China’s Belt and Road Initiative (BRI) hopes to deliver trillions of dollars in infrastructure financing to Asia, Europe, and Africa. If the initiative follows Chinese practices to date for infrastructure financing, which often entail lending to sovereign borrowers, then BRI raises the risk of debt distress in some borrower countries. This paper assesses the likelihood of debt problems in the 68 countries identified as potential BRI borrowers. We conclude that eight countries are at particular risk of debt distress based on an identified pipeline of project lending associated with BRI.Because this indebtedness also suggests a higher concentration in debt owed to official and quasi-official Chinese creditors, we examine Chinese policies and practices related to sustainable financing and the management of debt problems in borrower countries. Based on this evidence, we offer recommendations to improve Chinese policy in these areas. The recommendations are offered to Chinese policymakers directly, as well as to BRI’s bilateral and multilateral partners, including the IMF and World Bank.

BackgroundTraditionally, clinical decision making has been perceived as a purely rational and cognitive process. Recently, a number of authors have linked emotional intelligence (EI) to clinical decision making (CDM) and calls have been made for an increased focus on EI skills for clinicians. The objective of this integrative literature review was to identify and synthesise the empirical evidence for a role of emotion in CDM.MethodsA systematic search of the bibliographic databases PubMed, PsychINFO, and CINAHL (EBSCO) was conducted to identify empirical studies of clinician populations. Search terms were focused to identify studies reporting clinician emotion OR clinician emotional intelligence OR emotional competence AND clinical decision making OR clinical reasoning.ResultsTwenty three papers were retained for synthesis. These represented empirical work from qualitative, quantitative, and mixed-methods approaches and comprised work with a focus on experienced emotion and on skills associated with emotional intelligence. The studies examined nurses (10), physicians (7), occupational therapists (1), physiotherapists (1), mixed clinician samples (3), and unspecified infectious disease experts (1). We identified two main themes in the context of clinical decision making: the subjective experience of emotion; and, the application of emotion and cognition in CDM. Sub-themes under the subjective experience of emotion were: emotional response to contextual pressures; emotional responses to others; and, intentional exclusion of emotion from CDM. Under the application of emotion and cognition in CDM, sub-themes were: compassionate emotional labour – responsiveness to patient emotion within CDM; interdisciplinary tension regarding the significance and meaning of emotion in CDM; and, emotion and moral judgement.ConclusionsClinicians’ experienced emotions can and do affect clinical decision making, although acknowledgement of that is far from universal. Importantly, this occurs in the in the absence of a clear theoretical framework and educational preparation may not reflect the importance of emotional competence to effective CDM.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-1089-7) contains supplementary material, which is available to authorized users.

Trauma-informed care (TIC) is increasingly recognized as an approach to improving consumers' experience of, and outcomes from, mental health services. Deriving consensus on the definition, successful approaches, and consumer experiences of TIC is yet to be attained. In the present study, we sought to clarify the challenges experienced by mental health nurses in embedding TIC into acute inpatient settings within Australia. A systematic search of electronic databases was undertaken to identify primary research conducted on the topic of TIC. A narrative review and synthesis of the 11 manuscripts retained from the search was performed. The main findings from the review indicate that there are very few studies focussing on TIC in the Australian context of acute mental health care. The review demonstrates that TIC can support a positive organizational culture and improve consumer experiences of care. The present review highlights that there is an urgency for mental health nurses to identify their role in delivering and evaluating TIC, inclusive of undertaking training and clinical supervision, and to engage in systemic efforts to change service cultures.

The aim of the study was to clarify and build upon current understandings of mental health nurse (MHN) identity. The study adopted a framework of social constructionism and qualitative methodology. Semistructured interviews were conducted, which were thematically analyzed using Nvivo software. Twenty-five MHN were recruited across three geographical sites in the UK. Participants constructed a cluster of seven MHN identity characteristics that constituted a unique contribution to talk-based therapies. These themes of characteristics are: (i) the MHN as generic specialist; (ii) the MHN as adopting a service-user focus; (iii) the MHN as positioning and utilizing the personal self; (iv) the MHN as spending time with the service user; (v) the MHN as delivering talk-based therapies in versatile ways; (vi) the MHN as having an everyday attitude; and (vii) the MHN as having transferable skills. The distinctiveness, and thus, professional identity of mental health nursing, must be understood as a cluster of capabilities rather than a search for a singular point of difference. The breadth of capabilities employed by MHN highlights the value and worth of their contribution to service-user care.

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