A discursive study exploring the professional identities of registered nurses employed in older person residential care settings.

BACKGROUND: The phenomenon of an ageing population is being experienced globally requiring the ongoing provision of residential care services. A large number of registered nurses work in these settings; however, many challenges exist in their recruitment and retention. OBJECTIVES: To explore professional identities and emerging discourses of registered nurses working in older person residential care settings. METHODS: This study employed a discursive-based research methodology with a central focus on the role language, and discourses play in identity construction. Fourteen in-depth narrative interviews were completed with registered nurses in residential care settings in the Republic of Ireland. Thematic analysis was underpinned by a critical discursive psychology framework. RESULTS: Four key identities and related discourses emerged: 'skilled professional identity', 'person-centred identity', 'subordinate identity' and 'product of healthcare reform identity'. Discourses presented contrasting professional identities held by nurses in residential care settings; on the one hand, they employed positive professional and person-centred discourses, while on the other hand, tensions associated with healthcare reform and a subordinate identity exist. CONCLUSIONS: This study presents unique insights into how registered nurses in residential care construct their professional identity and in doing so, enhances opportunities to promote recruitment and marketing in this setting. Equally, the challenges and opportunities of healthcare reform require sensitive management so that the professional identity of nurses working in residential care is enhanced and protected. IMPLICATIONS FOR PRACTICE: How registered nurses working in residential care settings view their professional identity directly impacts on attitudes and behaviours and the subsequent delivery of care. Greater understanding and insight into how they construct their professional identity may enhance recruitment and retention initiatives. Study results also provide an opportunity for policymakers and service providers to create more positive working environments that promote professional identity development for this nursing group.

Redox-Dependent HMGB1 Isoforms as Pivotal Co-Ordinators of Drug-Induced Liver Injury: Mechanistic Biomarkers and Therapeutic Targets.

SIGNIFICANCE: High-mobility group box 1 (HMGB1) is a critical protein in the coordination of the inflammatory response in drug-induced liver injury (DILI). HMGB1 is released from necrotic hepatocytes and activated immune cells. The extracellular function of HMGB1 is dependent upon redox modification of cysteine residues that control chemoattractant and cytokine-inducing properties. Existing biomarkers of DILI such as alanine aminotransferase (ALT) have limitations such as lack of sensitivity and tissue specificity that can adversely affect clinical intervention. RECENT ADVANCES: HMGB1 isoforms have been shown to be more sensitive biomarkers than ALT for predicting DILI development and the requirement for liver transplant following acetaminophen (APAP) overdose. Hepatocyte-specific conditional knockout of HMGB1 has demonstrated the pivotal role of HMGB1 in DILI and liver disease. Tandem mass spectrometry (MS/MS) enables the characterization and quantification of different mechanism-dependent post-translationally modified isoforms of HMGB1. CRITICAL ISSUES: HMGB1 shows great promise as a biomarker of DILI. However, current diagnostic assays are either too time-consuming to be clinically applicable (MS/MS) or are unable to distinguish between different redox and acetyl isoforms of HMGB1 (ELISA). Additionally, HMGB1 is not liver specific, so while it outperforms ALT (also not liver specific) as a biomarker for the prediction of DILI development, it should be used in a biomarker panel along with liver-specific markers such as miR-122. FUTURE DIRECTIONS: A point-of-care test for HMGB1 and the development of redox and acetyl isoform-targeting antibodies will advance clinical utility. Work is ongoing to validate baseline levels of circulating HMGB1 in healthy volunteers.