The effect of new public management on intensive care unit staff
The NHS is largely dependent on two groups of professionals – medics and nurses. Recent government changes support the development of a central role for management. The impact of these changes on the roles and relationships of those working in the NHS must be understood in light of the structures already in place within it. Medical dominance in healthcare decision‐making, nursing power emanating from the strength of the medical‐nursing relationship and the hierarchies within and between the two professions all affect and are affected by recent management changes. In intensive care a key feature of the context, insularity, had already significantly modified these structures prior to recent reforms. This paper starts by discussing and contrasting the response of medics and nurses to these changes before highlighting the differences in the way these changes have impacted on staff in intensive care. Analysis is based on data from an observational study of the formation of a new directorate and interviews with senior nurses, medics and managers in intensive care.
Telephone Advisory Services - Nursing between Organisational and Occupational Professionalism
In this paper, we explore how telephone advisory services (TAS) and the implementation of new technology affect nurses and the nursing profession. This study shows that TAS and applied technology embodies ideas of standardisation and efficiency, and promotes an organisational professionalism such that it challenges occupational professionalism. Torn between organisational and occupational professionalism, the nurses develop strategies to deal with their contradictory demands.
Coexistence of Virulence and Antibiotic Resistance Genes in Pasteurella multocida Isolated from Diseased Rabbits
Pasteurella multocida (P. multocida)is considered a predominant pathogenic bacterial agent causing respiratory manifestations (snuffles) in rabbits with considerable economic losses and unfavorable prognosis in Egypt. A few recent P. multocida strains exhibit resistance to the most commonly used antibiotics in the veterinary field. Therefore, the present study was carried out to investigate the prevalence of both virulence and antibiotic resistance genes among P. multocida isolated from diseased rabbits in Sharkia Governorate, Egypt. Only 10 out of 100 tested rabbits` nasal swabs were finally confirmed positive for P. multocida of serogroup A by polymerase chain reaction (PCR). Antibiotic susceptibility testing of the recovered isolates revealed that they were all multidrug resistant (MDR) with a predominance of resistance to amoxicillin, ampicillin, amoxicillin/clavulanic acid, neomycin and tetracycline (100% each), followed by kanamycin and streptomycin (90% each). All the recovered isolates were further subjected to PCR screening of some common virulence and antibiotic resistance genes of interest . With the exception of toxA gene, the other virulence associated genes (ptfA, Omp87 and nanB) were found among all the examined isolates. Totally, all MDR P. multocida isolates contained at least one antibiotic resistance gene with aphA1 being the most prevalent (100%), followed by ermX gene (40%). Antibiotic resistance genotyping demonstrated the presence of multiple antibiotic resistance genes among majority of the isolates (40%) with only one isolate harboring 4 genes encoding identical resistance phenotypes. Evidentially, all MDR P. multocida isolates possessed at least 3 virulence genes accompanied by the attendance of antibiotic resistance genes. These findings evidenced that rabbits are potential sources of pathogenic P. multocida strains harboring virulence and antibiotic resistance genes. Therefore, it is evident that there is an urgent need for the judicious use of antibiotics in rabbits` treatment systems to successfully mitigate the propagation of drug resistance across P. multocida species.