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Zn2Al/-layered double hydroxide (LDH) with intercalated MoO4(2-) was investigated as a potential source of soluble molybdate inhibitor in anticorrosion coatings for hot dip galvanized steel (HDG). The effect of solution pH, soluble chlorides, and carbonates on the release kinetics of the interleaved MoO4(2-) ions from the LDH powder immersed in solutions containing different anions was studied by X-ray diffraction, in situ attenuated total reflectance infrared (ATR-IR) spectroscopy, and inductively coupled plasma atomic emission spectroscopy (ICP-AES). The effect of the solution composition on the total release and the release kinetics was demonstrated. Less than 30% of the total amount of the intercalated MoO4(2-) was released after 24 h of the immersion in neutral 0.005-0.5 M NaCl and 0.1 M NaNO3 solutions whereas the complete release of MoO4(2-) was observed after 1 h in 0.1 M NaHCO3 or Na2SO4 and in alkaline solutions. The in situ ATR-IR experiments and quantification of the released soluble species by ICP-AES demonstrated the release by an anion exchange in neutral solutions and by the dissolution of Zn2Al/-LDH in alkaline solutions. The anion exchange kinetics with monovalent anions was described by the reaction order n = 0.35 ± 0.05 suggesting the diffusion control; for divalent anions, n = 0.70 ± 0.06 suggested the control by a surface reaction. Dissolution of Zn from coated HDG with and without Zn2Al/-MoO4(2-) fillers, leaching of MoO4(2-) from the coating, and the electrochemical impedance spectroscopy response of the coated systems were measured during the immersion in 0.5 M NaCl solutions with and without 0.1 M NaHCO3. Without carbonates, the release of soluble MoO4(2-) was delayed for 24 h with no inhibiting effect whereas with 0.1 M NaHCO3 the immediate release was accompanied by the immediate and strong inhibiting effect on Zn dissolution. The concept of controlling the inhibition performance of LDH hybrid coatings by means of the environment composition is discussed.
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The impacts of climate extremes on terrestrial ecosystems are poorly understood but important for predicting carbon cycle feedbacks to climate change. Coupled climate-carbon cycle models typically assume that vegetation recovery from extreme drought is immediate and complete, which conflicts with the understanding of basic plant physiology. We examined the recovery of stem growth in trees after severe drought at 1338 forest sites across the globe, comprising 49,339 site-years, and compared the results with simulated recovery in climate-vegetation models. We found pervasive and substantial "legacy effects" of reduced growth and incomplete recovery for 1 to 4 years after severe drought. Legacy effects were most prevalent in dry ecosystems, among Pinaceae, and among species with low hydraulic safety margins. In contrast, limited or no legacy effects after drought were simulated by current climate-vegetation models. Our results highlight hysteresis in ecosystem-level carbon cycling and delayed recovery from climate extremes.
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Ciclo del Carbono , Cambio Climático , Sequías , Bosques , Árboles/crecimiento & desarrollo , Europa (Continente) , Modelos Teóricos , Estados UnidosRESUMEN
In this article, we describe the major findings of an ethnographic study undertaken to investigate nurses' experiences of managing nurses and being managed by nurses in an Australian critical care unit. Our purpose was to valorize and make space for nurses to speak of their experiences and investigate the cultural practices and knowledges that comprised nursing management discourses. Subjugated practices, knowledges, and discourses were identified, revealing how nurses were inscribed by, or resisted, the discourses, including their multiple mobile subject positions. Informed by critical, feminist, and postmodern perspectives, nine mobile subject positions were identified. Direct participant observation, participant interviews, and reflective field notes were analyzed for dominant and subjugated discourses. The major finding described is the subject position of "junior novice." Nurses informed by dominant patriarchal and organizational discourses participated in constructing and reinscribing their own submissive identity reflected in interprofessional relations that lacked individual valuing and undermined their self-esteem.
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Curiosity as holistic engagement in a recent research study between a researcher and participants is highlighted. Surgical inpatient participants initiated and extended interpersonal dialogue on the basis of their curiosity. It is argued that patient/participant curiosity should be encouraged because it is a positive component of holistic engagement and transformative in research processes.
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Conducta Exploratoria , Hospitalización , Proyectos de Investigación , Sujetos de Investigación , Adolescente , Adulto , Anciano , Comunicación , Femenino , Salud Holística , Humanos , Masculino , Persona de Mediana Edad , Pacientes , Investigadores , Adulto JovenRESUMEN
A person-centred health promotion model of care to improve self-care and lifestyle changes for older people with chronic illnesses is conceptualized in this paper. The model supports effective interpersonal communication with nurses and health-care consumers and is developed to concept stage. Older people with chronic illnesses who experience stress, anxiety or social isolation are more likely to be admitted and re-admitted to acute hospitals. Interventions to decrease the risk factors are frequently unsuccessful in this patient group. Programmes, led by nurses, aimed at reducing stress, anxiety and social isolation while supporting older people postdischarge from hospital might be successful. The model integrates research from synthesized case studies and a critical literature review. The practices of interrelating four key elements-'construct', 'context', 'process' and 'outcome'-are proposed for nurses to assist patients advancing self-care and lifestyle change. The model is designed for implementation in outpatient, clinic or community settings.
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Enfermedad Crónica/enfermería , Promoción de la Salud/organización & administración , Estilo de Vida , Atención Dirigida al Paciente/organización & administración , Autocuidado , Anciano , Humanos , Modelos de EnfermeríaRESUMEN
BACKGROUND: The paper reports on the importance of the interpersonal nexus within qualitative research processes, from a recent research project on patient experiences of shoulder surgery. Our aim is to reveal the importance of qualitative research processes and specifically the role of the interpersonal nexus in generating quality data. Literature related to the importance of human interactions and interpersonal communication processes in health-related research remains limited. Shoulder surgery has been reported to be associated with significant postoperative pain. While shoulder surgery research has investigated various analgesic techniques to determine key efficacy and minimization of adverse side effects, little has been reported from the patient perspective. METHODS: Following institutional ethics approval, this project was conducted in two private hospitals in Victoria, Australia, in 2010. The methods included a survey questionnaire, semistructured interviews, and researcher-reflective journaling. Researcher-reflective journaling was utilized to highlight and discuss the interpersonal nexus. RESULTS: This research specifically addresses the importance of the contributions of qualitative methods and processes to understanding patient experiences of analgesic efficacy and shoulder surgery. The results reveal the importance of the established research process and the interwoven interpersonal nexus between the researcher and the research participants. The interpersonal skills of presencing and empathetic engagement are particularly highlighted. CONCLUSION: The authors attest the significance of establishing an interpersonal nexus in order to reveal patient experiences of shoulder surgery. Interpersonal emotional engagement is particularly highlighted in data collection, in what may be otherwise understated and overlooked qualitative findings in patient experiences of shoulder surgery.
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INTRODUCTION: There is much evidence to indicate a shortage of Registered Nurses (RNs) in Australia and to suggest that the shortage may be more pronounced in rural and remote locations. Attracting RNs to work in rural and remote areas may not be as simple as increasing the intake of students into university undergraduate pre-registration nursing courses. There is some evidence indicating that student nurses may be more likely to enter the nursing workforce in rural and remote locations if they have existing associations with rural and remote areas and/or their undergraduate education provides opportunities to undertake supported placements in rural and remote settings. Two important difficulties have been associated with measuring outcomes in relation to rural and remote pre-registration nursing students. One is defining what constitutes a rural or remote location and the other is suspect data on the number of nursing students enrolled in, and completing, nursing courses. The aims of this study were to provide a longitudinal profile of the number of domestic students studying and completing undergraduate pre-registration nursing courses in Australia, with a particular emphasis on identifying those at rural and remote university campuses, and to compare results across States and Territories. METHODS: This study presents the combined findings from two investigative reports. Data on undergraduate pre-registration nursing student numbers were collected via electronic survey instruments completed by staff at all Australian educational institutions offering undergraduate pre-registration nursing education programs in 2001 and 2002. Australian domestic students were the focus of this study. Data included the total number of domestic students enrolled in undergraduate pre-registration nursing courses in 2001 and 2002, the number of domestic students who successfully completed courses in 1999, 2000 and 2001, and estimates for the number expected to complete in 2002. Surveys were sent to course coordinators or other staff nominated by heads of divisions of nursing at each institution. RESULTS: There was a 100% response rate. Twenty-four rural and remote campus locations were identified using an adjusted form of the Rural, Remote and Metropolitan Areas (RRMA) classification system. The Australian Capital Territory and the Northern Territory did not have any rural or remote campus locations. In contrast, undergraduate pre-registration nursing in Tasmania was offered at a rural campus only (for the first 2 years). From 2001 to 2002, there was an increase of just over 5% in the total number of domestic students enrolled in undergraduate pre-registration nursing courses in Australia (2002 total = 22,811 students). Rural and remote location students accounted for slightly more than 25% of these students in 2001, and almost 27% in 2002. The States Victoria, New South Wales and Queensland had the highest percentage of students enrolled at rural and remote campus locations, greater than the Australian average for both years. In contrast, South Australia and Western Australia had less than 11% of students enrolled at rural and remote campus locations for each year. Total undergraduate pre-registration course completions increased by approximately 16% across Australia between 1999 (n = 4868) and 2002 (n = 5667), although for 2002, the figure was projected. Of these total course completions, the percentage of students completing at rural and remote campus locations increased from almost 23% to nearly 28% during the same period. Of the States/Territories with both metropolitan and rural/remote campus locations, only Victoria and Queensland had more than 25% of their total student completions consisting of students enrolled at rural and remote campus locations for each year. In contrast, South Australia and Western Australia had approximately 6% of student completions consisting of students enrolled at rural and remote campus locations in 1999, increasing to approximately 12% projected for 2002. CONCLUSIONS: In this study, the authors attempted to improve the accuracy of data collection in relation to the number of domestic undergraduate pre-registration nursing students in Australia, which is representative of the potentially new Australian domestic RN workforce. There was a trend towards an increasing number of students being enrolled in undergraduate pre-registration nursing courses, and also toward an increasing number of course completions. From the perspective of the rural and remote RN workforce, the percentage of students enrolled and completing courses at rural and remote campus locations was found to be increasing. However, there may be some areas of concern for education and workforce planners in States and Territories that are providing a smaller percentage of their undergraduate pre-registration nursing courses in rural and remote areas. Several study limitations are discussed and suggestions made for future research.
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Numerous publications highlight the need for critically evaluating medical information on the Internet. This review identifies Internet resources specifically dedicated to end-of-life care. An annotated review of key web-based resources is presented. The Internet has the potential to catalyze the doctor-patient relationship toward true "partnership." Physicians and patients will benefit from using a focused research strategy.
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Servicios de Información/organización & administración , Internet/organización & administración , Cuidado Terminal/organización & administración , Capacitación de Usuario de Computador , Humanos , Almacenamiento y Recuperación de la Información/métodosRESUMEN
The effect of high-molecular-weight hyaluronan (HA) on peritoneal and systemic inflammation and peritoneal permeability to water and solutes was studied during endotoxin-induced peritonitis in rats. Acute peritonitis was induced by adding lipopolysaccharide (LPS) to the dialysis fluid (Dianeal 3.86; Baxter Healthcare, Ireland, Castlebar). HA was added to the dialysis solution in a concentration of 10 mg/dL. During 4- and 8-hour dwells of the dialysis fluid, we studied the intensity of peritoneal (dialysate) and systemic (blood) inflammation (dialysate cell count and differential, cytokine and HA levels), as well as the transperitoneal transport of solutes and water. In rats, the addition of LPS to the dialysis fluid induced changes in inflammatory reaction and transperitoneal transport similar to those seen in continuous ambulatory peritoneal dialysis patients with peritonitis. During peritonitis, the addition of HA to the dialysis fluid reduced the loss of ultrafiltration, which resulted in a greater peritoneal creatinine clearance during the 8 hours of dwell (29.9 +/- 6.7 mL/8 h in the HA-LPS group versus 19.7 +/- 7.8 mL/8 h in the LPS group; P < 0.05). Dialysate interferon-gamma (INF-gamma) levels during peritonitis were greater in HA-treated animals (536.8 +/- 296.6 pg/mL in the HA-LPS group versus 169.8 +/- 137.8 pg/mL in the LPS group; P < 0.05). Dialysate elastase activity increased during peritonitis (44.4 +/- 9.3 versus 14.2 +/- 4.1 U/mL in peritonitis-free rats); during peritonitis, the increase in dialysate elastase activity was less pronounced in the rats that had HA in the dialysate (27.3 +/- 4.1 U/mL versus the LPS group; P: < 0.01). We conclude that HA added to the dialysis fluid reduces loss of ultrafiltration during peritonitis in rats. In the presence of HA dialysate, INF-gamma levels during peritonitis increased, whereas elastase activity decreased; these changes might improve the peritoneal immune reaction during peritonitis and at the same time prevent peritoneal membrane injury.
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Ácido Hialurónico/uso terapéutico , Diálisis Peritoneal/efectos adversos , Peritoneo/metabolismo , Peritonitis/tratamiento farmacológico , Peritonitis/metabolismo , Enfermedad Aguda , Animales , Creatinina/metabolismo , Interferón gamma/metabolismo , Interleucina-1/metabolismo , Masculino , Peso Molecular , Elastasa Pancreática/metabolismo , Peritoneo/efectos de los fármacos , Peritonitis/etiología , Permeabilidad/efectos de los fármacos , Ratas , Ratas WistarRESUMEN
A descriptive study was designed and implemented by the Australian College of Critical Care Nurses (ACCCN) Workforce Planning Advisory Committee to capture data pertaining to workforce issues of intensive care nurses. All intensive care units (ICUs) within Australia were mailed a self reporting survey. Despite a low response rate (52 per cent) and difficulty reported by respondents in gaining the appropriate data requested, the results revealed an interesting snapshot of the intensive care nursing workforce. Types of services offered by units varied considerably; paid overtime hours were low (< 2 per cent of total hours worked) and use of both part-time and agency staff was also low (10 per cent of total hours worked). Private hospitals utilised a greater proportion of part-time and agency nursing staff than public hospitals (20:10 per cent). The turnover rate for registered nursing staff was estimated at 18 per cent, with education, skill acquisition and improved communication reported as the major incentives used by managers to attract and retain staff. This study demonstrated that valuable data are currently uncaptured and recommends a more refined process of a national database to record and manage this important information for future workforce planning.
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Cuidados Críticos , Unidades de Cuidados Intensivos/organización & administración , Enfermería , Australia , Humanos , Admisión del Paciente/estadística & datos numéricos , Sociedades de Enfermería , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
Virus retention during ultrafiltration through A/G Technology filter cartridges was investigated to characterize the removal process and validate the degree of virus titre reduction during the filtration of red blood cell haemolysates performed as part of the production of diaspirin crosslinked haemoglobin (DCLHb). When viruses were suspended in phosphate buffered saline solution, retention was greater with larger sized viruses and smaller filter pore size. Virus titre was maintained at starting levels in the filter retentate circuit during the course of filtration, suggesting that the virus removal mechanism is predominantly size exclusion. Evaluation of specific processing variables indicated that the retention of phiX174 virus was increased in the presence of red blood cell haemolysate or at high membrane crossflow rates and transmembrane pressures, while the retention of EMC virus was less sensitive to variations in these parameters. Using these results to design a validation protocol, log reduction values of >7.9 were demonstrated for the retention of human immunodeficiency virus, pseudorabies virus and bovine viral diarrhoea viruses, 7.6 for hepatitis A virus, and 4.2 for porcine parvovirus. It was also shown that the retention of viruses was maintained during repetitive use of the same filter cartridge.
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Aspirina/análogos & derivados , Contaminación de Medicamentos , Hemoglobinas/aislamiento & purificación , Ultrafiltración , Virus , Animales , Aspirina/aislamiento & purificación , Bacteriófago phi X 174 , Línea Celular , Virus de la Diarrea Viral Bovina , Virus de la Encefalomiocarditis , Diseño de Equipo , Eritrocitos , Estudios de Evaluación como Asunto , VIH , Hemólisis , Hepatovirus , Herpesvirus Suido 1 , Humanos , Macaca mulatta , Membranas Artificiales , Tamaño de la Partícula , Parvovirus , Seguridad , Porcinos , Ultrafiltración/instrumentación , Ensayo de Placa ViralRESUMEN
OBJECTIVE: Autologous interleukin 2 (IL-2)-activated natural killer (NK) cells kill a broad spectrum of tumor targets, including breast cancer. We hypothesized that mobilization with IL-2 and granulocyte colony-stimulating factor (G-CSF) for collection of peripheral blood progenitor cells (PBPC) may enhance the anti-tumor activity of the graft in autograft recipients. We determined the dose-limiting toxicity and maximum tolerated dose of subcutaneous IL-2 given with G-CSF for PBPC mobilization, the ability of IL-2 + G-CSF mobilized stem cells to reconstitute hematopoiesis, and the in vitro immunologic function of the graft in patients with advanced breast cancer. MATERIALS AID METHODS: Forty-three women with stage IIIA/B or metastatic breast cancer underwent mobilization of PBPC with IL-2 administered subcutaneously for 14 days along with G-CSF for the latter 7 days. IL-2 was given in a dose-escalated manner, with the maximum tolerated dose determined to be 1.75 x 10(6) IU/m(2)/day. Fifteen women with stage IIIA/B or metastatic breast cancer underwent G-CSF mobilization alone and served as a control group. RESULTS: [corrected] Fifty-two percent of the patients mobilized with 1L-2 at the maximum tolerated dose reached the target number of CD34(+) cells for transplantation with three aphereses compared to 93% of control patients who were mobilized with G-CSF alone. [corrected] There was no significant impact on time to engraftment of neutrophils or platelets using either mobilization regimen. The addition of subcutaneous IL-2 to mobilization increased the cytotoxicity of IL-2-activated mononuclear cells from the PBPC product against the breast cancer cell target, MCF-7, and increased the percentage of NK cells and activated T cells in the PBPC product. The enhanced NK cell number was sustained in the early posttransplant period. CONCLUSIONS: [corrected] IL-2 + G-CSF mobilization is safe, may lead to a more immunologically functional graft without impairing hematologic recovery, and thus merits further exploration to evaluate the clinical anti-tumor efficacy of these immunocompetent grafts. [corrected] Limitations of this combined approach to stem cell mobilization include a decrease in the number of CD34(+) cells mobilized with the combined cytokines and the short duration of the increased number of anti-tumor effector cells after transplant.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/inmunología , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Células Madre Hematopoyéticas/efectos de los fármacos , Inmunoterapia Adoptiva , Interleucina-2/administración & dosificación , Adulto , Anciano , Antígenos CD34/biosíntesis , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias de la Mama/secundario , Neoplasias de la Mama/terapia , Relación CD4-CD8 , Quimioterapia Adyuvante , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Supervivencia de Injerto/efectos de los fármacos , Factor Estimulante de Colonias de Granulocitos/efectos adversos , Antígenos HLA-DR/biosíntesis , Movilización de Célula Madre Hematopoyética/métodos , Trasplante de Células Madre Hematopoyéticas , Células Madre Hematopoyéticas/inmunología , Células Madre Hematopoyéticas/metabolismo , Humanos , Inmunofenotipificación , Inyecciones Subcutáneas , Interleucina-2/efectos adversos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Células Tumorales CultivadasRESUMEN
BACKGROUND: A narrow subspecialty model of cancer care has led to cancer treatment often being given outside the full medical context of the patient. The full range of comorbid illness must be considered in all aspects of diagnosis and treatment. This study was conducted to describe the prevalence of comorbidity in cancer patients and examine its relation with multiple demographic and clinical variables. METHODS: A case comparison study of 15,626 population-based incident cases of cancer was conducted between 1984-1992 in 3 metropolitan Detroit counties (a National Cancer Institute Surveillance, Epidemiology, and End Results program). Chronic disease status and demographics were collected by self-report; cancer diagnoses and staging were obtained by medical record review. Univariate and multiple logistic regression analyses were performed. RESULTS: Comorbidity was present in 68.7% of cancer patients, and 32.6% of these individuals had > or = 2 comorbid conditions. Frequency was increased in the elderly, African-American patients (particularly African-American women), smokers, and those with lower socioeconomic status. Rates also appeared to vary by specific tumor site. CONCLUSIONS: Comorbid chronic diseases are common in persons with cancer. The prevalence of comorbidities has important clinical, health service, and research implications. The disease specific model of oncology may limit appropriate care for these patients, and enhanced integration of primary care into the ongoing management of cancer may offer better outcomes.
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Enfermedad Crónica , Neoplasias/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Población Negra , Estudios de Casos y Controles , Demografía , Femenino , Humanos , Incidencia , Modelos Logísticos , Masculino , Michigan , Persona de Mediana Edad , Estadificación de Neoplasias , Planificación de Atención al Paciente , Prevalencia , Estudios Retrospectivos , Programa de VERF , Factores Sexuales , Fumar/efectos adversos , Clase Social , Resultado del Tratamiento , Población BlancaRESUMEN
Access to hospice care continues to be an enigma. Hospice has been available for nearly three decades in the United States, but the services continue to be underutilized. In an effort to better understand access barriers, a series of focus groups were held with recently bereaved caregivers (mean = 9.9 months since the death of the patient). During the process of the focus group discussions, participants relived their experience with hospice. Although the purpose of this research was to ascertain access recommendations, participants integrated their access comments into the overall richness of their hospice experience. The 12 participants were divided into two groups, and each group met twice with a 2-week interval between sessions. From the focus group discussions, six themes emerged. Two of the six themes related to access issues: (1) societal and health system issues related to delayed hospice access and (2) education and practice needs of health professionals that affect hospice access. Participants provided recommendations to address the concerns expressed through both of these access themes.
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A perceived shortage of critical care nurses in Victorian public and private hospitals, largely attributed to an increase in attrition from critical care areas and a failure to attract sufficient replacement for those who leave, served as the impetus for this project, which explored registered nurses' (RNs') attraction to and attrition from critical care practice areas. Multiple sources of data were utilised, including a series of individual interviews and focus group discussions with critical care students and past and current critical care nurses, telephone interviews with RNs who had completed a critical care re-entry course, interviews with key informants and an analysis of applications to study in a critical care postgraduate nursing course. Results revealed that the challenge of the work, intellectual stimulation, the high level of autonomy, use of increased knowledge and career development were primary motivators for RNs to engage in critical care practice. Limitations to lifestyle choices, practice demands, political changes within critical care arenas, inappropriate remuneration and a lack of career structure and opportunity were salient features of why employment was discontinued within the critical care practice areas.
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Actitud del Personal de Salud , Selección de Profesión , Cuidados Críticos , Personal de Enfermería en Hospital/psicología , Personal de Enfermería en Hospital/provisión & distribución , Selección de Personal/métodos , Reorganización del Personal , Movilidad Laboral , Grupos Focales , Humanos , Motivación , Investigación Metodológica en Enfermería , Personal de Enfermería en Hospital/educación , Encuestas y Cuestionarios , Victoria , Recursos HumanosRESUMEN
The diagnosis of life-threatening illness delivers patients and families into new and often unfamiliar territory--a place one author has named "the country of illness." There are no easy road maps in that new world, and the way is made harder by the burdens thrust upon its inhabitants. For cancer patients, one of the greatest burdens is the pain that comes with the disease.
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Neoplasias/complicaciones , Dolor Intratable/prevención & control , Cuidados Paliativos/métodos , Analgésicos no Narcóticos/efectos adversos , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/efectos adversos , Analgésicos Opioides/uso terapéutico , Terapias Complementarias , Humanos , Neoplasias/radioterapia , Neoplasias/cirugía , Dolor Intratable/tratamiento farmacológico , Dolor Intratable/radioterapia , Dolor Intratable/cirugía , Estados UnidosRESUMEN
Patient care within an intensive care unit (ICU) can be a difficult and stressful task for even the most experienced and skilled critical care nurse. Good communication between the patient, relatives and nurse is integral to quality care of the patient and should extend to the entire health-care team. This article reviews the literature on nurse-patient communication in the ICU. While numerous research studies have been completed, they are predominantly qualitative and descriptive. Recent studies have investigated the patients' perceptions and recollections of the communication that transpired between them and nurses while they were cared for within an ICU. The literature indicates that nurses communicate extremely poorly with patients, despite a high level of knowledge and skill with respect to communication. Tentative explanations of high stress levels, a preoccupation with physical care and technology, and the attraction to critical care areas of nurses with specific personality types are discussed as possible reasons for this. The need for further research into, and attempts to alleviate, this problem is clearly demonstrated.