP2A6, CYP2B6, CYP2C9, CYP2C19 and CYP2D6, which have been extensively studied and well characterized. CYP1A2 and CYP3A4 expression varies significantly, and the cause has been suggested to be mainly of genetic origin but the exact molecular basis remains unknown. We present a review of the major polymorphic CYP alleles and conclude that this variability is of greatest importance for treatment with several antidepressants, antipsychotics, antiulcer drugs, anti-HIV drugs, anticoagulants, antidiabetics and the anticancer drug tamoxifen. We also present tables illustrating the relative importance of specific common CYP alleles for the extent of enzyme functionality. The field of pharmacoepigenetics has just opened, and we present recent examples wherein gene methylation influences the expression of CYP. In addition microRNA (miRNA) regulation of P450 has been described. Furthermore, this review updates the field with respect to regulatory initiatives and experience of predictive pharmacogenetic investigations in the clinics. It is concluded that the pharmacogenetic knowledge regarding CYP polymorphism now developed to a stage where it can be implemented in drug development and in clinical routine for specific drug treatments, thereby improving the drug response and reducing costs for drug treatment.
Pharmacogenetics affects both pharmacokinetics and pharmacodynamics, thereby influencing an individual's response to drugs, both in terms of response and adverse reactions. Within the area of ...pharmacogenetics, findings of genetic variation influencing drug levels have been more prevalent, and variation in the cytochrome P450 (CYP) enzymes is one of the most common causes. Much of the work concerning sequence variations in CYPs aims at finding biomarkers of use for individualised treatment, thereby increasing the treatment response, lowering the number of side effects and decreasing the overall cost of treatment regimens. For over ten years, the Human Cytochrome P450 Allele Nomenclature (CYP-allele) website (http://www.cypalleles.ki.se/) has offered a database of genetic information on CYP variants, along with effects at the molecular as well as clinical level. Thus, this database serves as an assembly of past, current and soon-to-be published information on CYP alleles and their outcome effects. The website is used by academic researchers and companies (eg as a tool in drug development and for outlining new research projects). By providing peer-reviewed genetic information on CYP enzymes, the CYP-allele website has become increasingly popular and widely used. Recently, NADPH cytochrome P450 oxidoreductase (POR), the electron donor for CYP enzymes, was included on the website, which already contains 29 CYP genes, hence POR alleles are now also designated using the star allele (POR*) nomenclature. Although most CYPs on the CYP-allele website are involved in the metabolism of xenobiotics, polymorphic enzymes with endogenous functions are also included. Each gene on the CYP-allele website has its own webpage that lists the different alleles with their nucleotide changes, their functional consequences and links to publications in which the allele has been identified and/or characterised. Thus, the CYP-allele website offers a rapid online publication of new alleles, as well as providing an overview of peer-reviewed data.
Aims and objectives
To conduct an integrative review of the literature to understand how the incorporation of traditional therapies affect First Nations people's utilisation of palliative care ...services.
Background
First Nations peoples face many barriers related to accessing and utilising specialised health services such as palliative care. Whilst culturally appropriate care has been shown to improve these outcomes, there is little evidence regarding how this may be achieved.
Design
Integrative review.
Methods
A systematic search was conducted using electronic databases CINAHL, Joanna Briggs, Medline, Scopus, ScienceDirect InformitHealth and ProQuest between the years of 2005
‐
2021 databases were searched for papers with full text available and published in English. Papers were included if they were primary‐based research and focused on the topics of the use of traditional therapies in a palliative care context by First Nations persons. The Critical Appraisal Skills Programme principles were used to assess the methodological quality of the selected articles.
Results
Seven studies met the inclusion criteria and were included in the review. The review included six qualitative studies and one quantitative study. From these studies, five themes were identified in the literature: supporting a holistic approach, developing culturally appropriate care, conflict within a Western medical model, regulatory issues, and geographical barriers.
Conclusion
There is a dearth of current literature available discussing the utilization of traditional therapies in palliative care. From the literature analysed, the benefits of including traditional therapies are overall positive, however, there are barriers including conflict with the Western model of medicine and regulation. More research is required in the provision of traditional therapies in palliative care.
Relevance to Clinical Practice
The incorporation of traditional medicines within a palliative care setting could help nurses provide holistic and culturally appropriate care, especially in rural and remote areas where they make up the majority of the healthcare force.
Background
Recently, the attempts to promote advance care planning (ACP) and advance directives (ADs) have appeared in mainland China. However, anecdotal evidence suggests that the concept of ACP and ...ADs is not widely known to the public and healthcare professionals.
Aim
To examine and synthesise currently available research about ACP and ADs for older people in mainland China, and to discuss implications for future nursing practice and research.
Design
An integrative literature review.
Methods
A systematic search was conducted in seven English electronic databases (CINAHL, MEDLINE, ProQuest, Cochrane, JBI, Scopus and Wiley) and four Chinese electronic databases (CNKI, Wanfang, VIP and CBM). Eligible articles were critically appraised using the Mixed Methods Appraisal Tool (MMAT).
Findings
From various groups including older people, families and healthcare professionals, low levels of knowledge and awareness about ACP and ADs are reported. Demographic characteristics such as age, gender, education and clinical conditions were related to positive or negative attitude towards ACP. The main reason people cited for being ‘reluctant/fairly reluctant’ to make an AD was that they were ‘Not familiar with it’.
Conclusions
Given that older people showed positive attitudes towards ACP, policy support and practice guidelines about ADs and ACP are necessary to respect their wishes and to guide healthcare professionals in mainland China.
Palm oil, the most widely used vegetable oil, is one of the largest drivers of greenhouse gas (GHG) emissions from global land use and land cover change. Here, we provide fine-resolution ...(100 m × 100 m) estimates of GHG footprints of current (2015) and potential future scenarios (2030) of crude palm oil (CPO) production in Indonesia. The current estimated average GHG footprint excluding production on Java is 5.7 t CO2 eq t−1 CPO; ranging from 0.7 t CO2 eq t−1 CPO in Hulu Sungai Tengah, Kalimantan to 26.0 t CO2 eq t−1 CPO in Pontianak, Kalimantan, and these vast differences are only discernible at fine spatial scales. The future GHG footprint of Indonesian CPO could be reduced by 42% without compromising increased output by limiting expansion to non-forest and non-peat land. Our fine-scale analysis provides a spatial screening approach to inform new oil palm concessions and sourcing decisions, before more cost-intensive patch analysis and carbon stock assessments are conducted.
Display omitted
•CPO GHG footprint varies spatially by a factor of 35 (0.7–26.0 t CO2 eq t−1 CPO).•Avoiding development on peat and forest reduces the GHG footprint in 2030 by 42%.•Expansion on current concessions increases the average GHG footprint by 25%.•35% of Papua's 2030 footprint is from direct C loss from expansion on concessions.•Forest edge effects are projected to account for 19% of GHG emissions in Papua.
Mental Health Nurse Consultants are advanced practice mental health nurses who consult with nurses and other health professionals in a general hospital setting. The aim of this review was to analyse ...and synthesize the available evidence related to the impact of Mental Health Nurse Consultants on the care of general hospital patients experiencing concurrent mental health conditions. The integrative literature review method was utilized as it allows for the inclusion and integration of quantitative, qualitative, and mixed methods research which produces a synthesized understanding of data to inform practice, policy, and research. The Preferred Reporting Items of Systematic Review and Meta‐Analyses guided the search strategy. All published studies examining the impact of clinical consultations provided by Mental Health Nurse Consultants on the mental health care of general hospital patients were included. The 19 selected articles were from North America, Australia, the United Kingdom, and Europe. Fifteen were quantitative, three were qualitative, and one used mixed methods. The findings highlight the role is generally positively received by hospital staff. The results indicate that clinical consultations provided by Mental Health Nurse Consultants (i) may improve patient experiences of mental health conditions, (ii) influence aspects of care delivery, (iii) are valued by staff, particularly nurses, and (iv) increase staff competence and confidence in the provision of mental health care. The review highlighted significant limitations of the available evidence, the need for contemporary discussion and debate of MHNC theory and practice, and further evaluation of the role to inform future service delivery.
Aim
To examine self‐reported exposure and experiences of negative workplace behaviour and ways of coping of nursing staff before and after educational workshops.
Design
A Quasi‐experimental design.
...Method/Setting/Participants
Data were collected pre‐ /postworkshops using a structured questionnaire. Nurses (N = 230) from 12 units in four regional acute care hospitals were invited to complete a pre‐intervention survey. Educational workshops were then implemented by the organization at two of the hospitals, after which, follow‐up surveys were undertaken.
Results
There were 74 responses in the pre‐intervention and 56 responses in the postintervention time period. There were 111 participants who attended the educational intervention, 20% (n = 22) completed the follow‐up survey. Participants were more likely exposed to work‐related bullying acts and they used problem‐focused coping strategies and sought social support as a way of coping when exposed to the negative behaviours. Overall, there was a decrease in both bullying and incivility experienced by participants; however, our findings were unable to establish that a statistically significant difference was made due to the implementation of the intervention.
Study Registration
Australian New Zealand Clinical Trials Registry (Registration No. ACTRN12618002007213; December 14, 2018).
Carbon stock estimates based on land cover type are critical for informing climate change assessment and landscape management, but field and theoretical evidence indicates that forest fragmentation ...reduces the amount of carbon stored at forest edges. Here, using remotely sensed pantropical biomass and land cover data sets, we estimate that biomass within the first 500 m of the forest edge is on average 25% lower than in forest interiors and that reductions of 10% extend to 1.5 km from the forest edge. These findings suggest that IPCC Tier 1 methods overestimate carbon stocks in tropical forests by nearly 10%. Proper accounting for degradation at forest edges will inform better landscape and forest management and policies, as well as the assessment of carbon stocks at landscape and national levels.
PDF
