Transformative agency and tensions in knowledge management-A qualitative interview study for nurse leaders.

AIM: To describe Finnish nurse leaders' perceptions of and experiences with knowledge management. BACKGROUND: Health science research has traditionally focused on knowledge transfer and research evidence instead of knowledge management, culture and organisational learning. Systematic reviews indicate a lack of awareness about nurse leaders' activities in knowledge management. DESIGN: Qualitative interview study according to the consolidated criteria for reporting qualitative research (see Supporting Information Table S1). METHODS: Data were collected at a Finnish public, social and healthcare organisation from 33 persons in 2015 and 2017 through 35 individual interviews and seven focus groups. Data were analysed by thematic analysis. RESULTS: Nurse leaders' daily knowledge management activities included assurance of smooth work functions and decisions about sudden changes. When managing knowledge promotion, nurse leaders focused on the near future and served information providers, coaches and developers of operating culture. Anticipatory management of knowledge requirements emphasised nurse leaders' roles as assessors and visionaries. Tensions while managing knowledge were related to the following: changes in clients' service needs, insufficient structures and tools to support the assessment and joint development of competence, time and information management, the operating culture, and nurse leader support. Participants reported only few attempts to solve tensions and therefore little to no transformative agency. CONCLUSION: Nurse leaders prioritised daily knowledge management over management of knowledge promotion and anticipatory management of knowledge requirements. Knowledge management in nursing is a complex task requiring a command of different kinds of agency and related leadership styles. The structures, processes and tools supporting knowledge management should be developed to ensure that activities are systematic. RELEVANCE TO CLINICAL PRACTICE: A description of nurse leaders' perceptions of and experiences with knowledge management could improve recognition of nurse leaders' agencies for knowledge management, identification of related tensions and application of lessons learned from tensions. This description could also promote nurses' professional competence and supplement nurse leaders' training.

Nurse leaders' perceptions and experiences of leading evidence: A qualitative enquiry.

AIM: The aim of this study was to describe nurse leaders' perceptions and experiences of leading evidence-based practices (EBP). BACKGROUND: Leaders can promote EBP in nursing with their own personal example and by striving to renew structures, processes and working cultures. However, previous studies have shown that nurse leaders have tended to be passive with regard to EBP. METHODS: An interview study using general qualitative methods. In total, 33 individual interviews and seven focus groups of leaders were conducted in 2015 and 2017. Data were analysed thematically. RESULTS: The respondents were unfamiliar with EBP as activities that lead to effective patient care. EBP were described as indistinguishable from other practices, lost and random. Overall, they lacked competence with EBP. The activities of nurse leaders do indicate a tentative commitment to EBP, but their main goals seem to be maintaining the status quo. CONCLUSION: Unfamiliarity with EBP reflects adversely on the operations of an entire organisation. The nurse leaders have an opportunity to enhance their understanding with EBP, which will lead to the renewal and improvement of the operating culture and the quality of strategic leadership. IMPLICATIONS FOR NURSING MANAGEMENT: Leaders should take clear responsibility for EBP on the strategic, operational and educational level.

A systematic review of factors influencing knowledge management and the nurse leaders' role.

AIM: To describe factors facilitating or inhibiting the development of registered nurses' competency and nurse leader's role in knowledge management. BACKGROUND: Nurses' competency directly influences patient safety and the quality and effectiveness of patient care. Challenges of nurse leaders in knowledge management include acquiring, assessing and utilising current knowledge and assessing and enhancing competency. EVALUATION: A systematic search was conducted in PubMed, CINAHL, SCOPUS and ERIC databases in April 2015. The search identified 18 relevant research articles published between 2009 and 2015. The quality of the studies was appraised in accordance with study designs. KEY ISSUE: Knowledge management is facilitated by an organisation culture that supports learning, sharing of information and learning together. Leader commitment and competency were factors related to leadership facilitating knowledge management. CONCLUSION: Nurse leaders need evidence-based interventions to support shared learning and to create infrastructures that facilitate competence development. Future research is especially needed to evaluate connections between knowledge management and patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP: The results of this review can be utilised in enhancing factors to facilitate knowledge management in clinical practice and identifying nurse leaders' role in strengthening nurses' competency.

Casein retention in curd and loss of casein into whey at chymosin-induced coagulation of milk.

Impact of milk protein composition on casein (CN) retention in curd during the milk coagulation process was studied using a model cheese making system. Individual milk samples from 110 cows in mid lactation of the Swedish Red and Swedish Holstein breeds with known genotypes of beta-casein, kappa-casein and beta-lactoglobulin were defatted, coagulated with chymosin, subjected to syneresis and subsequent pressing simulated by centrifugation. The results indicated that kappa-casein concentration of milk plays an important role in the curd formation process and initial syneresis (whey after cutting), whereas an increased CN ratio was associated with less casein in whey after simulated pressing. Increased kappa-casein concentration of milk also characterized the milk samples with no measurable loss of casein in whey, compared with milk samples with casein lost in whey, both after cutting and after simulated pressing. Concentrations of alphas1-casein, beta-casein, and total casein in milk were positively associated with fresh curd yield, which showed a strong correlation with amount of casein retained in curd. No effect of protein genotype on fresh curd yield or casein in whey was found. The beta-lactoglobulin BB genotype was associated with increased casein retention in curd, most likely due to the association of this genotype with CN ratio.

Relative impact of alpha-tocopherol, copper and fatty acid composition on the occurrence of oxidized milk flavour.

The oxidative process in milk fat, resulting in spontaneous oxidized off-flavour (SOF), is commonly assumed to depend on contents of pro- and antioxidants in milk and availability of fatty acids acting as their substrate. An important antioxidant in milk is alpha-tocopherol whereas the most potent prooxidant is the metal ion copper. The separate effects of alpha-tocopherol, copper, and milk fatty acid profile, and their combined effect on SOF development were examined in milk from 44 multiparous cows fed different roughage types and different amounts of dietary, unsaturated fat. A clear association between concentrations of copper and poly-unsaturated fatty acids in milk and the risk for developing SOF was found. Heritability estimates suggest that occurrence of SOF is partly under genetic control which indicates that milk quality may be compromised if breeding bulls are selected that carry genotypes predisposing for milk prone to develop SOF.

Composition of poorly and non-coagulating bovine milk and effect of calcium addition.

Ninety-nine individual milk samples from 37 cows in lactation week 10-35, selected for producing well or poorly/non-coagulating milk, were compared regarding protein composition, total calcium content, casein micelle size, pH, and coagulating properties after addition of 0·05% CaCl2. The results showed that a low κ-casein concentration in milk was a risk factor for non-coagulation. CaCl2 addition improved coagulating properties (coagulation time, curd firmness) of nearly all samples and eliminated differences between poorly/non-coagulating and well-coagulating milk, particularly regarding curd firmness. A second, independent data set with 18 non-coagulating or well-coagulating milk samples were analysed for protein composition, where indications of a similar association with κ-casein was observed.

Association of polymorphisms at DGAT1, leptin, SCD1, CAPN1 and CAST genes with color, marbling and water holding capacity in meat from beef cattle populations in Sweden.

The objective of this study was to investigate the associations of single nucleotide polymorphisms (SNPs) at five candidate genes with meat pH, color, marbling and water holding capacity (WHC) in young bulls from five beef breeds (n=243) in Sweden. The UASMS2 polymorphism at the leptin gene and the SNPs at the Stearoyl-CoA desaturase 1 gene (SCD1.878) and µ-calpain gene (CAPN1:c.947) were associated with variation in meat color traits after 6days of exposure to air. The K232A polymorphism at the diacylglycerol O-acyltransferase 1 (DGAT1) gene and the CAPN1:c.947 SNP were associated with level of beef marbling. There was no association between the SNP at the calpastatin gene (CAST:c.155) and meat quality traits, nor was there any association of the tested SNPs with WHC traits and pH value.

A nonsense mutation in the FMO3 gene underlies fishy off-flavor in cow's milk.

Fish-odor syndrome or Trimethylaminuria (OMIM #602079) in humans is an inborn error of metabolism associated with a characteristic fishy body odor due to elevated levels of trimethylamine (TMA) in body fluids. It is caused by loss-of-function mutations in FMO3 encoding flavin-containing mono-oxygenase 3. A fishy off-flavor is occasionally observed in cow's milk and it has been established recently that this phenotype is due to elevated TMA levels. Here, we report that fishy off-flavor in cow's milk is caused by a nonsense mutation (R238X) in the bovine FMO3 ortholog. RT-PCR analysis indicated that the mutant transcript is present in a very low amount. The mutation was found to be surprisingly common (q = 0.155) in one breed of cattle.

High trimethylamine concentration in milk from cows on standard diets is expressed as fishy off-flavour.

To establish whether fishy off-flavour observed in cows' milk in Sweden is due to abnormal concentrations of trimethylamine (TMA) in milk, 15 milk samples from 13 cows of the Swedish Red and White breed (SRB) were analysed for this compound using dynamic headspace (DHS) gas chromatography (GC). A mass selective detector (MSD) was used for the qualitative and a flame ionization detector (FID) for the quantitative analyses. Further confirmation was obtained using a solid phase microextraction (SPME) followed by GC-olfactometry (GC-O) and GC-NPD (nitrogen and phosphorus detector). Samples were also evaluated by a two-person organoleptic panel for the presence of fishy off-flavour. Results showed that the seven milk samples with a fish-like taint contained > 1 mg TMA/kg milk, whereas, with a single exception, the seven samples that were judged to be normal did not contain this compound. Furthermore, there were indications of a dose-dependent relationship between TMA concentration and fishy off-flavour score.