Nurses' perception of how an e-message system influences cross-sectoral communication: A qualitative study.

AIM: To investigate hospital and home care nurses' experiences on how an e-message system influences cross-sectoral communication 2 years after introduction. BACKGROUND: Cross-sectoral communication is identified as the main barrier for high quality in transitional care. An e-message system was introduced to ensure dialogue and precise and useful information exchange. METHODS: Nurses from one hospital and six collaborating municipalities were included. Semi-structured focus group interviews and participation observation was conducted and data were analysed using content analysis. RESULTS: The e-message system was used in both sectors but did not promote cross-sectoral dialogue. The home care nurses expressed distrust in the information from the hospital. The hospital nurses' intention was to provide relevant and accurate information but their main focus was to fulfil the standards within the system rather than the quality of the information exchanged. CONCLUSIONS: The e-message system supports a one-way information flow, rather than the intended loop of information exchange and dialogue. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should recognise that although an e-message system is being used in a clinical setting, it may not support exchange of high-quality information and dialogue. Focus must be on both standards as well as quality when new systems are introduced.

Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework.

AIM: The aim was to identify the factors that were perceived as most important as facilitators or barriers to the introduction and intended use of a new tool in the emergency department among nurses and a geriatric team. BACKGROUND: A high incidence of functional decline after hospitalisation for acute medical illness has been shown in the oldest patients and those who are physically frail. In Denmark, more than 35% of older medical patients acutely admitted to the emergency department are readmitted within 90 days after discharge. A new screening tool for use in the emergency department aiming to identify patients at particularly high risk of functional decline and readmission was developed. DESIGN: Qualitative study based on semistructured interviews with nurses and a geriatric team in the emergency department and semistructured single interviews with their managers. METHODS: The Theoretical Domains Framework guided data collection and analysis. Content analysis was performed whereby new themes and themes already existing within each domain were described. RESULTS: Six predominant domains were identified: (1) professional role and identity; (2) beliefs about consequences; (3) goals; (4) knowledge; (5) optimism and (6) environmental context and resources. The content analysis identified three themes, each containing two subthemes. The themes were professional role and identity, beliefs about consequences and preconditions for a successful implementation. CONCLUSIONS: Two different cultures were identified in the emergency department. These cultures applied to different professional roles and identity, different actions and sense making and identified how barriers and facilitators linked to the new screening tool were perceived. RELEVANCE FOR CLINICAL PRACTICE: The results show that different cultures exist in the same local context and influence the perception of barriers and facilitators differently. These cultures must be identified and addressed when implementation is planned.

Glucose induced MAPK signalling influences NeuroD1-mediated activation and nuclear localization.

The helix-loop-helix transcription factor NeuroD1 (also known as Beta2) is involved in beta-cell survival during development and insulin gene transcription in adults. Here we show NeuroD1 is primarily cytoplasmic at non-stimulating glucose concentrations (i.e. 3 mM) in MIN6 beta-cells and nuclear under stimulating conditions (i.e. 20 mM). Quantification revealed that NeuroD1 was in 40-45% of the nuclei at 3 mM and 80-90% at 20 mM. Treatment with the MEK inhibitor PD98059 or substitution of a serine for an alanine at a potential mitogen-activated protein kinase phosphorylation site (S274) in NeuroD1 significantly increased the cytoplasmic level at 20 mM glucose. The rise in NeuroD1-mediated transcription in response to glucose also correlated with the change in sub-cellular localization, a response attenuated by PD98059. The data strongly suggest that glucose-stimulation of the MEK-ERK signalling pathway influences NeuroD1 activity at least partially through effects on sub-cellular localization.