ABSTRACT
The use of "Caring Cards" is a unique innovation, which builds on reliable Lean processes. It adds the way we emotionally care for people to a Lean methodology. This article describes how the foundational constructs of nursing theory are paired with aspects of universal fall precautions. In a pilot prioritizing Caring Cards, conversations between leaders and staff provide a way for the nurse to describe his or her critical thinking about fall prevention that is individualized to a patient. Leaders collect information on barriers to care and demonstrate follow-up actions to staff members who raise concerns. The system allows for structured leader and staff interactions that are coaching and mentoring in nature. These support an environment where nurses care for patients, while leaders also care for staff. By partnering Lean methodology with the heart of nursing, patient care can be improved. The pilot project utilizing this methodology was performed on a neurological unit. It resulted in a dramatic reduction in falls. The unassisted patient fall rate per 1000 patient-days dropped from 11.60 to 5.81 falls, a 50% reduction.
Subject(s)
Accidental Falls/prevention & control , Guideline Adherence/standards , Patient-Centered Care/methods , Quality Improvement/trends , Humans , Nurse-Patient Relations , Organizational Culture , Patient Safety/standards , Precision Medicine/methods , Precision Medicine/psychologyABSTRACT
Oocytes of Crassostrea gigas and Mytilus galloprovincialis are arrested in metaphase I when they are spawned and ready to be fertilized. To investigate the role of MAP kinase in maintaining metaphase I arrest, oocytes were exposed to the MEK inhibitor U0126, and the effects on chromosome behavior and MAPK activity were examined by bisbenzimide staining and in immunoblots with anti-phospho MAPK antibodies. Following treatment with 50 microM U0126, active MAPK was undetectable and oocytes resumed meiosis, forming enlarged polar bodies and undergoing chromosome decondensation. Prophase stage oyster oocytes maturing spontaneously in seawater completed germinal vesicle breakdown in the presence of U0126, but failed to arrest in metaphase I, and also formed polar bodies and underwent chromosome decondensation. Treatment of oyster oocytes with the protein synthesis inhibitor, emetine (500 microM), also caused them to resume meiosis, although substantial MAPK activity remained. Levels of phospho-MEK also decreased during emetine treatment. 35 S-methionine incorporation in emetine treated oocytes was reduced to only 5% of control values. These data show that, while active MAPK is necessary to maintain metaphase I arrest, other proteins are also required.
Subject(s)
Bivalvia/physiology , Mitogen-Activated Protein Kinase Kinases/metabolism , Mitogen-Activated Protein Kinases/metabolism , Oocytes/physiology , Ostreidae/physiology , Animals , Bivalvia/cytology , Bivalvia/genetics , Blotting, Western/methods , Butadienes/pharmacology , Electrophoresis, Polyacrylamide Gel , Emetine/pharmacology , Enzyme Inhibitors/pharmacology , Female , Meiosis/physiology , Metaphase/physiology , Microscopy, Fluorescence , Mitogen-Activated Protein Kinase Kinases/drug effects , Mitogen-Activated Protein Kinases/drug effects , Nitriles/pharmacology , Oocytes/cytology , Oocytes/drug effects , Ostreidae/cytology , Ostreidae/genetics , Prophase/physiology , Protein Synthesis Inhibitors/pharmacology , Serotonin/pharmacologyABSTRACT
In marine invertebrates, as in most other organisms, normal development requires that only one sperm nucleus joins with the egg nucleus at fertilization. The principal mechanisms employed are (1) prevention of sperm-egg plasma membrane fusion and (2) modifications of the egg extracellular coat to prevent sperm binding and/or penetration. In a third strategy, fertilization is polyspermic, but only one sperm nucleus fuses with the egg nucleus. Other factors such as gamete density during spawning, chemotaxis, and localized sites for sperm entry may also affect the numbers of sperm reaching the egg.
