Asunto(s)
Enfermería de Urgencia/organización & administración , Servicios de Urgencia Psiquiátrica/organización & administración , Defensa del Paciente , Guías de Práctica Clínica como Asunto , Sociedades de Enfermería/organización & administración , Gestión de la Calidad Total/organización & administración , Conducta Cooperativa , Enfermería de Urgencia/educación , Humanos , Política Organizacional , Enfermería Psiquiátrica/educación , Enfermería Psiquiátrica/organización & administración , Administración de la Seguridad , Análisis de Sistemas , Estados UnidosRESUMEN
Self-mutilation or cutting is not uncommon and may be detected in the workplace. It stems from an underlying psychological illness, specifically borderline personality disorder (BPD). Individuals diagnosed with BPD are usually attempting to handle negative childhood experiences and feelings of abandonment. They often overreact to social stress and engage in cutting to alleviate uncomfortable feelings. A small percentage go on to attempt suicide. Dialectical behavior therapy (DBT) is the preferred treatment modality for individuals with BPD. Occupational health nurses are in a pivotal position to identify workers who cut and to refer them to appropriate treatment options. In addition, occupational health nurses can learn to reinforce the social skills learned in DBT.
Asunto(s)
Trastorno de Personalidad Limítrofe/psicología , Trastorno de Personalidad Limítrofe/terapia , Rol de la Enfermera , Enfermería del Trabajo/organización & administración , Conducta Autodestructiva/psicología , Conducta Autodestructiva/terapia , Trastorno de Personalidad Limítrofe/epidemiología , Manejo de Caso , Terapia Cognitivo-Conductual , Medicina Basada en la Evidencia , Necesidades y Demandas de Servicios de Salud , Humanos , Modelos Psicológicos , Psicoterapia , Factores de Riesgo , Conducta Autodestructiva/epidemiología , Resultado del TratamientoRESUMEN
Nursing education in Poland are developing slowly but steadily in response to changing social needs and emerging healthcare issues. In particular, the immediate demand for more nurses is generating innovation in nursing education and encouraging Polish universities to graduate more nurses. Unfortunately, nursing wages remain low in regards to other professions, which only fuels the nursing shortage. Polish nurses are also facing staffing issues. At times, the nurse-patient ratio is 28 to 1. These working conditions also discourage people from pursuing a career in nursing. Finally, male nurses are rare in Poland. The future of nursing in Poland will be dictated by the Polish government and university systems and their efforts to produce more graduate nurses who can thrive and practice in a more complex, evolving world and who receive competitive pay for their expertise.
Asunto(s)
Educación en Enfermería/tendencias , Enfermeras y Enfermeros/provisión & distribución , Condiciones Sociales , Educación en Enfermería/organización & administración , Femenino , Humanos , Masculino , Enfermeras y Enfermeros/economía , Enfermeros , Polonia , Salarios y BeneficiosRESUMEN
We have engineered enhanced DNA-binding function into the a1 homeodomain by making changes in a loop distant from the DNA-binding surface. Comparison of the free and bound a1 structures suggested a mechanism linking van der Waals stacking changes in this loop to the ordering of a final turn in the DNA-binding helix of a1. Inspection of the protein sequence revealed striking differences in amino acid identity at positions 24 and 25 compared to related homeodomain proteins. These positions lie in the loop connecting helix-1 and helix-2, which is involved in heterodimerization with the alpha 2 protein. A series of single and double amino acid substitutions (a1-Q24R, a1-S25Y, a1-S25F and a1-Q24R/S25Y) were engineered, expressed and purified for biochemical and biophysical study. Calorimetric measurements and HSQC NMR spectra confirm that the engineered variants are folded and are equally or more stable than the wild-type a1 homeodomain. NMR analysis of a1-Q24R/S25Y demonstrates that the DNA recognition helix (helix-3) is extended by at least one turn as a result of the changes in the loop connecting helix-1 and helix-2. As shown by EMSA, the engineered variants bind DNA with enhanced affinity (16-fold) in the absence of the alpha 2 cofactor and the variant alpha 2/a1 heterodimers bind cognate DNA with specificity and affinity reflective of the enhanced a1 binding affinity. Importantly, in vivo assays demonstrate that the a1-Q24R/S25Y protein binds with fivefold greater affinity than wild-type a1 and is able to partially suppress defects in repression by alpha 2 mutants. As a result of these studies, we show how subtle differences in residues at a surface distant from the functional site code for a conformational switch that allows the a1 homeodomain to become active in DNA binding in association with its cofactor alpha 2.