ABSTRACT
Every year increasing numbers of nurses and midwives leave the NHS. In the current climate of staff shortages it is crucial to understand why this is happening and try to resolve the problem; in Birmingham we have taken steps to do this. This article explores the different workforce generations, along with strategies that could enhance nursing and midwifery careers, ensuring they meet the needs of all generations, thereby encouraging practitioners to stay in their profession for longer.
Subject(s)
Nurses , Personnel Selection , Personnel Turnover , Retirement , State Medicine , Cohort Effect , Health Services Needs and Demand , Humans , Personnel Management , United KingdomABSTRACT
This paper describes the process of conducting critical case reviews as part of a leadership programme for critical care. Forty-five cases were reviewed over 2 years in five different hospitals and permission was sought from local research ethics committees and research and development committees for the discussions to be treated as research data. Typically the cases presented were patients with complex needs whose trajectory of care had not gone smoothly. Key themes to emerge from the case reviews were: The case reviews themselves were: Communication failures between professional groups, between professional themselves, between staff and families, between wards and departments and between different hospitals. Documentation was also often less than satisfactory. Teams often had problems in working together as a team and different professionals often had different expectations of other members of the team. Individual action may compensate for weaknesses in formal clinical risk system. The case reviews themselves were showcases of the difficulties the health service faces every day and the challenges of communicating effectively. The case reviews provided an effective medium to both resolve those difficulties and model a means through which teams could effectively manage and communicate patient care issues. Furthermore their strength as a learning tool was attributed to team learning as a powerful catalyst for change.
Subject(s)
Critical Care/organization & administration , Nursing Audit/organization & administration , Quality Assurance, Health Care/organization & administration , Attitude of Health Personnel , Communication , Cooperative Behavior , Documentation , Humans , Interprofessional Relations , Leadership , Needs Assessment , Nursing Evaluation Research , Nursing Records , Nursing Staff, Hospital/education , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Organizational Innovation , Outcome and Process Assessment, Health Care/organization & administration , Systems AnalysisABSTRACT
The C-terminal binding protein (CtBP) family includes four proteins (CtBP1 [CtBP1-L], CtBP3/BARS [CtBP1-S], CtBP2, and RIBEYE) which are implicated both in transcriptional repression and in intracellular trafficking. However, the precise mechanisms by which different CtBP proteins are targeted to different subcellular regions remains unknown. Here, we report that the nuclear import of the various CtBP proteins and splice isoforms is differentially regulated. We show that CtBP2 contains a unique nuclear localization signal (NLS) located within its N-terminal region, which contributes to its nuclear accumulation. Using heterokaryon assays, we show that CtBP2 is capable of shuttling between the nucleus and cytoplasm of the cell. Moreover, CtBP2 can heterodimerize with CtBP1-L and CtBP1-S and direct them to the nucleus. This effect strongly depends on the CtBP2 NLS. PXDLS motif-containing transcription factors, such as BKLF, that bind CtBP proteins can also direct them to the nucleus. We also report the identification of a splice isoform of CtBP2, CtBP2-S, that lacks the N-terminal NLS and localizes to the cytoplasm. Finally, we show that mutation of the CtBP NADH binding site impairs the ability of the proteins to dimerize and to associate with BKLF. This reduces the nuclear accumulation of CtBP1. Our results suggest a model in which the nuclear localization of CtBP proteins is influenced by the CtBP2 NLS, by binding to PXDLS motif partner proteins, and through the effect of NADH on CtBP dimerization.
Subject(s)
Carrier Proteins/metabolism , Cell Nucleus/metabolism , DNA-Binding Proteins/metabolism , Nuclear Localization Signals/metabolism , Phosphoproteins/metabolism , Transcription Factors/metabolism , Alcohol Oxidoreductases , Amino Acid Sequence , Animals , Bacterial Proteins/analysis , Bacterial Proteins/genetics , Carrier Proteins/analysis , Carrier Proteins/genetics , Cell Nucleus/chemistry , Cells, Cultured , DNA-Binding Proteins/analysis , DNA-Binding Proteins/genetics , Humans , Luminescent Proteins/analysis , Luminescent Proteins/genetics , Mice , Molecular Sequence Data , Nuclear Localization Signals/analysis , Nuclear Localization Signals/genetics , Phosphoproteins/analysis , Phosphoproteins/genetics , Sequence Deletion , Transcription Factors/analysis , Transcription Factors/geneticsABSTRACT
This paper describes the genesis, design and implementation of a leadership programme for critical care. This was an initiative funded by the National Health Service (NHS) Nursing Leadership Project and had at the core of its design flexibility to meet the needs of the individual hospitals, which took part in it. Participation was from the multi-disciplinary critical care team. Six NHS hospitals took part in the programme which was of 20 days duration and took place on hospital sites. The programme used the leadership model of as its template and had a number of distinct components; a baseline assessment, personal development, principles of leadership and critical case reviews. The programme was underpinned by three themes; working effectively in multi-professional teams to provide patient focussed care, managing change through effective leadership and developing the virtual critical care service. Each group set objectives pertinent to their own organisation's needs. The programme was evaluated by a self-reporting questionnaire; group feedback and feedback from stakeholders. Programme evaluation was positive from all the hospitals but it was clear that the impact of the programme varied considerably between the groups who took part. It was noted that there was some correlation between the success of the programme and organisational 'buy in' as well as the organisational culture within which the participants operated. A key feature of the programme success was the critical case reviews, which were considered to be a powerful learning tool and medium for group learning and change management.
Subject(s)
Critical Care , Education, Nursing, Continuing/organization & administration , Leadership , Nurse Administrators/education , Staff Development/organization & administration , Attitude of Health Personnel , Career Mobility , Curriculum , Focus Groups , Health Services Needs and Demand , Humans , Inservice Training/organization & administration , Nurse Administrators/organization & administration , Nurse Administrators/psychology , Nurse's Role , Nursing Education Research , Nursing Methodology Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/organization & administration , Nursing Staff, Hospital/psychology , Organizational Culture , Organizational Innovation , Patient Care Team/organization & administration , Program Development , Program Evaluation , Surveys and QuestionnairesABSTRACT
A previous paper described the development of a leadership programme for critical care and highlighted that one of the strengths of the programme was the critical case review. This paper sets out in some depth the major theoretical influences in the construction of the case review. Case reviews have been used in education for some time but often have predetermined outcomes. The education approach favoured here was based on action learning, which in itself belongs to the broad church of reflective practice. While reflective practice has been advocated in nursing since 1986 together with the introduction of clinical supervision neither have met with unqualified success in their own right. This paper concludes that while the concept and construction of the critical case review may be new it is in essence no more than a jigsaw of already well-established practices of reflection, clinical supervision and action learning woven into the foundations of clinical risk management and whole systems working.
Subject(s)
Critical Care/organization & administration , Education, Nursing, Continuing/methods , Leadership , Nurse Administrators/education , Nursing Records , Problem-Based Learning/methods , Humans , Models, Educational , Narration , Nursing Audit/organization & administration , Nursing Process , Nursing, Supervisory , Organizational Case Studies/methods , Patient-Centered Care , Program Development , Risk Management , Systems Analysis , ThinkingABSTRACT
The Sp/KLF transcription factors perform a variety of biological functions, but are related in that they bind GC-box and CACCC-box sequences in DNA via a highly conserved DNA-binding domain. A database homology search, using the zinc finger DNA-binding domain characteristic of the family, has identified human KLF17 as a new family member that is most closely related to KLFs 1-8 and 12. KLF17 appears to be the human orthologue of the previously reported mouse gene, zinc finger protein 393 (Zfp393), although it has diverged significantly. The DNA-binding domain is the most conserved region, suggesting that both the murine and the human forms recognize the same binding sites in DNA and may retain similar functions. We show that human KLF17 can bind G/C-rich sites via its zinc fingers and is able to activate transcription from CACCC-box elements. This is the first report of the DNA-binding characteristics and transactivation activity of human KLF17, which, together with the homology it displays to other KLF proteins, put it in the Sp/KLF family.
Subject(s)
Kruppel-Like Transcription Factors/genetics , Kruppel-Like Transcription Factors/metabolism , Sp1 Transcription Factor/genetics , Sp1 Transcription Factor/metabolism , Amino Acid Sequence , Animals , Binding Sites , COS Cells , Cell Line , Chlorocebus aethiops , Cloning, Molecular , Computational Biology , Conserved Sequence , Databases, Factual , Electrophoretic Mobility Shift Assay , Expressed Sequence Tags , Gene Expression , Humans , Insecta/cytology , Molecular Sequence Data , Phylogeny , Polymerase Chain Reaction , Protein Binding , Protein Structure, Tertiary , Sequence Homology, Amino Acid , Transcription Factors/chemistry , Transcription Factors/genetics , Transcription Factors/metabolism , Zinc/chemistry , Zinc Fingers/geneticsABSTRACT
GATA-1 and friend of GATA (FOG) are zinc-finger transcription factors that physically interact to play essential roles in erythroid and megakaryocytic development. Several naturally occurring mutations in the GATA-1 gene that alter the FOG-binding domain have been reported. The mutations are associated with familial anemias and thrombocytopenias of differing severity. To elucidate the molecular basis for the GATA-1/FOG interaction, we have determined the three-dimensional structure of a complex comprising the interaction domains of these proteins. The structure reveals how zinc fingers can act as protein recognition motifs. Details of the architecture of the contact domains and their physical properties provide a molecular explanation for how the GATA-1 mutations contribute to distinct but related genetic diseases.
Subject(s)
Carrier Proteins/chemistry , DNA-Binding Proteins/chemistry , Nuclear Proteins/chemistry , Transcription Factors/chemistry , Zinc Fingers , Binding Sites , Carrier Proteins/metabolism , DNA-Binding Proteins/genetics , DNA-Binding Proteins/metabolism , Erythroid-Specific DNA-Binding Factors , GATA1 Transcription Factor , Hematologic Diseases/drug therapy , Hematologic Diseases/genetics , Humans , Models, Molecular , Molecular Structure , Mutation/physiology , Nuclear Proteins/metabolism , Protein Binding/genetics , Protein Conformation , Transcription Factors/genetics , Transcription Factors/metabolismABSTRACT
Two functionally distinct classes of coactivators are recruited by liganded estrogen receptor, the DRIP/Mediator complex and p160 proteins, although the relative dynamics of recruitment is unclear. Previously, we have shown a direct, estradiol-dependent interaction between the DRIP205 subunit of the DRIP complex and the estrogen receptor (ER) AF2 domain. Here we demonstrate the in vivo recruitment of other endogenous DRIP subunits to ER in response to estradiol treatment in MCF-7 cells. To explore the relationship between DRIP and p160 coactivators, we examined the kinetics of coactivator recruitment to the ER target promoter, pS2, by chromatin immunoprecipitation. We observed a cyclic association and dissociation of coactivators with the promoter, with recruitment of p160s and DRIPs occurring in opposite phases, suggesting an exchange between these coactivator complexes at the target promoter.
