Exploring the contradictions between Brazil’s role in the global climate change regime and its position in regional environmental governance.

Similar to other developing countries Brazil’s position on climate change emphasises national sovereignty and the principle of “common but differentiated responsibilities”. However, in recent years Brasilia has also announced voluntary reductions in carbon emissions, making Brazil one of the leading emerging countries in its approach to climate change, while enhancing its international reputation and legitimacy. Compared to its neighbours Brazil has older and more developed domestic environmental institutions and movements. Yet, Brazil’s global leadership on climate change does not translate into a similar role in regional environmental governance. In the 2000s Argentina and Uruguay became embroiled in a bitter environmental conflict involving a shared natural resource, the Uruguay River. Brazil not only refused to mediate, but also kept it out of regional forums insisting on the conflict’s bilateral nature. Furthermore, Mercosur’s environmental agenda has progressively become eroded while Brazilian-led Unasur lacks an institutional framework dedicated to environmental concerns. This indicates that environmental concerns are far more important for Brazil’s global image than for its role as a regional leader. It also highlights the limited scope of the climate change negotiations which focus narrowly on reducing carbon emissions, without taking wider concerns over energy generation or environmental and social justice into account. Brazil has promoted hydropower generation, portrayed as “clean” energy. Yet, these projects have sparked strong domestic and regional civil society opposition due to their social and environmental costs which make it difficult for Brazil to claim a regional leadership role on environmental concerns.

Intensive care survivors’ experiences of ward-based care: Meleis’ theory of nursing transitions and role development among critical care outreach services.

Aims and objectives. To explore the psychosocial needs of patients discharged from intensive care, the extent to which they are captured using existing theory on transitions in care and the potential role development of critical care outreach, follow-up and liaison services. Background. Intensive care patients are at an increased risk of adverse events, deterioration or death following ward transfer. Nurse-led critical care outreach, follow-up or liaison services have been adopted internationally to prevent these potentially avoidable sequelae. The need to provide patients with psychosocial support during the transition to ward-based care has also been identified, but the evidence base for role development is currently limited. Design and methods. Twenty participants were invited to discuss their experiences of ward-based care as part of a broader study on recovery following prolonged critical illness. Psychosocial distress was a prominent feature of their accounts, prompting secondary data analysis using Meleis et al.’s mid-range theory on experiencing transitions. Results. Participants described a sense of disconnection in relation to profound debilitation and dependency and were often distressed by a perceived lack of understanding, indifference or insensitivity among ward staff to their basic care needs. Negotiating the transition between dependence and independence was identified as a significant source of distress following ward transfer. Participants varied in the extent to which they were able to express their needs and negotiate recovery within professionally mediated boundaries. Conclusion. These data provide new insights into the putative origins of the psychosocial distress that patients experience following ward transfer. Relevance to clinical practice. Meleis et al.’s work has resonance in terms of explicating intensive care patients’ experiences of psychosocial distress throughout the transition to general ward–based care, such that the future role development of critical care outreach, follow-up and liaison services may be more theoretically informed.