Staying with nursing: the impact of conflictual communication, stress and organizational problem-solving.

AIM: To predict nurses' intent to stay on the job as a function of organizational culture. BACKGROUND: Organizational climate significantly contributes to retention of nurses. Communication by conflict and organizational control over problem-solving has not thoroughly been studied. METHODS: A cross-sectional design was used with a randomly selected final sample of 367 nurses from regional hospitals in Hungary. Organizational climate, perceived stress, locus of control and self-esteem were assessed as main measures. Nurses indicated their intent to stay for the next 5 years. Spearman correlation coefficients were calculated to evaluate associations. Bivariate logistic regression was performed to predict intent to stay in nursing. FINDINGS: Organizational climate was negatively correlated with perceived stress and personal locus of control and positively with personal self-esteem. Organizational level internal locus of control (belief that employees have control over problem-solving) doubled the probability of staying on the job. Conflictual communication and perceived stress both decreased intent to stay by 50%. DISCUSSION AND CONCLUSIONS: Organizational internal locus of control, stress and conflictual communication were main predictors of intent to stay. The belief that nurses had collective control over problem-solving capabilities had a positive and greater impact on nurse retention compared to other measures. IMPLICATION FOR NURSING POLICY: Healthcare organizations should routinely scan workplace culture for conflictual communication, stress and organizational problem-solving capacities. Graduate nurse and nurse manager training should include practices that enable developing positive work atmospheres. Hospital managements should allocate training budget to stimulate and achieve cultural change. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers should promote internal trainings to help staff nurses adopt techniques that minimize conflict and emphasize positive impact of collaborative problem-solving.

Health services and the treatment of immigrants: data on service use, interpreting services and immigrant staff members in services across Europe.

BACKGROUND: The number of immigrants using health services has increased across Europe. For assessing and improving the quality of care provided for immigrants, information is required on how many immigrants use services, what interpreting services are provided and whether staff members are from immigrant groups. METHODS: Structured interviews were conducted with 15 health services (9 primary care, 3 emergency departments, 3 mental health) located in areas with high immigrant populations in each of 16 European countries (n=240). Responses were collected on the availability of data on service use by immigrant patients, the provision of interpreting services and immigrant staff members. RESULTS: Data on service use by immigrants were recorded by only 15% of services. More than 40% of services did not provide any form of interpreting service and 54% of the services reported having no immigrant staff. Mental health services were more likely to use direct interpreting services, and both mental health and emergency services were more likely to have immigrant staff members. DISCUSSION: For assessing and improving the quality of care provided for immigrants, there is a need to improve the availability of data on service use by immigrants in health services throughout Europe and to provide more consistent access to interpreting services.

Factor XIII of blood coagulation as a nuclear crosslinking enzyme.

Intracellular localization and distribution of Factor XIII subunit A (FXIIIA) was investigated in association with monocyte-macrophage differentiation in a long term culture of human monocytes by light- and electron microscopical as well as biochemical and immunobiochemical techniques. To allow the detection of FXIIIA in cells with well-preserved ultrustructure, immunosera against glutaraldehyde-derivatized recombinant FXIIIA were developed in rabbits, then characterized and used in this study. In the early phase of macrophage differentiation intranuclear accumulation of FXIIIA was detected as a transient phenomenon in cells of the 2nd day culture by optical sectioning with 0,7 microm steps in laser scanning confocal microscopy and immunoblotting technique. FXIIIA could be detected by immunoelectron microscopic postembedding staining over electrodense DNA-containing areas. Fluoresceinated monodansylcadaverine incorporation assay was used to demonstrate that FXIIIA is not only present in the nuclei, but also expresses its transglutaminase activity. Our finding of the nuclear accumulation of FXIIIA in differentiating human macrophages is also unique in that a blood clotting factor has, for the first time, been localized in nuclei and has been shown to be an intracellular crosslinking enzyme. The possible role of nuclear FXIIIA in association with cellular processes involving chromatin structure remodeling, such as cell death, cell differentiation or cellular proliferation requires further in-depth investigation.

Effect of tumor-conditioned medium on intercellular communication and proliferation of Balb/c 3T3 cells.

The possible role of tumor cell-derived factors in the regulation of gap junctional intercellular communication and proliferation of fibroblasts was studied in a model system of Balb/c 3T3 cells growing in tumor conditioned medium by Lucifer Yellow CH dye-transfer and BrdU incorporation assays. Six to 24 h incubation of Balb/c 3T3 cells in a medium conditioned by WiDr adenocarcinoma cells enhanced the gap junctional communication between the cells by 25-40% as revealed by intercellular transfer of a fluorescent dye Lucifer Yellow CH. Simultaneously the cell proliferation rates were examined and found to be reduced by 23% at 24 h treatment. Since adenocarcinoma cells are known to secrete different growth factor-like polypeptides into their conditioned medium, we suppose that tumors that produce these molecules might alter their host environment through the enhancement of cell-cell communication thereby facilitating the exchange of modulatory factors.

Single-cell measurement of superoxide anion and hydrogen peroxide production by human neutrophils with digital imaging fluorescence microscopy.

Besides flow cytometry, fluorescence microscopy combined with computerized image analysis offers an alternative tool for assessing phagocyte oxidant generation at the single-cell level. This technique provides an opportunity for the direct visualization of cells and simultaneous measurement of cellular fluorescence intensity. Thus, we developed a simple method for the quantitative evaluation of intracellular superoxide anion and hydrogen peroxide production with image cytometry by using hydroethidine and dihydrorhodamine 123 dyes, respectively. Human neutrophils stimulated with phorbol dibutyrate and labeled by these fluorogenic substrates showed intense, well recognizable red or green fluorescence. The intensity of signals from individual granulocytes of cytospin preparations were quantitatively measured in digitized images. There was a great heterogeneity in response to the stimulus within the granulocyte population as shown by the integrated fluorescence intensity values. In agreement with the results of parallel flow cytometric experiments, this simple image analysis performed on cells of cytospin preparations was able to detect the defects in the oxidative metabolism of neutrophils from patients with cervix carcinoma. We demonstrated that even minor alterations in superoxide anion/hydrogen peroxide generation can be detected by image cytometry as efficiently as by flow cytometry. This result validates imaging microscopy as an alternative to flow cytometry in such experiments. In addition, the image cytometric technique allows the observation of the kinetics of free radical production in individual cell under adherent conditions. Therefore, we carried out image analysis of the oxidative burst of neutrophils adherent to uncoated glass and fibronectin- and type IV collagen-coated surfaces in response to stimulation with phorbol dibutyrate or N-formyl-methionyl-leucyl-phenylalanine. We elaborated a calibration technique for the quantitative measurement of the ethidium bromide generation mediated by superoxide anion within individual adherent granulocytes. The ethidium bromide production varied between 0.48 and 1.17 amol/cell/min.

Deep wound infection after transpedicular fixation of traumatised thoraco-lumbar spine. Case report of 5 patients.

The authors report 5 deep infections after posterior stabilisation of 96 fractured thoraco-lumbar spine. A transpedicular plate fixation device was used, which was constructed by them. They analyse the reasons of infections and the management of developed wound complications. If the irrigation was ineffective, they left the wound open after debridement and filled up the cavity with Gentamicin PMMA chain. With this management the infections were eliminated withouth neurologic deterioration, but due to infection with considerable loss of spine function.

Arthrodesis of the septic ankle joint.

In chronic septic complications of the ankle joint bony fusion can be achieved with radical resection of necrotic tissues, special positioning of the foot and extrafocal stabilisation. For non-cooperative patients with bland infections intramedullary stabilisation can be used after which early full weight bearing is possible. The correct technique of operation together with adjuvant therapy with a Septopal chain increases the healing chances of patients and reduces the time and costs of therapy.

Prevention of recurrent infection after removal of intramedullary metal of the infected femur and tibia.

Prevention of recurrence after consolidation of infected femur and tibia fractures and nonunions is based on two principles. First necrotic bone is eliminated with reaming and rinsing the intramedullary canal after metal removal. As missing inramedullary tissue granulates gradually, prevention of retention cavities is achieved by a drainage tube that is gradually removed in the direction of gravity. In chronic cases the method is combined with application of a Septopal chain. Since 1978 this method has been used in 39 cases of which 32 have been succesful.

Late results of fractures and pseudoarthroses of the leg after tibiofibular synostosis.

The authors present the late results of 10 male patients with open leg fractures and nonunions treated between 1978 and 1985 with tibiofibular synostosis. This was achieved by autologous cancellous bone grafting. The average time of the follow-up study was 11 years at which time all patients were free of fistulas, fully weight-bearing and able to work. In their subjective opinion these advantages compensated for reduced ankle motion and tolerable periodic pain.

[Claw plates--new implants for para-articular osteosynthesis]. / Krallenplatten--die neuen Implantate für gelenknahe Osteosynthesen.

The claw plate types used by us are manufactured according to the same principle. These plates are mostly applied in the treatment of multiple fragment fractures and in the fixation of osteotomies. A strong fixation of the plate, also to little fragments close to the joint, is achieved by the claws and one screw. The plates may be used for neutralization or as a support, distance piece, or compression plate. The shape of the variable plate as well as the claws can be formed. The masses of the maximum and minimum plate are adapted to the different sizes of bones. No special instrument is needed to insert the claw plate, and the region around the joint can be laid open in a sparing manner. Regarding the experience accumulated during ten years and the good results obtained, we are of the opinion that claw plates can be used successfully to complete the methods applied hitherto in the treatment of joint-near fractures of all long bones except the femur.

[The role of the fibula in the stability of the lower leg]. / Die Rolle der Fibula in der Statik des Unterschenkels.

The authors wanted to study on 24 prepared lower leg sceleton the biomechanical role of the fibula in a "total load" position. The supporting capacity of the fibula makes nearly 1/3 of the total, therefore the surgical reconstruction of the fibula can be useful in the treatment of fractures of the lower leg.

[A new way of producing autogenous cancellous bone graft (author's transl)]. / Uj típusú autológ spongiosa elöállítása dezantigenizált heterológ spongiosából.

Transplantation of autogenous cancellous bone graft is used with an increasing frequency in the operative treatment of fractures or in reconstructive procedures for stimulating bone healing, replacing traumatic or other defects, treating non-unions, especially in septic conditions. The amount of autogenous cancellous bone available for transplantation often is below the requirements in certain cases, e.g. in large bone defects or when repeated transplantations have to be done. To cover these needs, the author filled the donor site in the iliac crest with large amount of "specially treated" (disantigenized) calf cancellous bone. 10 weeks later a known quantity of fibrous reticular tissue with osteo-inductive capacity filled the framework of the implanted graft, which could be transplanted as autogenous cancellous bone. The procedure can be repeated according to further requirements.