Conflict of interest: nurses at risk!

Conflict of interest as it relates to healthcare is gaining increasing attention. Pharmaceutical companies and manufacturers that produce medical devices are coming under greater scrutiny because of the influence that their marketing practices may have on the patient management decisions made by healthcare professionals. The result is that healthcare agency administrators are developing conflict of interest policies and procedures for their professional employees. The driving force behind many of these policies is the need to maintain the trust of the public by refraining from questionable professional conduct. This article presents 2 hypothetical cases to provide nurses with an understanding of the concept of conflict of interest and the ethical considerations this issue raises, and describes the subtle and not-so-subtle influences on professional practice decisions. Recommendations are offered to help nurses avoid conflict of interest and preserve their professional integrity. It is incumbent upon nurses to become cognizant of the types of situations that may present a conflict of interest for them and to take the necessary steps to avoid such professional impropriety.

Clinical nurse specialist influence in the conduct of research in a clinical agency.

Clinical nurse specialists (CNSs) have a unique view and understanding of patients in their environment and are a valuable resource that has not been adequately engaged in research, even when CNSs assist researchers in the conduct of research. The purpose of this article is to outline activities for supporting the conduct of research that capitalize on the clinical strengths of the CNS from an ecological framework. To illustrate the contributions of CNSs in the conduct of research, 3 clinical research studies are described. Discussion of these studies within the context of an ecological framework offers a systematic approach to describing the potential involvement of the CNS in the implementation of nursing research.

Nephrology nurses' perspectives on difficult ethical issues and practice guideline for shared decision making.

Nephrologists and nephrology nurses have struggled with the technological, financial, and ethical concerns surrounding the life sustaining treatment of hemodialysis for as long as this treatment as been available. One of the overriding issues for the nephrology community has been appropriate utilization of this technology and the appropriate restraint for prescribing dialysis. Since the inception of dialysis, there has been discussion of guidelines for deciding who should receive and who should not receive this therapy. In 2000, a clinical guideline was developed to assist in directing the care of patients. The knowledge and acceptance of this guideline by nephrologists has been researched in the past. However, there is no data of knowledge and acceptance of the guideline by nephrology clinical nurses or nephrology nurse practitioners. A survey was conducted to begin to ascertain this information in order to better understand the perspectives of nephrology nurses.

Re-defining nursing expertise in the United kingdom.

There is now international recognition of the importance of practice expertise in modern and effective health services. The Expertise in Practice Project in the United Kingdom began in May 1998 and continued to 2004. It included nurses working in all four countries of the United Kingdom, and it covered clinical specialists from pediatrics to palliative care. The project added to the current understanding of what nursing practice expertise is, through the identification and verification of attributes and factors which enable expert practice. The proposed framework offers a language for sharing what constitutes practice expertise and offers insight into what occurs between the expert practitioner and the people that experience their care. The Expertise in Practice Project demonstrates that nurses affect change and facilitate performance and organizational development.

Palatable truth.

Parents can be devastated when a scan reveals their expected baby has a cleft palate. Nurses working in this specialist field can offer support and practical information to help parents cope.

Promoting professional oncology nursing practice through position papers.

The position papers discussed in this article emphasize issues that relate to the clinical practice of oncology nursing and focus on promoting nursing roles, decreasing barriers to nursing practice, and address issues pertinent to nursing education and research. Position papers are not only helpful for advocating policy change with government and regulatory bodies, but nurses can use them to directly improve their work environments.

Inappropriate use of dialysis for some elderly patients: nephrology nurses' perceptions and concerns.

The purpose of this study was to determine what percentage of elderly patients (age 65 years and older) nephrology nurses (NN) believe should not be dialyzed and to identify NN percep tions and concerns about the inappropriate use of dialysis for these patients. The design was descriptive using a cross-sectional survey instrument. Data was collected in 1996 from 393 NN (44% response rate), with a mean age of 41 years and 9 years of dialysis experience. The sample was 1,000 NN randomly selected from 7,000 members of the American Nephrology Nurses'Association (ANNA) who selected hemodialysis as a special area of interest. Quantitative analysis of respondents revealed that NN felt that 15% of elderly dialysis patients (EDP) should not be dialyzed, and 80% were troubled by decisions to start dialysis for some elderly patients. Content analysis of qualitative responses supported the NN concerns revealed in the quantitative analysis. Five themes with interrater reliability of > 98% were identified: qualiy of life (QoL), patient/family inadequate knowledge, patient influences on decision making age, and other (cost/legal reasons). QoL issues accounted for 75% of NN responses. Statistical analyses including an ANOVA, t-tests, and chi square failed to identify relationships between themes and demographic factors, such as age, gender, years of experience, education level, unit profit status, and type of staff position. The researchers conclude that NN believe dialysis is inappropriate for a significant percentage of EDP, these perceptions and concerns are widespread, and QoL issues are key factors in decisions to withhold or withdraw dialysis. NN may decrease the inappropriate use of dialysis by identifying QoL factors for EDP, facilitating discussions with family members and nephrologists, and continuing to advocate for the rights of EDP with poor QoL.