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Subsurface Geopressure Prediction: Perception and Pitfalls

DOI: 10.31038/GEMS.2024674

Abstract

In this short article, a review of the subsurface geopressure forecast’s characteristic in relation to geological building blocks is briefly presented. Geopressure is the driving mechanisms of generating and migrating of oil and gas to their traps. Geopressure is a double edge sword. Most of the large hydrocarbon pools are embedded in this pressure zone, and on the other hand it can be a serious hazard for drilling crews and properties. The lack of understanding the prediction process can resulted in unintended miscalculation and ambiguous interpretation. The science of predicting the sedimentary column pressure profile drift is widely diverse and mostly driven by algorithms rather than the exploration prospect’s geological settings.

Introduction

Pore pressure prediction (PPP) is a process synonym of estimating the subsurface pressure before and post drilling. However, predictions should apply only if the calculation takes place before drilling. On the other hand, any estimation or assessment of the pressure from drilling records and logs data should not be considered as forecasts. They are pressure calibration or simulation instead of prediction. Subsurface pressure compartments are the response of sedimentation process, that lead to compaction and burial. Sand and shale/clay dominate most of the deltaic and shallow marine environments. Compaction due to sediment load leads to fluids expulsion out of the rock matrix that leads to increase pressure. Terzaghi and Peck (1948) [1] illustrated this process with a mechanical device filled with water. Most of the geopressure scholars believe the clastic sedimentary column is divided to two sections: Normal and Abnormal pressure (geopressure) zones. Eaton (1975) [2] made a successful leap to build the base model of calculating subsurface pressure increasing with depth using petrophysical properties (sonic, resistivity and density). The assumption of two main subsurface zones were utilized in his assessment as well. Shaker (2015) [3,4] recognized a new concept in the presence of 4 pressure zones in offshore and 3 zones in onshore in the clastic sedimentary columns. Based on the new established subsurface compartmentalization, a geological based prediction model of the subsurface geopressure is attained. This was an eye opener for some of the unintended pitfalls of geopressure prediction methods.

The Basic Geological Framework

Sediments reach the depositional basin carried by water through the water shed feeder areas. Suspended detrital grains begin the slow consolidation and compaction throughout time and additional load. During the periods of high sea stand, capable competent seals form. The top seal represents the choking barrier for the subsurface fluids outflux. This is referred to as the top of geopressure (TOG). Studying many subsurface petrophysical properties behavior led to the updated conclusion of subdividing most of subsurface clastic into four main pressure compartments [3,4). This is because the change in porosity and consequently pore pressure directly impacts the rock sonic velocity, electric resistivity, and density. Figure 1 exhibits, in a nut-shell, the relationship between 15 million years of compartmentalized sedimentary sequence, velocity (sonic ∆t) profile drift due to compaction, pressure in psi, and the designated four zones (after shaker, 2019) [5]. The compaction drift of the data (sonic/resistivity etc.) in zone B [4,5] follows an exponential trend. The deeper extension of this trend is used to estimate the pore pressure (Figure 1).

Figure 1: Exhibits P-D conceptual cartoon plot represents a 15 million years four zones (A,B,C,D) of high sea stand shale beds interbedded with reservoir sand beds . Shale Velocity drift with depth reflects the pressure increase changes across the shale beds. CT is the compaction trend. Red arrows represent the Effective Stress [1,2]. The right display is in linear scale (exponential compaction trend), whereas the log display on the left is in logarithmic scale (linear compaction trend).

The following are some basic criteria for pressure prediction calculations:

Predicting pore pressure (PP) is before drilling and calibrations/simulation are during and post drilling.
Predicting PP is always in the section below the Top of Geopressure [1,2,5].
Petrophysical data should be representing the clean shale/clay lithology only [1, 2 ].
Normal hydrostatic pressure resides in the very shallow zone (A) only [3,4,5].
The deeper extrapolation of zone B compaction trend is used only to calculate the Pore Pressure (PP) in zones C (top seal) and the compartmentalized geopressured zone D [2,5]. It is designated as CT instead of NCT by [5].
Calibration of the predicting pressure’s model should not rely solely on the measured PP (MPP) in reservoir sands. Mud logs and drilling records should be collaborated in this process [5].

Pitfalls

Most of the pitfalls in calculation of subsurface pressure is driven by the lack of geological and geomechanical building blocks input in the prediction model. Since excess pressure generation and causes are the product of stressed water bearing formation, principal and minimum stresses vectors should be known in addition of the overburden gravity vector (Shaker,2024) [6]. Applying the old theorem that subsurface pressure profile is divided to two segments (Normal and Abnormal pressure zones) separated by the TOG can cause substantial miscalculations (Figure 2). This is because the misleading assumption of considering the compaction trend data set represents a normally pressured sequence (NCT). Compaction and expulsion of fluids by differential pressure is not normally hydrostatic pressure gradient [5]. Sequence stratigraphy also can be a guidance to geopressure compartmentalization and assessing sealing verses breaching reservoirs (Shaker, 2002) [7]. Calibrating and simulating the predicted pore pressure in the shale with the measured pp using the wireline tools in the reservoir can lead to substantial calculation errors. This due to the fact that most of the effective stress methods are designed for shale beds [1,2]. Figure 3 shows the prediction modeling blunder if the prediction model is enforced to follow the measured pressure value data. Utilizing pressure prediction software does not include the manipulation of extracting certain lithology or the flexibility of maneuvering the stresses vectors especially in salt basins and can be a main source of unintended pitfalls [6].

The symptoms of pitfalls are usually revealed on the interpreted pressure plots such as:

Predicting pressure data trace (values) facing a porous/permeable lithology especially in reservoir sands/sandstones e.g. Bowers, 1995 [8], Ehsan M. et al. 2024 [9], and Merrell et al. 2014 [10].
Extrapolating a Normal Compaction Trend (NCT) that covers the entire drilled lithological section four zones e.g. Berry et al. (2003) [11].
Swaying and breaking the NCT to separate segments for the purpose of matching the predicted pp in the shale to the measured pp in the sand reservoirs e.g. Kuyken. and de Lange (1999) [12].
Predicting pp in salt basins utilizing the Overburden as principal stress (S1), regardless the effect of salt – sediments differential stresses and salt buoyancy e.g. Shaker and Smith 2002 [13], Merrell et al. 2014 [10], and Zhang and Yin, 2017 [14].

In summary, geopressure prediction modeling is a product of multi-disciplinary geoscience and engineering fields of expertise. Therefore, collaboration between these different disciplines can improve and enhance forecasting and simulate a bonified subsurface pressure profile.

Figure 2: P-D plot showing correlation between Predicting seismic Velocity – Pressure model using the conventional NCT vs. CT/4 zones. The data using NCT shows ambiguous profile whereas prediction data using the CT/4 zone shows a bonified prediction with an agreement with the data extracted from nearby offset well.

Figure 3: Shows two P-D plots for the same deepwater well. On the left panel measured reservoir’s pp (RFT) only used as calibration tool for Predicting PP in shale (PPP shale). Note the mismatch between the circle and arrow zones. On the right panel is the right prediction method that using the shale only for prediction modeling.

Acknowledgement

Special Thanks to Kate Mariana of the research open world for facilitate publishing this short article.

References

Terzaghi K, Peck RB (1948) Soil mechanics in engineering practice. John Wiley & Sons, Inc. N.Y., Pg: 566.
Eaton BE (1975) The equation for geopressure prediction from well logs. Society of Petroleum Engineers of AIME paper #SPE 5544, 11.
Shaker SS (2015a) A new approach to pore pressure predictions: Generation, expulsion, and retention trio—Case histories from the Gulf of Mexico. Gulf Coast Association of Geological Societies Transactions. 65: 323-s337.
Shaker SS (2015b) Velocity for pore pressure modeling. Society of Exploration Geophysicist Annual Meeting, 1797-1801.
Shaker SS (2019) Pore Pressure Prediction Before and During Drilling Applying the Four Zones Method, Offshore Technology Conference, OTC-29517-MS.
Shaker SS (2024) Pore and fracture pressures prediction — A new geomechanic approach in deepwater salt overthrusts: Case histories from the Gulf of Mexico, Interpretation. 12: T501-T521,
Shaker SS (2002) Predicted vs. Measured Pore Pressure: Pitfalls and Perceptions, Offshore Technology Conference, Houston Tx., OTC 14073.
Bowers GL (1995) Pore pressure estimation from velocity data: accounting for overpressure mechanisms besides undercompaction. Society of Petroleum Engineers Paper SPE–27488, PA, Pg: 7.
Ehsan M, Manzoor U, Chen R, Hussain M, Abdelrahman K, Radwan AE, Ullah J, Iftikhar MK, Arshad F, Pore pressure prediction based on conventional well logs and seismic data using an advanced machine learning approach, Journal of Rock Mechanics and Geotechnical Engineering, Pre – Print
Merrell, M.P., Flemings, P.B., and Bowers, G.L.,2014, Subsalt pressure prediction in the Miocene Mad Dog field, Gulf of Mexico. AAPG Bulletin. 98: 315-340.
Berry JR, McCormack N, Doyle E (2003) Overcoming pore-pressure challenges in deepwater exploration. OFFSHORE, Penn Well Corp., Reservoir Engineering.
Kuyken CW, de Lange F (1999) Pore Pressure Prediction allows for tighter pressure gradient control, OFFSHORE, Penn Well Corp., Drilling Technology.
Shaker SS, Smith M (2002) Pore Pressure Predictions in the Challenging Supra / Sub-Salt Exploration Plays in Deep Water, Gulf of Mexico. AAPG Search and Discovery Article #90007, presented at AAPG Annual Meeting.
Zhang J, Yin S (2017) Fracture gradient prediction: an overview and an improved method. Springer, Pet Sci 14: 720-730.

Dysregulation of Cell-Mediated Immunity in Patients with Long ICU Stay Affected of Multiple Organ Dysfunction Syndrome and Multifocal Candidiasis

Contribution to the Eruption Mechanism of Carbonatitic Diatremes and Volcanoes

2 Replies

DOI: 10.31038/GEMS.2024673

Abstract

The Eifel Volcanic Field (EVC) is one of the best-known intraplate volcanic fields on earth. Carbonatitic ejecta were already described at the beginning of the last century and were associated with volcanism. The investigation of carbonatitic tephra from the EVC, the Kaiserstuhl (KVC) and El Hierro (EHSR) with regard to shape, size, composition and geochemistry, together with thermodynamic and fluid mechanical considerations, allow a reconstruction of the eruption process that ultimately calls into question the sole interpretation of maar formation as a phraetomagmatic eruption.

Introduction

In their overview of the worldwide distribution of carbonatites, Woolley and Kjarsgaard (2008) [1] report 527 carbonatite localities, 46 of which are classified as extrusive. The ratio is unlikely to have changed significantly to date. While the intrusive carbonatites represent the frozen state of a relatively slow intruding melt that has cooled in the host rock, the extrusive carbonatites are the result of sudden events that, due to the physical nature of the carbonatite melts, leave behind mechanical but only minor chemical traces. The genesis of carbonatitic melts can be very different, depending on whether they occur alone or in combination with alkali silicate rocks. They can be formed primarily by partial melting in the mantle or also by fractional crystallization of melilitic-nephelinitic magmas or generally by segregation of silicate melts supersaturated with carbonate [2]. In all cases considered, the carbonatitic events are determined by the unique properties of the carbonatite melts themselves [2]. For example, carbonatites generally have a high solubility for rare earth elements, which makes them economically interesting. They have a strongly pressure-dependent density of 2000 kg /m³ at P = 0.1 GPa up to 2900 kg/m³ at P = 10 GPa, a very low viscosity and a high solubility of CO₂ and H₂O (Genge et al 1995). The high solubility of CO₂ in carbonatitic melts is associated with the onset of incongruent melting of CaCO₃ at temperatures > 1230°C and a pressure range of 0.1 – 0.7 GPa according to the reaction [3].

2CaCO₃ (solid) = (CaCO₃ +CaO)(liquid) + CO₂ Eq (1)

A further increase in pressure ultimately leads to congruent melting [3-4]. The incongruent melting behavior of CaCO₃ explains the high saturation of carbonatite melts with CO₂ . This saturation is associated with a drastic reduction in the melting temperature (solidification temperature). According to Huang and Wyllie (1976) [5], saturation of the carbonate melt with CO₂ to 11.5 wt% at 2.7 GPa results in a melting point reduction from 1610°C to 1505°C. Investigations by Eggler (1974) [6] on the solubility of CO₂ in diopside at 3 GPa show that mantle silicate melts dissolve approx. 5 wt% CO₂ , which is associated with a melting point reduction of 120 degrees. Due to the incongruent melting behavior of the carbonate [Eq (1)], a high CO₂ content of the melt combined with high fluidity and low density is inevitable. A high H₂ O content also has the effect of lowering viscosity and melting point, which is particularly important in silicate melts. The low viscosity of carbonatitic melts leads to magma ascent velocities of 20 – 65 m/s (70-230 km/h) if the appropriate tectonic conditions are present [45]. However, this also means that extrusive carbonatitic events are unpredictable. Furthermore, rapid magma ascent leads to rapid depressurization, which results in spontaneous release of the CO₂ dissolved in the melt and decomposition of the carbonate according to the relationship leads.

CaCO₃ = CaO + CO ₂Eq (2)

This creates a gigantic CO₂ fan at depths of 3 – 20 kilometers. This means that the probability of carbonatitic melt reaching the earth’s surface is very low. Such carbonatitic diatreme fillings are characterized by a quantitatively high proportion of accessory rock xenoliths, which can amount to 70% and more [7]. Silicate-magmatic tephra occurs when the eruptive reservoir is a carbonate-bearing silicate magma. Stoppa et al (2003) [8] have pointed out these processes. The type of eruption also means that only small traces of the carbonatite itself can be found. This may also be the reason why only a small number of extrusive carbonatites have been detected to date. A model is being developed from the known data of carbonatitic melts, which allows a better understanding of the phenomena associated with carbonatitic volcanism and a better interpretation of the material found in the field. For this purpose, data from sample material from three known volcanic fields are used: the Eifel (EVC = Eifel Volcanic Complex), the Kaiserstuhl KVC = Kaiserstuhl Volcanic Complex) and El Hierro (EHSR = El Hierro South Rift).

Geological Context of the Regions Belonging to the Sample Material

EVC, Eifel Volcanic Complex

One of the most famous intraplate volcanic districts in the world is located in the Eifel, as it contains the type locality of the Maar eruption type. The Eifel volcanic field has two quaternary volcanic fields that follow tectonic northwest-southeast AC fissures of the Variscan folded crust. The West Eifel consists of around 240 eruption centers, the East Eifel of around 100 [9]. Due to the economic use of the volcanic structures for the extraction of building materials, gravel and pumice, the two Eifel volcanic fields are excellently accessible for geological investigations. Multiphase volcanic activity began in both volcanic fields around 700 ka ago [10-11]. The last activities occurred in the Western Eifel around 11 ka ago with the eruption of the Ulmen Maar [12] and in the Eastern Eifel around 13 ka ago with the eruption of the Laacher See Volcano [13]. Two older foidite suites (melilitite, melilitite-nephelinite and ol-nephelinite/leucitite and leucite- phonolite) and a younger basanite-tephrite-phonolite suite [14-16] occur in both volcanic fields. In the West Eifel, the basanite suite first appears around 80 ka, in the East Eifel at around 215 ka [10-11]. These alkali-rich magmas originate from varying degrees of partial melting in the upper mantle (< 120 km), which were subjected to more or less strong differentiation by fractional crystallization on their way to the Earth’s surface. The foiditic magmas in particular are potential sources of carbonate-bearing to carbonatitic magmatic rocks, which have long been known from the Laacher See region [17-19]. They were first described from the West Eifel by Lloyd and Bailey (1969) – [20] and again investigated by Riley et al. (1996) [21] and Riley et al. (1999) [22]. To date, however, scientific interest in the Eifel carbonatites has remained rather low. A dissertation on the genesis of the Laacher See carbonatites was published by Liebsch (1997) – [23]. He interpreted the Laacher See carbonatites as precipitates from a phonolitic silicate melt supersaturated with carbonate in the last stage of differentiation and cooling. This work is little known as its results have not been published. Schmidt et al. (2010) [24] investigated the temporal development of intrusive carbonatites using uranium-thorium dating on the same sample material. Since 2019, an international working group led by the German Volcanological Society has turned its attention to the problem of Eifel carbonatites. The initial focus is on a geological survey combined with the discovery of further carbonatite deposits.

The carbonatite deposit of the Laacher See volcano is the youngest in the Eifel with an age of 13 ka years. The other known carbonatite deposits in the Eifel are located in the Rieden complex (Eastern Eifel) [25] and in the Western Eifel in the Rockeskyll and Essinger Maar area. They are generally linked to phonolitic magmatism and are characterized by the associated occurrence of sanidine megacrysts with masses of up to 60 kilograms. In terms of age, the West Eifel deposits can be dated to approx. 469 ka years ago and the East Eifel deposits to 410 ka years ago [10, 26]. If one takes the conspicuous association of sanidine megacrysts and carbonatites as an indicator, then there are still 3 carbonatite-rich areas. One area is the Kerpener- Maar in the West Eifel. This is a phonolitic maar, which is also known for its sanidine megacrysts [14]. The other two deposits are located in the Eastern Eifel. One is located on the southern edge of the Wehrer Kessel, a polyphase phonolitic eruption center where, according to Frechen (1976) [27], sanidine megacrysts were also found in the Wehr I tephra. The age of the deposits of the Wehr I eruption is given by Wörner et al. (1988) [28] as 480 ka years. The other occurrence is in the area of the Leilenkopf near Niederlützingen, where the oldest melilitic-nephelinitic deposits of the Leilenkopf volcano are also said to contain sanidine megacrysts [29]. The age of these sanidine ejecta was determined to be 405 ka years [30]. However, all 3 of these carbonatite-rich deposits are currently unexplored.

KVC, Kaiserstuhl Volcanic Complex

The Kaiserstuhl Volcanic Complex is the best-studied carbonatite complex in Europe [31-34]. Its age is given as 16-19 Ma [35], Braunger [36]. It consists mainly of tephritic to phonolitic rocks, associated with a small proportion of olivine nephelinites and melilites. The youngest formations are the carbonatites, whose age is given as 15 Ma [33]. The magmatic origin of the carbonatites from the Kaiserstuhl was first postulated by Högbom in 1895 [33]. The carbonatites of the KVC occur both as subvolcanic carbonatite bodies of sövitic character and as extrusive events in the form of dykes, veins and carbonatitic tephra. Carbonatitic tephras are of particular importance for the investigation of the eruption mechanism of carbonatitic volcanoes. A special feature of the Kaiserstuhl ejecta are the lapillite tuffs known from Henkenberg and Kirchberg, which are only known from a few other localities (Cape Verde, Silva et al. 1981 [37], Fort Portal Volcanic Field, Uganda, Barker and Nixon 1988) [38]. They are so distinctive that they form the locus typicus for this type of tuff. Since this paper is concerned with the interpretation of the eruption mechanisms of carbonatitic volcanoes, only those samples that can be expected to contribute to this topic were considered in the processing.

Region El Hierro, South Rift (EHSR)

El Hierro is one of the seven volcanic islands of the Canary Islands archipelago, which is located approximately 100 kilometers northwest of Africa in the Atlantic Ocean. The age of the archipelago is estimated at around 60 million years, with the island of El Hierro being the youngest link in this chain at around 1.2 million years old. All islands are considered volcanically active [39]. El Hierro can be divided into 3 rift systems [40]. The North-East Rift (Tinor Volcano, 1.2-0.88 Ma), the West Rift (El Golfo Volcano, 0.55-0.176 Ma) and the South Rift (0.158 Ma – today). The South Rift is the youngest formation and had its last eruption in 2011 as a submarine volcano off the southern tip of the island. The South Rift volcanism is characterized by highly differentiated lavas of tephritic character. Such lavas originating from tephritic magmas are certainly indicative of carbonate-enriched silicate rocks and their differentiates (carbonatites). The search for carbonatitic ejecta is therefore quite promising and opens up the possibility of verifying the thesis of the dissociation of CaCO₃ with subsequent recombination according to equations 2 to 5 by applying the C¹⁴ determination method. Since C¹⁴ is only formed under the influence of high-energy particles in the atmosphere, volcanic CO₂ is ad hoc free of C¹⁴ . If the detection of C¹⁴ in carbonatitic tephra is successful, then the proof for the sequence of reactions according to equations 2 to 5 is provided. As the isotope C¹⁴ is a relatively short- lived nuclide with a half-life of 5730 years, verification must take place in a young volcanic area with carbonatitic episodes. Through a systematic search, the author found suitable sample material for a C¹⁴ determination in the South Rift of El Hierro.

Gas Mechanical Processes in the Light of Volcanology

Depending on pressure, flow velocity, flow type, solid and liquid content, a gas flow through a tube produces effects that have long been used in technology and that can be studied excellently on extrusive carbonatites from the Eifel. Some of the gas-mechanical processes that we will deal with below are known as fluidized bed processes. In volcanology, publications dealing with this topic appear from time to time [41-44].

Basically, three processes can be distinguished in the fluidized bed process, depending on the prevailing conditions:

Agglomeration, granulation, integration
Abrasion, disintegration, fragmentation
Transportation

The result of all three modes can be demonstrated on diatremes in the Eifel.

We want to understand a diatreme sensu stricto as a volcanic ascent channel, which is very narrow in relation to its length and can reach the Earth’s mantle under certain circumstances. It is tectonically pre-formed and is created by mechanical fragmentation as a result of rapidly rising highly fluid melts (70-230km/h; Genge et al 1995) [45]. In the case of carbonate-containing melts, these reach a pressure level during ascent at which the decomposition reaction of the calcium carbonate according to Eq. (1) and Eq. (2) begins explosively, which is accompanied by a fragmentation of the residual channel up to the earth’s surface. This leads to foreign xenolith contents of up to 70% and more in the eruption centers. The explosive initial phase can be followed by a quieter degassing phase, which can be described by a kind of boiling reaction in a relatively narrowly defined area of the ascent zone, whereby this area can be characterized by the diameter of the diatreme and the thickness of the boiling zone. The intensity of the eruption is determined by the amount of material extracted from the depth per unit of time. The onset of the reactions according to equations (1) and (2) is associated with the emission of large quantities of CaO in the volcanic ejecta. This fact has not yet been mentioned in the literature, although one has to ask how carbonatitic tuff was formed. Obviously, it is tacitly assumed that a carbonate liquid phase cemented the tephra particles. However, we have no known C, O and Sr isotope data to prove that the binding phase of the tephra is magmatic in nature (according to the usual criteria for magmatic isotopy, Taylor et al. 1967) [46]. As a way out of this dilemma, it is argued that the isotopy of the tephra has been altered by alteration processes (Demeny et al 1998) [47].

Accordingly, large quantities of CaO and CO₂ are released into the atmosphere during the eruption. The overall isotopic picture of the CaCO₃ is therefore split into a CaO isotope and a CO₂ isotope. Both components are carried into the atmosphere, where they are influenced by the prevailing conditions such as humidity, temperature and air velocity. While the CO₂ remains as a gas, the CaO sinks back to the earth’s surface as dust. The CaO can recombine with volcanic CO₂ or CO₂ from the air or react with the moisture in the air. The following reactions are possible:

CaO + CO₂ = CaCO₃ Eq (3)

CaO + H₂ O = Ca(OH)₂ Eq (4)

Ca(OH)₂ + CO₂ = CaCO₃ + H O₂ Eq (5)

There is therefore ultimately a fallout of clasts (predominantly xenoliths from secondary rocks, but also xenocryst fragments from the primary carbonate melt) and a dust mixture of CaO, Ca(OH)₂ and CaCO₃ , with CaO as the main component. This dust forms the binding material for the carbonatitic tuff, whereby CaO and Ca(OH)₂ are transformed into CaCO₃ by the atmospherics according to Eqs. (4) and (5), a process that also takes place with quicklime. Ultimately, a tuff with a carbonate binder phase is formed. We will return to these facts below (Figure 1a-1c).

Figure 1a-c: Tuff with carbonate binder phase.

Above the evaporation zone, turbulence can occur within the ascent channel if the appropriate conditions for flow velocity and pressure are present, leading to the formation of a fluidized bed. This means that the diatreme is in agglomeration or granulation mode. Depending on the role played by the liquid phase involved, we obtain accretionary lapilli or droplet lapilli. Accretionary lapilli are formed when dust particles collect in a rotating gas flow and stick together due to a highly fluid medium (carbonatite melt). Droplet lapilli are formed when low-viscosity silicate melt (e.g. melilititic or melilite- nephelinitic) is atomized and the droplets agglomerate in the turbulent gas space. This causes the so-called “cauliflower surface” of these lapilli (Figure 2a-2b).

Figure 2:

The lapilli can occur with or without a nucleation center, with the droplet lapilli often forming around an inclusions or juxtaposed xenolith (Figure 2c-2d) with and without nucleation center (micrograph, edge length approx. 2.5 cm). If the flow conditions in the ascending channel change, the system can switch from agglomeration mode to abrasion mode. In this case, the rotating clasts transported in the conveyor chute are rounded in a similar way to a sandblasting fan. The rounded sanidine megacrysts from Rockeskyll and Hohenfels- Essingen, whose rounded surfaces have so far been interpreted as fusions, are well known (Eilhard 2018) [48]. There are also plenty of rounded accessory rock xenoliths and comagmatic clasts in the form of pyroxenites and amphibolites (Figure 3a-3b).

Figure 3:

The Problem of the Carbonatitic Binding Phase in Tephra

Ultimately, the problem of CO₂ emission in carbonatitic volcanic eruptions can only be solved according to equation 2 by analyzing the binding phase of carbonatitic tephra. For this reason, we will deal with carbonatitic tephra from various volcanic regions in the following. These volcanic areas are the Eifel (EVC = Eifel Volcanic Complex), the Kaiserstuhl (KVC = Kaiserstuhl Volcanic Complex) and El Hierro (EHSR = El Hierro South Rift).

Sample Material from the EVC

The sample material comes from both the Eastern Eifel (EEVC) and the Western Eifel (WEVC).

In detail, the samples are as follows:

68.3 Tephra, EEVC, Thürer Wald

101.5 subvolcanic soevite, EEVC, Thürer Wald

101.6 Sövite, carbonatitic vein, EEVC, Thürer Wald

94.1 Tephra, WEVC, Essinger Maar

94.5 Tephra, WEVC, Essinger Maar

94.6 Tephra, WEVC, Essinger Maar

95.1 Tephra WEVC, Pulvermaar

Material 101.5 and 101.6 are subvolcanic carbonatites. Figures 4a and 4b provide a visual impression.

Figure 4:

The isotope signature can be used as a starting point (Table 1):

These data are typical for magmatic carbonatites. We will find comparable data in the subvolcanic soevites of the Kaiserstuhl.

Table 1: Isotope signature.

	δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
101.5	–	-6,12	7,52	0,70442	14990
101.6	–	-5,79	7,53	0,70439	15060

Description of the Sample Material

Tephra Thürer Wald, Sample 68.3

The volcanic clastics are cemented by a zeolitic-carbonatitic binding phase. As a result of a syneruptive or posteruptive hydrothermal phase. The geochemical data of the carbonatitic phase are listed in the following table (Table 2).

Table 2: Geochemical data of the carbonatitic phase.

	δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
68.3	–	-7,54	21,68	0,70442	3500

The oxygen signature indicates that the fluid phase was under the influence of vadose waters, with the magmatic signature of carbon and Sr preserved.

Tephra Essinger Maar, Sample 94.1/5/6 and Tephra Pulvermaar, Sample 95.1

They show the volcanic clastics embedded in a carbonatitic binding phase, whose isotopic signature is shown in the following table (Table 3 and Figure 5a-5c).

Table 3: Volcanic clastics embedded in a carbonatitic binding phase.

	δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
94.1	–	-17,94	19,47	0,70594	800
94.5	0,53	-13,32	22,18	0,70645	410
94.6	0,59	-20,35	19,51	0,70613	1900
95.1	–	-12,64	25,60	0,70603	1900

Figure 5: The tephra of the Essinger Maar is shown in a-c.

The direct indication of the magmatic origin of the Eifel tephra is provided by the high Sr content. The Sr content of sedimentary limestones of the Eifel is max. 300 ppm. The C and O isotopy of the carbonate tephra binding phase can no longer represent the Taylor criteria for magmatic isotopy [46] due to its origin. The strontium content of the carbonate binding phase was determined at the tephra of the three localities EM, PM and TW using the ICP-OES method. The tephra of the Pulvermaar is not yet diagenetically consolidated due to its young age. The CaCO₃ appears as an outer coating on the tephra particles, as demonstrated in the Figure 6.

Figure 6: Tephra from the Pulvermaar.

The figure shows the state of the tephra of the Pulvermaar on the left and the state after treatment with diluted acetic acid on the right. The CaCO₃ coating has been removed in this case. However, this means that the tephra particles were embedded in the dusty fallout of CaO, Ca(OH)₂ and CaCO₃ and not in a liquid binding phase of CaCO₃ melt.

Sample Material from KVC

The material was collected in 2023 and then processed. In detail, the samples are as follows:

Sample. Remarks.

69.1. subvolcanic sövite, Badloch

97.2 Droplet lapilli, Kirchberg

105.1. Droplet lapilli, Henkenberg

105.4 Droplet lapilli, Henkenberg

105.5 white tephra, Henkenberg

105.6 hydrothermal limestone, Henkenberg

105.9 gray tephra, Henkenberg

105.10 gray tephra, Henkenberg

Sample 69.1 is the reference value for the initial magma with the following isotope ratios (Table 4):

Table 4: The reference value for the initial magma with isotope ratios.

δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
0,60-	-6,05	7,08	0,70357	0,70357

Description of the Sample Material

Droplet lapilli from Kirchberg, 97.2.

Figures 7a and 7b provide a visual impression of the sample material. The scale in mm is indicated at the bottom of the images. Figure 7b clearly shows the spherical shape of the droplets (droplet), which indicates that they were deposited in a solid state.

Figure 7a and b: Droplet lapilli from Kirchberg.

The isotope data are as follows (Table 5):

Table 5: Isotope data.

δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
0,48	-7,92	15,53	0,70354	4690

Figures 8a, b and c show the BSE image and the Ca and Sr element distribution mapping of a droplet. The Sr- mapping shows very nicely large Ca primary crystals floating in a matrix of fine crystalline CaCO₃, which can be interpreted as residual solidification.

A pronounced carbonatitic binding phase similar to that of the Thürer Wald sample material is not present. This is also confirmed by comparing the δ¹³C values of the whole rock (wr) and the isolated droplet, which are almost identical (see Hubberten 1988 [49] Hay and O’Neil 1983 [50] and table 10.

Droplet Lapilli vom Henkenberg, 105.1 and 105.4.

A striking feature of Figure 9a is the occurrence of light (Dl) and dark (Dd) droplets in the center of the image, embedded in a strongly developed carbonate phase (M). Detailed examinations of the microstructural components (see pictures) reveal the following picture (Table 6).

Table 6: Detailed examinations of the microstructural components.

	δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
Dd dark	0,66	-7,91	14,66	0,70376	3450
Dl light	–	–9,43	15,67	0,70376	3450
Matrix	0,80	-11,57	24,6	–	<NWG

Figure 9: a, b and c provide an optical impression of the sample material. Figure c shows a micrograph.

The absence of strontium and the high δ¹⁸O value of 24.6 ‰, as well as the occurrence of drusen spaces with calcite crystals in the matrix (9b) indicate a hydrothermal post-phase with vadose waters, which also explains the partial alteration of the magnetites and the associated brown coloration of part of the droplets.

Siliceous tephra from Henkenberg, 105.9 and 105. 10.

Figure 10 gives an optical impression of the tephra. 84% of the material consists of CaCO₃ . In addition, fragments of silicate minerals such as olivine, pyroxene, Al-Ca-Fe-containing garnet and Mg-Al-Ti- containing iron spinel occur.

Figure 10: 84% of the material consist of CaCO3. In addition fragments of silicate minerals such as olivin, pyroxene, Al-Ca-fe containing garnets and Mg-Al-Ti containing spinel occur.

The isotope data are as follows (Table 7):

Table 7: Isotope data.

Sample	δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
105.9	0,42	-10,02	24,02	0,70477	281
105.10	0,80	-10,26	23,95	0,70485	239

Remarkable is the occurrence of calcite crystal fragments, with strontium contents of approx. 3000 μg g^-1, which are interpreted as ejected primary crystal fragments from the carbonatitic magma (Figure 11a-b, 12a-b, and 13a-c).

Figure 11: a and b shows an 800 µm x 450 µm primary crystal fragment in thin section. Figure a parallel polarizers, figure b crossed polarizers. It can be clearly seen that the calcite matrix has recrystallized at the edge of the primary crystal fragment. The grain size of this edge is up to 100 µm in contrast to the matrix, which has a grain size of approx. 15 µm. The same proportions can also be seen on the primary crystal fragments of garnet and spinel in Fig. 12 a and b.

Figure 12:

Figure 13: a, b and c show the BSE image and the Ca and Sr mappings of the calcite xenolith.

Silicate-free tephra from Henkenberg, 105.5.

The material consists of 99% CaCO₃ . Figure 15 gives a visual impression of the sample material (Figure 14).

Figure 14: Silicate-free tephra.

The isotope data are as follows (Table 8):

Table 8: Isotope data.

Sample	δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1
105.5	1,03	-9,82	24,42	0,70656	68

The thin section shows a uniform growth structure with grain sizes of 20µm to 50µm. No foreign mineral phases are recognizable (Figure 15).

Figure 15: Thin section of sample 105.5.

The results of samples 105.5, 105.9 and 105.10 can be easily explained if one assumes that CaO and CO₂ are erupted during a carbonatitic volcanic eruption and that the reactions take place according to equations 2 to 5.

During the eruption, CaO dust is blown into the atmosphere, which gradually sediments again. Coarser particles, such as mineral fragments and calcite clasts, are also deposited near the eruption site, as can be seen in material 105.9 and 105.10. The heavy SrO is also deposited near the eruption site. The material of sample 105.5 was transported further, making it xenolith-free, as the heavy crystal fragments sediment near the eruption site. Similarly, the strontium content decreases with distance from the eruption site. The material from Badloch has a strontium content of 9300 μg g^-1, material 105.9/10 has a strontium content of 280 μg g^-1 and material 105.5 of 68 μg g^-1. The xenolith crystals of samples 105.9/10 act as nucleation centers for carbonate formation, as can be clearly seen.

Sample Material from EHSR

The find situation can be seen in Figures 16 and 17.

The discovery points are approx. 3 kilometers apart.

Figure 16: Finding point sample 108.1.

Figure 17: Finding point samples 108.2 and 108.3

Description of the Sample Material

The geochemical data is shown in the table (Table 9 and Figure 18a-c). These three tephras are not yet strongly diagenetically consolidated. As a result, surface waters can exert a strong altering influence. Nevertheless, the tephras show a clear magmatic signature, the C and O isotope values are shifted in the sense of Hay and O’Neil towards carbonates in equilibrium with meteoric water [50]. The ¹⁴C isotope analysis has shown that a considerable ¹⁴C content is present, which correlates with ages of 9000 and 4000 years. These ages represent maximum values, as the dilution effect of the natural air CO₂ content by the volcanic CO₂ means that the initial value of ¹⁴C is lower than is normally assumed. In any case, the detection of ¹⁴C in the tephra confirms the sequence of reactions according to equations 2 to 5.

Table 9: Geochemical data.

sample	δ⁴⁴Ca	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	Sr/μg g^-1	¹⁴C
108.1	0,79	-7,71	28,55	0,70390	980	0,5497
108.2	0,91	-8,931	28,12	0,70373	1100	n.d.
108.3	1,41	-8,832	29,24	0,70464	494	0,3262

Figure 18: a to c provide an impression of the sample material.

Results and Discussion

It can be seen that the δ¹⁸O value of the carbonatitic binder phase is generally greater than 20 ‰. Obviously, the δ¹⁸O value of the carbonatitic source materials (CaO and CO₂) changes under the influence of atmospheric oxygen (δ¹⁸O = 23.5 ‰) in the eruption cloud to these high values of δ¹⁸O > 20‰ (Table 10).

Table 10: Summarizes the results of the tephra data.

Sample	Location	age/Ma	Sr/μg g^-1	δ¹³C	δ¹⁸O	⁸⁷Sr/⁸⁶Sr	δ⁴⁴Ca
68.3	TW	0,44	3500_ic	-7,54	21,68	0,70442	n.d.
94.1	EM	0,47	800_ic	-17,94	19,47	0,70594	n.d.
94.5	EM	0,47	410_ic	-13,32	22,18	0,70645	0,53
94.6	EM	0,47	1900_ic	-20,35	19,51	0,70613	0,59
95.1	PM	0,03	1900_ic	-12,64	25,6	0,70603	n.d.
105.5	KS/HB	16,4	68_ic	-9,822	24,42	0,70656	1,03
105.9	KS/HB	16,4	281_ic	-10,02	24,02	0,70477	0,42
105.10	KS/HB	16,4	238_ic	-10,26	23,95	0,70458	0,8
97.2	KS/K	16,4	4690_wr	-7,92	15,53	0,70354	0,48
105.1/GLD	KS/HB	16,4	3450	-7,91	14,66	0,70376	0,66
105.1/GLH	KS/HB	16,4	3450	-9,43	15,67	0,70376
105.1/M	KS/HB	16,4	<NWG	-11,57	24,6		0,8
wr	KS/K	16,4	n.d.	-7,6	16,9		Data from [49]
wr	KS/K	16,4	n.d.	-7,8	15,7		Data from [49]
isolated lapilli	KS/K	16,4	n.d.	-7,1	15,6		Data from [49]
isolated lapilli	KS/HB	16,4	n.d.	-8,8	15		Data from [49]
M	KS/HB	16,4	n.d.	-10,4	24,6		Data from [49]
M	KS/HB	16,4	n.d.	-10,2	24,7		Data from [49]
M	KS/HB	16,4	n.d.	-10,2	24,6		Data from [49]
GL	KS/HB	16,4	3500	-9,3	13,9	Data from [50]	Data from [50]
GL	KS/HB	16,4	3500	-9,2	14,3	Data from [50]	Data from [50]
GL	KS/HB	16,4	3500	-8,4	14,7	Data from [50]	Data from [50]
M	KS/HB	16,4	<NWG	-17,7	20,6	Data from [50]	Data from [50]
M	KS/HB	16,4	<NWG	-12,1	23	Data from [50]	Data from [50]
108.1	El_H	0,003	980_ic	-7,71	28,55	0,70390	0,79
108.2	EL_H	0,003	1100_ic	-8,931	28,12	0,70373	0,91
108.3	El_H	0,003	494_wr	-8,832	29,24	0,70464	1,41

Ic: isolated carbonate, wr: whole rock, n.d.: not detected.

The δ¹³C value does not change during the eruption as it lacks the exchange partner and the small amount of CO₂ in the air also has a δ¹³ C value of -6.5‰. This means that the change in the δ C value of the tuffitic binding phase is due to later alteration. This can be seen very clearly in the tephra of El Hierro, which can be regarded as recent at around 3 ta and which still fulfills the Taylor criterion for carbon with values of δ¹³C of around -8‰, while the oxygen is already far from this with values of 28 ‰. This shows that the C isotope ratio will be changed by alteration processes after the eruption. However, the lapilli tephra from Kaiserstuhl also shows that the isotopic composition δ¹³C of massive carbonatite, as present in the lapilli, is much more stable than the δ¹⁸O isotopy. The values in the table also show that in cases where the δ¹³C isotope does not deviate or deviates only slightly from the Taylor criterion, the ⁸⁷Sr/⁸⁶Sr value has a magmatic signature. The formation of the droplet lapilli at Kirchberg and Henkenberg must have taken place under conditions that are extremely rarely realized in nature. This shows that only three such sites are currently known: Kaiserstuhl [51], Cape Verde Islands [37] and Fort Portal Volcanic Field, Uganda (Barker and Nixon 1988 [38]). The carbonate melt must have spattered. It then formed into a sphere due to the surface tension and suddenly solidified. Accordingly, the micrographs Figure 8c show calcite primary crystals precipitated from the melt and a fine-grained matrix as residual solidification.

Figure 8: a, b and c show the BSE image and the Ca and Sr element distribution mapping of a droplet. The Sr- mapping shows very nicely large Ca primary crystals floating in a matrix of fine crystalline CaCO₃ , which can be interpreted as residual solidification.

The synthesis of physical data on the pressure- and temperature- dependent phase relationships in the CaCO₃ system and the findings on the dissolution behaviour of CaCO₃ and H₂O in silicate melts and their influence on the density and fluidity of the melts under consideration, as well as the calculation of the associated ascent rates, allow conclusions to be drawn about the eruption behaviour in diatremes. Diatremes are bound to tectonically predetermined structures that allow the highly fluid melts to rise rapidly and thus leave them no time to cool. If the melts reach the pressure range that results in the decomposition of the CaCO₃ or the release of the CO₂, a gigantic fan is created that opens the vent to the Earth’s surface by fragmenting the overlying cover, which explains the high content of wall rock xenoliths in the diatreme. If one now takes into account the phenomena known from technology that are associated with the transport of particles in flowing gases (fluidisation), then the tephras of volcanic pipes that can be found in the terrain can be easily explained. Furthermore, the detection of the carbon isotope ¹⁴C in carbonatitic tephra confirms the dissociation and recombination of CaCO₃ during the eruption. For the Eifel, this means that the formation of the maars exclusively by phreatomagmatic processes must be reconsidered. This concept was already criticised in the work of Rausch et al. (2015) [52], but was only included in the work of Schmincke et al (2022) [53], in which the formation of maars in the Eifel by sudden magma degassing is also considered possible.

Acknowledgement

We would like to thank A.Pack, Georg-August University of Göttingen for massive support at measuring the oxygen und carbon isotopy. We would also like to thank L. Viereck for valuable advice during the preparation of the manuscript.

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The Psychological and Social Impact of Immigration Policies: A Minority Stress Perspective

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DOI: 10.31038/PSYJ.2024653

The incoming Trump administration has outlined plans to implement a series of immigration policies emphasizing stricter enforcement measures, prioritizing mass deportations, enhanced border security, and the rollback of humanitarian programs [1]. Key components are expected to include the reinstatement of the “Remain in Mexico” program, requiring asylum seekers to await their court proceedings outside the United States; rolling back Temporary Protected Status (TPS) for individuals from certain countries; targeting the Deferred Action for Childhood Arrivals (DACA) program; reducing pathways for family-based immigration; re-introducing the Social Security Administration (SSA) no-match letters program to identify employees who are unable to establish continued authorization to work in the U.S. [2]; and deploying the U.S. military to aid in deportation efforts [3]. While framed as mechanisms to enhance national security and uphold legal frameworks, these policies are likely to foster a hostile social environment that disproportionately affects immigrant populations in the country. When analyzed through the lens of social determinants of health and minority stress theories, the potentially far-reaching implications of these policies on mental health become evident.

Social Determinants of Health and Hostile Environments

Dynamic systems theory asserts that humans are susceptible to their social environments, and challenging conditions can profoundly affect physical and mental well-being. Aligning with this perspective, the World Health Organization recognizes that social and community contexts- where individuals are born, grow, live, work, and age – significantly shape health outcomes [4]. Hostile social environments shaped by stigma, prejudice, and racism can act as substantial sources of chronic stress, with detrimental effects on targeted individuals’ well-being [5].

The incoming administration’s proposed policies will likely intensify these challenges by fostering environments steeped in fear and uncertainty. The plan for mass deportations with the potential use of the military would exacerbate the sense of insecurity among irregular immigrants, increasing their anxiety and stress levels. Programs like “Remain in Mexico” could disrupt the social and community contexts central to health, forcing asylum seekers into precarious living conditions that lack access to stable housing, healthcare, and safety. These policies are likely to serve as structural mechanisms that amplify the chronic stressors already affecting marginalized populations.

Minority Stress and Stigma Consciousness

The chronic stress experienced by individuals belonging to marginalized social groups is referred to as minority stress. The sources of minority stress are categorized into external (distal) and internal (proximal) stressors. External stressors include observable experiences such as rejection, discrimination, and acts of violence (Meyer, 1995) -all of which are likely to escalate under the incoming administration’s stricter enforcement measures.

Internal stressors, on the other hand, involve internalized perceptions of stigma and societal prejudices, such as internalized racism or homophobia (Meyer, 1995). This process, also referred to as stigma consciousness [6], reflects an individual’s heightened awareness of sociocultural stereotypes and biases targeting their group. For immigrants in the U.S., stigma consciousness is further intensified by public narratives that dehumanize them and portray them as “threats” to social order and public security (E.g., Haitian immigrants eating pets).

Political leaders and public figures significantly shape societal perceptions and influence inter-group dynamics [7]. Provocative rhetoric that labels irregular immigrants as “illegal,” “criminal,” or even “pet-eaters” harms both communities. It creates immigraphobia, an irrational fear of incoming migrants and immigration, by fostering perceptions of threat to national identity, public safety, or resource availability amongst the American public, creating divisions and mistrust. Also, it simultaneously fuels stigma consciousness, fear, and anxiety within immigrant populations. Furthermore, the psychological strain of concealing one’s vulnerable identity, such as an immigrant with irregular status hiding their identity due to the fear of deportation, will add to the cumulative burden of minority stress (Meyer, 1995).

Research shows that stigma consciousness and vicarious experiences of racism – such as witnessing or hearing about discriminatory policies or deportations- foster pervasive fear and anxiety (Yip et al., 2022). Even in the absence of direct personal attacks, the anticipation of rejection, hostility, discrimination, or expulsion can place individuals in a chronic state of stress and hyper-vigilance, with long-lasting consequences for their mental health and well-being. The psychological harm resulting from prolonged personal, collective, and vicarious experiences of racism and discrimination can culminate in racial trauma [8] with symptoms of hyper-vigilance to threats, flashbacks, avoidance of others, heightened suspiciousness, and somatic symptoms such as headaches, heart palpitations (Comas-Díaz et al., 2019). Furthermore, research has consistently correlated perceived racial discrimination with increased severity of anxiety, depression, and psychological distress [9-13]. These findings underscore the profound and multifaceted potential impacts of planned exclusionary policies on the mental health of immigrants, highlighting the urgent need for systemic changes to mitigate these stressors.

Broader Impacts on Immigrant Communities

The ripple effects of the above-mentioned hostile migration policies may extend beyond individuals, disrupting the social fabric of immigrant communities. Deportations and fear-based environments can erode collective resilience, weaken informal support systems, and instill mistrust in institutions such as healthcare and education. This mistrust may discourage immigrants from accessing essential services, including mental health support, further compounding the psychological toll. Fear of exposure or legal repercussions can exacerbate this avoidance, leaving individuals without critical resources to mitigate the stressors they face.

Conclusion

The incoming Trump administration’s planned immigration policies are likely to contribute to a hostile sociopolitical environment, intensifying stigma consciousness and minority stress among immigrant populations. Based on research and theory, these policies are expected to exacerbate mental health disparities while undermining community cohesion and individual resilience. The resulting cycle of fear and exclusion could perpetuate systemic inequalities, highlighting the urgent need for more inclusive and equitable approaches to immigration and public health. By addressing the structural and systemic factors that contribute to chronic stress and trauma, policymakers can foster environments that promote mental health and well-being for all individuals, regardless of their immigration status.

References

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Cokley K, Krueger N, Cunningham SR, Burlew K, Hall S, et al. (2021) The COVID-19/racial injustice syndemic and mental health among Black Americans: The roles of general and race-related COVID worry, cultural mistrust, and perceived discrimination. Journal of Community Psychology. [crossref]
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Articles in Progress

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Bridging Knowledge and Practice: Exploring Evidence Based Practice Implementation in Acute Care Nursing

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DOI: 10.31038/IJNM.2024554

Abstract

Background: The effective implementation of evidence-based practices (EBPs) in healthcare is essential for enhancing patient outcomes. However, in acute care settings, the adoption of EBPs can be inconsistent due to organisational barriers, hierarchical structures, and limited resources. Interprofessional collaboration and continuous professional development (CPD) are critical in overcoming these challenges, empowering nurses to apply evidence-based knowledge in clinical practice.

Aim: This study aims to investigate how EBPs are implemented in two large acute care hospitals in East England, focusing on the roles of interprofessional collaboration, nurse led initiatives, and CPD in facilitating or hindering EBP adoption.

Materials and method: A collective qualitative case study design was used to examine EBP implementation across two hospitals with different organisational contexts. Data were collected through semi-structured interviews with nurses and physicians, and non-participant observation. Thematic analysis was conducted to identify key themes.

Results: The findings highlight that formal interprofessional collaboration, such as regular interdisciplinary meetings, significantly supports EBP adoption by enhancing communication and shared decision-making between nurses and physicians. However, professional silos and hierarchical barriers remain prevalent, often slowing EBP implementation and limiting nurse input. Nurses used their clinical expertise to independently advocate for and lead small-scale EBP changes, particularly in infection control and wound care, resulting in notable patient outcome improvements. CPD emerged as a powerful enabler, boosting nurses’ confidence and capacity to challenge outdated practices and advocate for evidence-based changes.

Conclusion: Formal collaboration structures and accessible CPD are essential to successful EBP implementation. Addressing hierarchical barriers and fostering interprofessional dialogue can improve the integration of evidence-based knowledge into routine care, empowering nurses as key drivers of change.

Background

Knowledge implementation stands at the forefront of healthcare advancements, essential for driving improvements in patient outcomes and elevating overall care quality [1-3]. Evidence-based practice (EBP) in nursing involves the integration of clinical expertise, patient values, and the best available evidence to inform clinical decision-making [4]. This approach not only enhances the effectiveness of patient care but also supports the professional development of nurses by grounding practice in research and evidence [1]. However, despite substantial evidence supporting EBPs and strong endorsements from health authorities like the National Institute for Health and Care Excellence (NICE) and the Nursing and Midwifery Council (NMC), there are significant barriers to EBP implementation in acute care settings, particularly in the United Kingdom [5]. These barriers often include organisational silos, hierarchical structures, and a lack of resources and time allocated for continuous professional development, which limit the capacity of nurses to fully integrate EBPs in routine practice [6,7]. Interprofessional collaboration has been shown to significantly enhance EBP implementation, as it encourages knowledge sharing and supports decision-making across disciplines [8]. Studies have demonstrated that healthcare environments promoting interdisciplinary teamwork foster more effective communication, increase the uptake of EBPs, and ultimately improve patient outcomes [9]. Yet, evidence also highlights that healthcare organisations often operate within rigid professional silos, which impede the collaborative processes essential for EBP integration [10,11]. In particular, nurses may face challenges when their input is undervalued or dismissed in favour of physician-dominated perspectives, limiting the full utilisation of their expertise and knowledge in decision-making [2]. The persistence of these silos suggests a gap in understanding the mechanisms by which interprofessional collaboration can be consistently and effectively integrated into acute care practices to support EBP.

Nurses play a pivotal role in identifying care gaps and initiating evidence-based changes due to their continuous patient interactions and hands-on care delivery experience [12]. Studies indicate that when nurses are empowered with autonomy and professional development opportunities, they can act as change agents, advocating for and implementing EBPs independently, which positively impacts patient care [13,14]. Nonetheless, despite the recognised value of nurse-led EBP initiatives, healthcare systems often lack structures that empower nurses to independently lead such efforts, particularly in resource-limited environments where formal professional development opportunities may be scarce [15]. This challenge is compounded in acute care settings where workload pressures and staffing shortages can further limit the ability of nurses to dedicate time to EBP [6]. Addressing these barriers through targeted support, professional development, and restructuring of roles could enable nurses to make greater contributions to evidence-based improvements. A key factor in empowering nurses to lead EBPs is continuous professional development (CPD), which has been shown to significantly increase confidence, advocacy skills, and the ability to challenge outdated practices [16]. However, studies highlight disparities in access to CPD, particularly in settings with limited resources [17]. While some research advocates for structured CPD to enhance EBP implementation [18], there remains a lack of comprehensive understanding regarding the ways CPD and nurse empowerment impact EBP adoption in under-resourced acute care settings. Given the crucial role of nurses in direct patient care, addressing the gap in CPD access and exploring its impact on EBP utilisation are essential for supporting sustained improvements in healthcare quality. In response to these gaps, this study aims to investigate the dynamics of interprofessional collaboration, nurse-led initiatives, and professional development as facilitators and barriers to EBP implementation in acute care settings. By examining these factors across two large hospitals in East England, this study seeks to provide insights into the specific organisational and professional elements that enable or hinder the effective integration of EBPs. The findings will contribute to a deeper understanding of how healthcare organisations can leverage interprofessional collaboration, empower nurses, and enhance CPD to optimise patient care and support sustained EBP adoption.

Material and Methods

Research Design

This study utilises a collective qualitative case study design. The collective case study approach is ideal for examining multiple cases with shared characteristics, allowing cross-case comparison and deeper analysis of complex phenomena like EBP in healthcare settings [19]. The qualitative case study design ensures a thorough and nuanced understanding of EBP implementation challenges across diverse hospital environments [3]. The study followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) [20].

Study Settings

The study took place between September 2017 and July 2023. Purposive sampling was conducted in two acute care settings in the East Midland region of England. The sample included one mid-sized general hospital (600 beds) and one large general hospital (700 beds), both selected to represent diverse leadership experiences and organisational contexts. These hospitals, the largest in the region, shared similar geographical and socio-cultural characteristics and were chosen to explore EBP in a complex clinical environment with rich data potential. The decision to focus on these two hospitals was driven by practical considerations of cost, time, and accessibility, aligning with Stake’s [21] recommendation to select cases that are both welcoming and feasible for research.

Sample Size and Participants

A total of 23 staff nurses (SNs) and nurse managers (NMs) and 2 Physicians participated in the study. The inclusion criteria were: (1) individuals with at least two years of experience working in these settings; and (3) those willing to participate and who signed the informed consent form. Participants were excluded if they had to withdraw due to work-related commitments or health issues during the interview period. Tables 1 and 2 present the demographics of participants. Participants in both study sites were similar. The participants’ years of experience ranged from 6 to 35 years, reflecting a broad spectrum of clinical expertise across both cases.

Table 1: Participants’ Demography (Site 1).

Table 2: Participants’ Demography (Site 2).

Data Collection

Data were collected through semi-structured interviews and non-participant observation (Table 3), enabling triangulation and validation of findings [22]. Interviews were guided by an interview guide (Table 4), recorded, and transcribed. Non-participant observation captured real-life interactions, providing insights into the practical implementation of evidence-based practices. In both sites, the lines of communication for EBPs were well-established, with the Research and Development (R&D) Unit playing a key role in facilitating communication and disseminating evidence-based guidelines. The R&D and Practice Development Units were also involved in developing local evidence guidelines for their respective teams.

Table 3: Data sources

Table 4: Interview Guide

Data Analysis

Braun and Clarke’s [23] thematic analysis framework was employed to systematically organise the finding following six key phases. The process began with familiarisation, where interview data, field notes, and observations were reviewed to understand participants’ experiences with EBP. During coding, key segments were labelled, including ‘collaborative protocol development’ ‘exclusion from decision-making’ and ‘empowerment through training’. These codes informed broader themes in the next phase: ‘Facilitators and Barriers to Knowledge Implementation’ ‘Nurses as Drivers of Knowledge Implementation’, ‘Enhancing Collaboration and Knowledge Sharing’, ‘Empowerment through Professional Development’, and ‘Transformative Impact of Nurse-Led EBP’. Themes were then reviewed for coherence and refined for clarity, defining each as it related to the study’s focus. For instance, ‘Knowledge sharing through collaboration’ addressed co-developed protocols, while ‘Barriers created by silos’ highlighted decision-making exclusions. In the final report, these themes collectively illuminated facilitators, barriers, and the impact of nurse led EBP, presenting a cohesive narrative on EBP integration in acute care settings. Overview of the key themes is presented in Table 5.

Table 5: A summary of key themes

Ethical Considerations

This study followed the ethical principles of the Declaration of Helsinki of 1964 and received approval from the University of Northampton Research Ethics Committee. Each hospital’s management also granted permission for participant recruitment. Broader ethical approval was not required, as the study did not involve minors, clinical trials, or pose any risks to participants, per UK regulations. Participants received electronic and written invitations detailing the study’s purpose, confidentiality, data handling, and their right to withdraw without consequences. Informed consent was obtained in line with GDPR. The researcher shared their professional background and explained the study’s aims to build trust [22], ensuring anonymity in reporting. All data will be securely stored and destroyed after publication, and participants were treated with respect throughout.

Rigour and Reflexivity

The study adhered to principles of credibility, transferability, dependability, and confirmability [22]. Triangulation, prolonged engagement, and multiple data collection methods, including interviews and observations, were employed to capture diverse perspectives. Spending eight months in the field enhanced credibility by providing a thorough understanding of issues affecting EBP implementation. The research process was meticulously documented, with detailed contextual information and a clear audit trail, ensuring transferability and potential replication [21]. Participant quotes supported data analysis, ensuring transparency [19]. Reflexivity was maintained through explicit acknowledgment of the study’s philosophical foundations, and a research diary preserved consistency during analysis. Finally, the COREQ guidelines were followed in reporting the qualitative results [20].

Findings

The findings reveal that effective knowledge implementation in acute care is influenced by interprofessional collaboration, nurse-led initiatives, and professional development. Key themes include the role of collaboration between nurses and physicians in facilitating knowledge sharing, though hindered at times by professional silos; nurses’ proactive leadership in driving EBPs, particularly in infection control and wound care; and the empowering effect of continuous professional development, which equips nurses to confidently advocate for and apply evidence-based changes in patient care.

Facilitators and Barriers to Knowledge Implementation

Findings from both sites show that the effective implementation of EBPs was influenced by the degree of interprofessional working between nurses and physicians. While collaboration often facilitated the integration of new practices, barriers still emerged where professional silos and communication breakdowns occurred. This theme explores how interprofessional collaboration supports or hinders the implementation of EBPs and highlights the challenges faced by nurses in these collaborative processes.

Knowledge Sharing Through Collaboration

Interprofessional collaboration was a crucial factor in facilitating knowledge implementation at both sites. The sharing of expertise between physicians and nurses allowed for the co-development of new care protocols, particularly when teams had clear communication pathways. In site 1, nurses shared: “…we worked with the doctors on a new pain management protocol, and by discussing the evidence together, we were able to agree on a more effective approach. It felt like real teamwork” (Interview, Senior Nurse, S1). Similarly, I site 2, collaboration led to quicker decision-making: “…the consultants started involving us in discussions about infection control measures…we shared our observations, and they adjusted the protocols…that kind of collaboration made a huge difference.” (Interview, Infection Control Nurse, S2). This finding demonstrates how interdisciplinary collaboration fosters a mutual understanding and respect for each profession’s expertise, enabling smoother EBP implementation.

Barriers Created by Professional Silos

Despite the benefits of collaboration, professional silos were a significant barrier at both study sites, with nurses often excluded from decision-making processes. This resulted in slower implementation of evidence-based changes and frustration among nursing staff. In site 1, nurses expressed that they “had solid evidence for a change in wound care practice, but we weren’t involved in the initial discussions…it took weeks for the doctors to acknowledge our input, which delayed everything” (Interview, Senior Nurse, S1). Similar experiences were reported in site 2 with nurses stating that they “…were pushing for months to update our catheter care protocol, but we weren’t getting feedback from the doctors…they would discuss it among themselves and leave us out, which slowed down the process.” (Interview, Nurse Manager, S2). These quotes highlight the negative impact that professional silos have on knowledge implementation, with nurses feeling marginalised and unable to influence critical decisions, despite having evidence-based insights to offer.

Nurses as Drivers of Knowledge Implementation

While hierarchical barriers remain, nurses at both study sites played a proactive role in driving the implementation of EBPs. Their clinical experience, patient proximity, and understanding of care needs positioned them as key advocates for change. This theme explores how nurses used their expertise to implement EBPs, even when formal collaboration with physicians was lacking.

Leveraging Clinical Expertise to Advocate for Change

Nurses at both sites demonstrated the capacity to introduce new practices based on evidence, using their clinical expertise to identify care gaps and push for changes. Even in environments with limited formal collaboration, nurses were able to initiate small-scale, impactful interventions. In site 1, Ward Managers seem to have utilised their expertise to advocate for EBP implementation. For example, one of the nurses expressed “…I noticed that our pressure ulcer incidence was increasing, so I introduced a new prevention strategy…the doctors were hesitant at first, but we showed results quickly, and it became standard practice” (Interview, Ward Nurse, S1)

Nurses in site 2 appeared to have done utilised similar strategies: “we started trialling a new dressing technique based on research, even before it was formally approved…once the physicians saw the improvement, they accepted it as part of our wound care protocol” (Interview, Senior Nurse, S2). These examples illustrate how nurses, using their practical knowledge, were able to implement EBPs independently, improving patient outcomes even without immediate approval from physicians.

Integrating EBP into Routine Care

Nurses at both sites consistently integrated evidence into daily care activities, often making subtle changes that did not require formal approval but had a significant impact on patient care. These routine adaptations of EBPs highlight nurses’ roles as continuous drivers of care quality improvements. In site 1, an observation of ward round revealed some clinical procedures related routine knowledge implementation: “…during rounds, a nurse adjusted a patient’s medication schedule to align with the latest evidence on pain management, even though the consultant had not yet approved the change. It made a noticeable difference in the patient’s comfort” (Observation, Ward Rounds, S1). A similar scenario played out in site 2 where during observation “nurses began closely monitoring post-surgical patients for early signs of infection, following new evidence on early detection, even though the formal guidelines hadn’t yet been updated” Observation, Post-Surgical Ward, Site 2). These examples demonstrate how nurses are able to integrate evidence into routine care processes, subtly driving improvements in patient outcomes, even when formal approval or recognition from physicians is delayed.

Enhancing Collaboration and Knowledge Sharing Through Interprofessional Initiatives

While professional silos remain a challenge, both study sites showed promising examples of initiatives aimed at fostering better collaboration between nurses and physicians. These initiatives helped to break down barriers, promote knowledge sharing, and accelerate the implementation of EBPs.

Formal and Informal Collaboration

A structured collaboration initiatives were established in site 1, with regular meetings to discuss new research and evidence-based changes in practice. This formal collaboration significantly improved communication and sped up the adoption of EBPs. One of the physicians shared: “…we’ve started having weekly meetings where the whole team, including nurses, discusses new research…it’s really improved our teamwork and made it easier to agree on new practices.” (Interview, Physician, S1). On the other hand, collaboration was less formal in site 2, but still made a positive impact as expressed by some of the nurses: “|…we don’t have regular joint meetings yet, but I’ve noticed that the doctors are increasingly asking for our input during rounds…it’s a good start” (Interview, Senior Nurse, S2). These examples suggest that while formal structures may enhance collaboration, even informal efforts can foster better communication and improve the implementation of EBPs.

Creating Interdisciplinary Knowledge Networks

Both sites showed an emerging recognition of the need for interdisciplinary knowledge networks that enable the continuous exchange of information and expertise across professional boundaries. In site 1, one of the nurses described the value of these networks as positive. “…we set up a group where nurses and doctors present the latest evidence guideline, they’ve come across…it’s helped bridge the gap between our roles and encouraged us to adopt new practices quicker.” (Interview, Senior Nurse, S1). A similar approach was developing in site 2 as indicated by the quote: “…whenever we get the chance to sit down together and discuss cases, it leads to real learning…that’s when the best ideas come up, and we’re able to implement them” (Interview, Nurse Manager, S2). The recognition of interdisciplinary knowledge sharing at both sites emphasises the importance of creating formal structures to support this collaborative learning, which is crucial for timely and effective EBP implementation.

Empowerment Through Continuous Professional Development

Education and continuous professional development are critical for empowering nurses to lead the implementation of EBPs. Both sites recognised the importance of investing in nurse education to strengthen confidence, knowledge, and the ability to advocate for evidence-based changes.

Education as a Driver of Confidence

Structured professional development opportunities, including workshops and training on EBPs, had a positive impact on nurses’ ability to implement new practices confidently. One of the nurses shared: “…after attending regular workshops on EBP, I feel much more confident bringing new ideas to the table…it’s made a huge difference in how we approach care” (Interview, Nurse Manager, S1). In site 2, education appeared to be self-driven, with nurses seeking out external opportunities: “…we don’t have as many formal training programmes, so we’ve had to find our own opportunities for development…it’s been challenging, but it’s also made us more proactive” (Interview, Senior Nurse, S2). These differing approaches highlight the need for more structured educational support at all sites to empower nurses in knowledge implementation.

Building Advocacy Through Education

Professional development not only improved knowledge but also empowered nurses to challenge outdated practices and advocate for EBPs. Nurses across both sites reported feeling more equipped to engage with physicians after receiving training. One of the nurses remarked: “…the EBP training gave me the tools I needed to confidently push for changes in the ward…now, I’m not afraid to challenge practices that don’t align with the evidence…” (Interview, Nurse, S1). Similarly, in site 2 “…the more I learn about the latest research, the more I feel I can make a real difference in care, even if it means going against established practices” (Interview, Senior Nurse, S2). These findings demonstrate how education enhances nurses’ capacity to advocate for evidence-based care and challenge traditional, less effective practices.

Transformative Impact of Nurse Led Knowledge Implementation

When nurses are empowered to implement EBPs, the results are transformative, both in terms of patient outcomes and the evolution of nursing practice. This theme explores the direct impact of nurse-led knowledge implementation on patient care and the professional development of nursing teams.

Improved Patient Outcomes

Both sites reported significant improvements in patient outcomes following the successful implementation of EBPs led by nursing teams. These improvements were particularly evident in infection control and wound care management. In site 1, a nurse shared: “…since we introduced the new infection control guidelines, we’ve seen a dramatic reduction in hospital-acquired infections…it’s been one of our biggest successes” (Interview, Infection Control Nurse, S1). In site 2, similar results were observed in post-operative care: “…the changes we made to wound care, based on the latest evidence, have reduced complications for our patients. It’s really shown how powerful EBPs can be” (Interview, Senior Nurse, S2). These success stories highlight the significant positive impact of nurse led EBP implementation on patient safety and care quality.

Transforming Nursing Practices

In addition to improving patient outcomes, nurse led EBP implementation has transformed nursing practices at both sites. Nurses reported feeling more empowered and respected within their teams, as their roles evolved from task-oriented responsibilities to research-driven care leadership. In site 1, a nurse reflects: “…implementing EBPs has changed how we work…it’s given us more credibility and made nursing more evidence-driven, which is how it should be” (Interview, Nurse Manager, S1). A similar sentiment was expressed in site 2: “…we’re no longer just following orders…we’re part of the decision-making process, and it’s changed how we see ourselves as professionals” (Interview, Senior Nurse, S2). These transformations underscore the critical role nurses play in leading the adoption of EBPs and improving the overall quality of care through evidence-driven practices.

Discussion

The findings of this study reveal complex interplays between interprofessional collaboration, hierarchical structures, and nurse-led initiatives in implementing EBPs within acute care settings. Key themes such as knowledge sharing, barriers due to professional silos, and the role of CPD emerged, all of which reinforce the necessity of a collaborative and empowering healthcare environment for EBP. These findings align with previous research while also highlighting unique challenges and opportunities within the study sites. The findings indicate that interprofessional collaboration significantly facilitates EBP adoption, a view supported by Reeves et al.., [8], who argue that interprofessional teamwork enhances knowledge exchange, ultimately leading to improved patient outcomes. Regular interdisciplinary meetings allowed nurses and physicians to share insights and align protocols, illustrating how formalised structures can improve communication, a point echoed by Grimshaw et al., [11]. However, the lack of formal collaboration structures slowed EBP adoption, suggesting that the absence of structured interactions may undermine the speed and efficacy of implementing evidence-based changes. Sullivan et al., [10] similarly argue that professional silos and the absence of regular interdisciplinary meetings can hinder EBP adoption, creating inefficiencies in decision-making. This comparative insight supports the notion that effective collaboration is contingent on formal structures that facilitate dialogue across professions, yet the findings also suggest that even informal collaboration, as observed at Site 2, can initiate positive change, albeit more slowly. Both study sites reported significant barriers due to professional silos, with nurses often excluded from decision-making processes. This aligns with the work of Dunn et al., [24-29] and Ominyi et al., [2], who found that hierarchical structures in healthcare often subordinate nursing perspectives to medical authority, limiting nurses’ capacity to advocate for EBPs effectively. The hierarchical barriers evident in this study exemplify how power dynamics in healthcare can stifle nurses’ evidence-based suggestions, even when such recommendations have the potential to improve patient outcomes. Brown et al., [15] also identified these silos as sources of frustration, as healthcare workers experienced delays in practice change implementation due to a lack of engagement and feedback from other professional groups. These barriers suggest that healthcare organisations must address hierarchical dynamics to facilitate a more inclusive decision-making process, enabling nurses to participate fully and contribute their insights into patient care practices.

Despite the hierarchical constraints, nurses at both sites demonstrated a proactive approach to EBP, using their clinical expertise to introduce evidence-based changes in infection control and wound care. This finding aligns with Harvey et al., [1], who highlight the critical role of nurses as change agents in direct patient care. Moreover, Gerrish et al., [6] found that empowering nurses to act independently often led to improved patient safety and care outcomes. Nurses in this study leveraged informal knowledge-sharing networks to drive improvements in practice, particularly when formal approval from physicians was not immediate. This self-driven initiative underscores the potential of nurse-led interventions in advancing EBP, even within restrictive organisational structures. The findings emphasise the importance of CPD in empowering nurses to implement EBPs confidently. Study findings reveal that structured CPD opportunities can boost nurses’ confidence in suggesting evidence-based changes, a result consistent with McCormack et al. [16], who argue that CPD enhances practitioners’ capacity to challenge outdated practices. However, Site 2’s reliance on self-driven educational pursuits illustrates the limitations of under-resourced environments, where formal CPD support is sparse. The disparity between the two sites reinforces Melnyk and Fineout-Overholt’s [4] argument that healthcare organisations must invest in continuous, structured professional development to support sustained EBP integration. Without organisational support for CPD, nurses may struggle to access the resources and training necessary to lead evidence-based improvements effectively. The study highlights the importance of interprofessional collaboration and nurse-led initiatives in effective EBP implementation. Formal interdisciplinary meetings enhance communication, decision-making, and reduce silos, thereby improving patient care. Additionally, investing in structured CPD for nurses builds confidence and strengthens their advocacy for evidence-based changes. Healthcare organisations should prioritise these areas to support sustained EBP integration and optimise healthcare delivery. For future research, examining ways to minimise hierarchical barriers and exploring the long-term impact of collaboration structures on EBP are essential. Research on structured CPD programmes, particularly in resource-limited settings, and identifying best practices in nurse-led EBP initiatives could further support patient care improvements.

Strengths and Limitation

This study’s strengths lie in its use of a collective qualitative case study design, providing an in-depth exploration of knowledge implementation across diverse acute care settings. Through triangulation of data from interviews, observations, and document analysis, the study ensures a comprehensive understanding of facilitators and barriers in EBP adoption. However, the study has limitations; the perspectives primarily represent staff nurses, nurse managers, and physicians, potentially overlooking insights from other key stakeholders, such as patients and policymakers, which could further enrich the understanding of interdisciplinary challenges in knowledge implementation.

Conclusion

This study highlights the importance of interprofessional collaboration, CPD, and nurse empowerment in implementing EBP within acute care settings. However, challenges persist, particularly regarding hierarchical barriers and inconsistent CPD support. Formal structures, such as interdisciplinary meetings, significantly enhance EBP adoption, though informal collaboration can still foster progress. Findings emphasise that nurses, even with limited formal support, can lead impactful EBP initiatives, illustrating their role in advancing patient outcomes. Further research should address strategies to reduce professional silos and support structured CPD, especially in resource-limited environments, to enable sustainable, nurse-led EBP integration in healthcare.

Acknowledgements

We wish would appreciate all nurses who participated in this study.

Author Contributions

JO and NA contributed to the conceptualisation and methodology of this study. JO and NA were involved in the investigation and validation of the results. JO and NA were responsible for data curation and formal analysis. JO contributed to the drafting of the manuscript, while NA reviewed and edited. JO supervised the study and provided necessary resources. All authors have read and approved the final version of the manuscript.

Funding

None received.

Data Availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Declarations

Ethical Approval and Consent to Participate

This study received approval from the University of Northampton Research Ethics Committee. Each hospital’s management also granted permission for participant recruitment. Broader ethical approval was not required, as the study did not involve minors, clinical trials, or pose any risks to participants, per UK regulations. They were informed that they could refuse to answer any questions or withdraw from the study at any time. All recordings were securely stored in accordance with confidentiality principles.

Consent to Publish

Not Applicable.

Competing Interests

We declare no conflict of interest.

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Information Architecture for the Management of Collaborative Information to the Citizen on Health Care Issues in the Areas of Pinar del Rio Municipality

1 Reply

DOI: 10.31038/IJNM.2024553

Abstract

Introduction: Information Technologies are currently essential elements for the improvement and development of a country, on the other hand, Cuba has identified from very early on the need to introduce Information and Communication Technologies in social practice and achieve a digital- technology culture as one of the crucial characteristics of the new man. Cuba is moving towards electronic-government, achieving digital technology and information literacy in the decisive processes, creating channels to increase citizen participation. How to contribute to the management of collaborative information to the citizen on health care issues in the areas of Pinar del Rio municipality?

Objective: to develop the Information Architecture for the Citizen Collaboration in the health care issues in the areas of Pinar del Rio municipality.

Methods: a Technological Innovation Research on information management in the health care areas of the municipality under study is carried out following the methodology of software development for Extreme Programming, and applying theoretical and empirical methods for the analysis, review and modeling of the processes under computerization.

Results: it was found that the proposal of information technology is based on managing the information of the different medical services, serving as a tool to help to the organization of the healthcare system and make it more efficient.

Conclusion: a computerized prototype was created that will avoid the gathering of people who come to the institutions in search of answers to questions directed to knowledge or orientation for a determined problematic on purpose of the community projection.

Keywords

Access to information, Software design, Software, Medical informatics applications, Information technology

Introduction

Information and Communication Technologies are currently fundamental elements for the improvement and development of a country [1]. In this sense, Cuba has identified from a very early stage the convenience and need to dominate and introduce social practice ICT and achieving a digital culture as one of the essential characteristics of the new man, which would facilitate society to get closer to the goal of sustainable development [2,3]. In the field of health, it offers a strength in technological progress that presents positive experiences worldwide [4,5]. The most optimistic projections in this regard suggest that a computerized and interconnected world not only ensures growth and development, but which also guarantees improvements in access to facilities that enhance the quality of life, and facilitate broad access to digital content and services for citizens [6,7]. The effort that the Cuban State has made to support the computerization of society is a fact. Concrete actions are developed throughout the country to conclude the initial stage of electronic government [8], it is not only to create the platforms, but also that they work with good practices, provide digital services to the population and interact with the people. In this way, digital and information literacy is achieved as the ability to locate, organize, understand, evaluate and analyze information through digital technology, create channels that allow increasing citizen participation [9,10]. The creation of a computer prototype [11], for the people of Pinar del Río who access the health areas of the main municipality of the province, allows the description of many useful processes to any citizen [12-14], and the possibility of having of them in a single and integrating platform [15,16]. This prototype is based on improving social welfare and the actions carried out by an informed population, in order to provide services and information to citizens, increase effectiveness and efficiency of public management [17], and increase the transparency of the sector with the participation of all communicators who require some information [18-20]. In the different health areas of the main municipality, several processes are developed, this research is immersed in the computerization of each of them, which are aimed at the satisfaction and knowledge of the citizen, maintaining the health of the population, with health promotion and community participation, with the planning, organization, monitoring and evaluation of the processes.

Whose objective is aimed at Electronic Government, where they can streamline, improve, adapt, socialize and reduce costs of the processes and/or activities of the public system, motivated by the use of advances in ICT, through channels that allow increasing participation citizen, with the aim of improving the health status of the population, increasing the quality and satisfaction of the people with the services provided, making the system efficient and sustainable and guaranteeing its development, through community projection. This will be achieved by bringing health services to the community, through the different medical specialties, and with the strengthening at all times of actions aimed at the well-being of citizens who require health services. In each polyclinic, health services are brought to the community with community projection where each specialty such as Surgery, Endocrine, Cardiology, Urology, Traumatology, Dermatology, Menstrual Regulation, Orthopedics, Adult and child Traumatology, Angiology, Nephrology, Gastroenterology, Rheumatology, Adult and child allergy, Optometry, ENT, Ophthalmology, Infertility Consultation, Driver’s License. They are carried out on different days of the week, when the patient is referred from the medical office to the area, or due to medical expenses, this arrives with the referral for the specialist to the admission department of the health unit, the Registration with the patient’s data, identity card, name and surname, doctor’s office, referred by, age, consultation date and time, and the patient is verbally notified of the day the consultation is scheduled. The patient goes to the polyclinic on the day scheduled with the specialist, without knowledge of the place or location of the consultation and the doctor who is going to attend him, as well as the regulations that are established, in addition to the different services that are provided in the institution. What results in a problem in terms of organization and rationalization of the services provided. The problem detected in the development of electronic government in the health sector justifies this research, developed with the participation of citizens who go to the different services. The work is the result of a research project of the master’s degree in Health Informatics, with the aim of developing the information architecture for citizen collaboration in health matters in the areas of the Pinar del Rio municipality.

Methods

The research is due to a technological innovation project for the development of a computer application for the management of Citizen Collaboration on health issues in the areas of the Pinar del Río municipality, in the period from 2019 to 2021, based on the study of the current needs and shortcomings of the population, in the four polyclinics of the Pinar del Rio municipality. The results presented correspond to the analysis and design stages of the project, and they used theoretical research methods such as historical-logical and induction-deduction, to capture functional and non-functional requirements, as well as modeling. of the information architecture on which the Citizen Collaboration management process in the areas of the municipality is based. Among the empirical methods, the following were used: the interview with citizens who require health services, as well as the bibliographic review during the analysis and design of the prototype of the computer application During the course of this research, periodic bibliographic reviews of articles in magazines, national newspapers, scientific publications, related to electronic government in Cuba, development and computerization of a society, literacy of the population regarding digitization of processes, web applications were carried out to manage information. The DeCS health descriptors were used as search strategies to determine keywords, databases such as SciELO, by indexing the terminologies from the common language to the permuted language. For the modeling of the prototype object of study and research, the following trends were used for its design and analysis: extreme XP programming, as an agile development methodology whose main objective is to increase productivity when developing a software project, to model, build and document the elements that make up a software product that responds to an object-oriented approach; the Unified Modeling Language (UML), for the capture of requirements, analysis, design and interoperability with other applications with a multiplatform support. ENTERPRISE ARCHITECT, one of the UML CASE tools, was also used. For the simulation of the behavior of the interfaces, the design of the wireframes and the basic prototype, Axure RP was used as a development tool.

Results

In the health sector of the Pinar del Rio municipality, several processes are developed in the admission area related to citizens who request medical appointments for the different consultations that are developed. Next, the relationship of the process to understand more clearly the aspects worked, starting from the citizen who refers his personal data to the worker who works in admission and in turn verifies if there are shifts for the required consultation, the reservation and notification of the same The research determined through the analysis of the process, the procedures, methods and techniques for solving the problem, based on the modeling of the collaborative management process with the citizen on health issues in the areas of the Pinar del Rio municipality, with the implementation of the following requirements that describe the functionality of the software. The functional requirements that the prototype must meet are nothing more than the capabilities of the product to satisfy both the customer and the end users.

Functional Requirements

R1. Authenticate User

R2. Change Password

R3. Manage Citizen Data

R3.1. Insert Citizen Data

R3.2. Modify Citizen Data

R3.3. Delete Citizen Data

R4. Manage Community Projection

R5. Show Reports

R5.1. Patient Consultations

R5.2. Patients by Date

R5.3. Query by Date

R5.4. Referred Patients

R5.5. Patients by Municipality

R6. Perform Searches

R6.1. Search Patient

R6.2. Search Patient Month

R6.3. Search Patient Office

R6.4. Search Patient by Sex

R6.5. Search Patient by Age Group

R7. Shift Notification

R8. Consult Help

The information architecture was designed, for which the analysis and design stages of the software development process were executed. The actors of the system are defined who constitute the entity that is in charge of the realization of one or more of the functionalities that must be executed. Two actors are defined in the proposed software: the citizen, who is the person who can only enter their personal data and the desired query, and receive notification of it. The admission staff is in charge of managing all the information in the application, that is, inserting, modifying and deleting, in addition to changing the password, and accessing all the consultation options, searches provided by the system and obtaining reports. The functionalities diagram based on the XP methodology is shown, with the relationship between the actors and the different processes of the proposed system.

Description of the System Functionalities

The tool is designed to satisfy the information management requirements of the Citizen Collaboration on health issues, by providing services to the community. With the implementation of the software, which is designed to work from the web, through the network of networks on any platform, which for Pinar del Río citizens who access the health areas of the head municipality of the province allows the description of many useful processes, and the possibility of having them in a single and inclusive platform and the actions carried out for the sake of an informed population, in order to provide services and information to citizens, increase the effectiveness and efficiency of public management. With an informed population, resources, development and knowledge are gained. At the same time, it allows the citizen from his home, work center, recreational area, through the technological development that the province has in terms of info-communications. This prototype manages information regarding health issues in terms of information from polyclinics on location, mission and vision, structural and organizational composition, in addition to the services provided, information related to primary health care, epidemiological alerts, programs specialized, and everything concerning the community projection.The system is designed so that any user can access its interface, select the health area and view the information options that it provides, the citizen must select the health area to which they belong in order to access it, obtain information on health issues and be able to request any consultation related to community outreach. The citizen presses on the community projection button, a window is displayed with the relationship of the consultations by specialty, with the time, day and frequency per week, as well as their location. It must be selected with a click on the query button to schedule a desired shift. The functionality for the Citizen Data management is essential for the beginning of each process, Once the health area has been selected, the citizen selects the consultation to which he was referred to program the doctor’s turn, the system refers you to a new window, to fill in the data requested by the form, name and surname, identity card, municipality, doctor’s office, age, sex, referred by, specialty. Once these data are entered, the citizen’s e_mail and contact telephone number is required so that he or she is notified of the turn for consultation. The citizen must fill in all the fields that present an asterisk (*), these data being mandatory. The system specifies the mandatory fields that must be filled in. When any field is left blank, the process does not end. The system sends you a message.

The system sends a message if when you are going to enter the identity card number you put letters instead of numbers and if any character is missing it returns a message specifying the error. When the citizen is going to enter the date for the consultation. Where the system specifies that only 24 appointments can be given per consultation and the 24 patients are already complete for that date. The system sends a message specifying that there are no available shifts for that date that you must select another and disables the remaining fields. If there are shifts for the selected date, it allows the introduction of the citizen’s email and contact telephone number, captcha the image provided by the system to make sure that it is not a robot and if a user. The citizen clicks on the save button where this information is stored in the Database and the fields are cleared. Once all the data has been entered correctly, click on the Send Notification button, the system sends a notification message of the shift via email with the confirmation of the requested medical shift. The admission staff for each health area enters the prototype through a form where they enter their Name and Password in the corresponding text boxes when pressing the Enter button. If the user is recognized by the application (he is registered in the database of users with access), it shows him the corresponding interface, according to his role in the application. If, on the other hand, the user is not recognized, the application displays an error message “Incorrect username and/or password” in which it warns the user that they do not have rights to access the management of the processes that are develop in the area. The functionality of the admission staff shows the data of the patients that were previously inserted by the citizen, and that are stored in the database; the Reports that the system allows, as well as the Searches to it. It also allows you to change the password periodically as a security measure, and consult the help of the application for any questions in this regard. The application shows the registry of all the patients who were introduced to the system by the citizen himself with his personal data, in addition to the community projection or consultation to which he was referred to be evaluated with the specialist. It allows the admission staff to modify some patient data or delete the unnecessary record. To modify the data of a patient or citizen in the system, the admission staff must select the name of the patient to be modified. As long as the patient has not been selected, the rest of the form data is disabled. Among the functionalities of the application are the Reports, which are aimed at providing information regarding the information management process with the citizen in relation to community projection. The event starts when it is necessary to know, according to a specific query, the patients that are registered. The system sends a message to select the consultation, and returns a list of all the patients that are registered for the selected consultation. In the same way, to know the patients who are registered for a previously selected date.

Discussion

The research carried out is due to a technological innovation project for the implementation of a computer application for citizen collaboration management in the health areas of the Pinar del Rio municipality. It is necessary to computerize the development of collaboration with the citizen on health issues in the different areas of the Pinar del Río municipality, which allows managing all the information of the different medical services, therefore it constitutes a tool to help organize the system and provide you with more efficiency. The absence of a computerized system for the management of information to the population results in disorganization, the accumulation of personnel who go to the institutions in search of answers about the consultations of a specialty, the time and location, the procedure to be followed in mind to be attended by trained personnel to provide quality service. As part of the study of the object of computerization, a review of health sites with related topics was carried out that provide information to citizens who interact with software used in the country. The website entitled, National and Foreign Health Sites, stands out, showing a compilation of links to sites on public health issues in Cuba Among them are the Provincial Nodes of Infomed, Health Specialties and Topics, Sites of Interest, Medical Societies, Health Legislation and Policies, Hospitals and Institutes, Faculties of Medical Sciences, as well as foreign sites on health in Spanish [15].⁾

The analysis carried out on similar sites that provide information to the population on health issues, allowed to shape the structure of the application according to the citizens of Pinar del Río, whether they refer to information of a general nature from the institutions, such as those related to health care properly with the community projection. Where it could be verified that, in the confronted sites, the information is very general and with the characteristics of each unit. In the province of Pinar del Rio there is El Portal del Ciudadano Pinareño [10], which is part of the strategy drawn up by the Government in the province of Pinar del Río to implement electronic governance. More than thirty entities subordinate to the Council of the Provincial Administration (CAP) and other organisms of the province participate in this project. In addition to showing the work of the Government, in favor of the well-being of citizens and society in general. Existing computer systems do not meet the expectations of the health sector because the population needs to be more documented, to know everything concerning community projection and how health services are brought to the community, through plans, services or programs than institutions. All with the aim of improving their living conditions and thereby stimulating support for the family.

Conclusions

With this research, the Information Architecture for Citizen Collaboration in Health matters was developed in the areas of the Pinar del Rio municipality. The results of the analysis and design stages of the information management software have been presented. In each stage, the required documentation has been prepared according to the development methodology, in addition, the implementation of the application prototype, as a conclusion of the design stage and its analysis. This software motivates the need to streamline, improve, adapt, socialize and reduce costs of the processes and/or activities of the public system and create channels that allow increasing citizen participation.

References

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Assessing the Effectiveness of Financial Management Technical Assistance to Immunization Programs:A Case Study on the Use of Mobile Money Payment Mechanisms in the Expanded Program on Immunization (EPI) Liberia

POLÍTICAS PÚBLICAS E SAÚDE MENTAL: UMAREFLEXÃO SOBRE COTIDIANO E ACESSOÀS AÇÕES PREVENTIVAS DE ESTUDANTESUNIVERSITÁRIOS

1 Reply

DOI: 10.31038/IJNM.2024551

Resumo: No Brasil, é determinado pela Constituição Federal de 1988, que o direito à saúde seja viabilizado por meio do Sistema Único de Saúde (SUS) e que o acesso deverá ser universal, integral e gratuito, esse acesso é realizado através da ações das políticas públicas, que representam um conjunto de programas, ações e decisões tomadas pelos governos (federal, estadual ou municipal) com a participação, direta ou indireta, de entes públicos ou privados, essas políticas têm como objetivo garantir a cidadania e o bem-estar social. É de responsabilidade do Estado o desenvolvimento da política de saúde mental, a assistência e a promoção de ações de saúde às pessoas em condições de transtornos mentais, com a devida participação da sociedade e da família. A literatura científica apresenta que estudantes universitários estão fortemente sujeitos ao esgotamento mental e ao desenvolvimento de Transtornos Mentais Comuns (TMC), pois enfrentam, em seu cotidiano, diversas mudanças e adaptações com o início da vida acadêmica que trazem além da mudança do ensino médio para acadêmico, outras transformações que vão desde a saída do lar parental e organização financeira ao planejamento de excedentes horas de estudo. Essa tensão se estende ao longo do curso com as cobranças acadêmicas. Este ensaio teórico teve por objetivo refletir sobre as diversas questões do cotidiano acadêmico e o impacto na saúde mental de estudantes universitários durante o processo de formação. Foi realizada uma busca exaustiva pela literatura científica dentro da temática de saúde mental universitária, que identificou a população jovem adulta como grupo risco para o desenvolvimento de TMC, apresentado problemas relacionados como a ansiedade, depressão e suicídio. Estudos têm apontado que o jovem quando inserido na universidade tem mais chances de adoecimento do que os outros jovens da mesma idade que não cursam a universidade. O Censo de Educação Superior de 2019 apresentou que 8,6 milhões de jovens brasileiros estão matriculados na universidade. Esse ingresso na universidade é uma grande conquista, mas envolve mudanças, desafios e, também, adoecimento. Em todo o mundo várias pesquisas envolvendo estudantes universitários são realizadas, motivadas por situações psicossociais, econômicas, políticas e até mesmo questões referentes ao próprio ensino. Há diversos fatores associados ao sofrimento psíquico de estudantes universitários, maior vulnerabilidade do sexo feminino e uma variância da prevalência de depressão de 9,3% a 85% de acordo com a localidade, aspectos socioculturais e econômicos. É preciso que haja discussões entre gestores de saúde e as instituições de ensino superior sobre necessidades de saúde, singularidades de diversos grupos específicos, população jovem e estudantes universitários para implementação de programas e políticas de saúde mental com vistas à promoção da saúde, prevenção de riscos ao adoecimento mental, com participação e proatividade de todos, efetividade das ações de diagnóstico, acompanhamento e controle, assegurando aos universitários a conquista de uma nova profissão e o direito ao acesso universal à saúde e à educação com qualidade e como princípio fundamental para o desenvolvimento da cidadania.

Palavras-chave

Estudantes Universitários; Políticas Públicas; Saúde Mental; Sofrimento Psíquico; Universidade

REFERÊNCIAS

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Ministério da Saúde. Lei n. 8.080, de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes, e dá outras providências. Diário Oficial da União, Brasília, 20 set. 1990.
Ministério da Saúde. Lei n. 8.142, de 28 de dezembro de 1990. Dispõe sobre a participação da comunidade na gestão do Sistema Único de Saúde (SUS) e sobre as transferências intergovernamentais de recursos financeiros na área de saúde e dá outras providências. Diário Oficial da União, Brasília, 1990.
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	Characteristics of the groups	LTT PHA 1st determination			LTT PHA 2^nd determination
		Number of cases	Median	Variance	Number of tests	Median	Variance
Control Group	Healthy volunteers	33	39.25%	46	33	39.25%	46
Study Group with days of UCI stay > 12	Survivors and Candida spp colonization	8	27.69%	104.62	4	26.70%	30.99
	Survivors and multifocal candidiasis	6	25.75%	111.35	4	37%	54.67
	Dead and multifocal candidiasis	10	20.75%	166.17	12	20.78%	163.54

		Frequency	Per cent	Valid Percent
Valid	Very satisfied	89	35.3	35.3
	Satisfied	159	63.1	63.1
	Neutral	4	1.6	1.6
	Total	252	100.0	100.0

		Frequency	Per cent	Valid Percent
Valid	Much better	70	27.8	27.8
	Better	151	59.9	59.9
	About the same	26	10.3	10.3
	Worse	5	2.0	2.0
	Total	252	100.0	100.0

	Value	df	Asymptotic Significance (2-sided)	Exact Sig. (2-sided)	Exact Sig. (1-sided)
Pearson Chi-Square	.282a	1	.595
Continuity Correction	.141	1	.708
Likelihood Ratio	.286	1	.593
Fisher’s Exact Test				.642	.357
Linear-by-Linear Association	.281	1	.596
N of Valid Cases	252