Lost, mislabeled, and mishandled surgical and clinical pathology specimens: A systematic review of published literature.

OBJECTIVES: To perform a systematic review of published academic literature related to lost, mislabeled, and mishandled surgical and clinical pathology specimens during the preanalytical stage. METHODS: The authors used Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines to search PubMed, MEDLINE, Web of Science, and Scopus for relevant articles published from January 1, 1990, to May 1, 2023. RESULTS: The authors screened 1313 articles and identified 44 peer-reviewed, English-language articles published between 1990 and 2021 for inclusion in the final systematic review. Most articles (n = 36) reported results from US-based facilities. Articles primarily focused on general clinical and general surgical pathology. Analysis of the articles revealed that articles reported a range of methodological approaches, including incident reports, implementation analyses, case studies, and commentary recommendations. Most articles focused on mislabeling errors (61.3%) and missing or lost specimens (18.2%), while several articles combined specimen errors (20.5%). Several implementation studies (22.7%) reported using multiple interventions to mitigate errors. Implementation efforts reported between 70% and 100% reduction in pathology errors. CONCLUSIONS: The review highlights the limited research on the topic, with an average of 2 articles per year discussing lost, mislabeled, or mishandled specimens. Intervention studies addressed The Joint Commission's patient safety goals for laboratory practice. More research is needed about error incidents and reporting in non-Western countries to gain a more global perspective on the topic.

Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study.

PURPOSE: This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). DESIGN: A qualitative, phenomenological approach using semi-structured, one-on-one interviews. SETTING: Interviews conducted on Zoom (n = 28) and in-person (n = 3). PARTICIPANTS: Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States. METHOD: This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. RESULTS: Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. CONCLUSION: Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.

Bearing Witness to Joy and Sorrow: Narrative Medicine and Reproductive Endocrinologist and Infertility (REI) Providers' Journeys in Infertility Treatment.

This study examines providers' perceptions of provider-patient communication in reproductive endocrinology and infertility (REI) practices. Grounded in narrative medicine, we interviewed six REI providers about their experiences providing fertility care. REI providers crafted a narrative of bearing witness by (1) situating personal and professional self in REI narratives, (2) sharing news as important medical moments, and (3) cultivating affiliation between provider and patient. These findings offer insight into the power of narrative medicine in fertility care, the role of emplotment in narrative sense-making, and the emotional labor associated with information delivery in REI treatments. We offer several recommendations for how patients and providers can improve communication experiences in REI.

Does Organizational Messaging Make a Difference? Investigating Themes and Language Style in Twitter Discourse and Engagement by Mental Health Organizations.

The present study investigated the latent topics and language styles present in mental health organizational discourse on Twitter. The researchers sought to analyze identifying the prevalence of and language used in social support messaging in tweets about mental health care, the overarching topics regarding mental health care, and predicted that tweets with higher engagement will have increased frequency of words with positively valenced emotion and cognitive processing. A GSDMM was run to uncover latent themes that emerged in a data set of 326.9k tweets and 7.2 m words about organizational discussions of mental health. A generalized linear model using the Poisson distribution was used to assess the role of engagement, positive emotion, and cognitive processing. The study found support for both positive emotion and cognitive processing as statistically significant predictors of engagement. Directions for research include the development of health message strategies, policy needs, and online interventions.

Disclosure Catalysts in Student Disclosures of Personal Health Information to College Instructors.

College students often struggle with the decision to disclose personal health information to their instructors. Students have to weigh the benefits and risks of disclosing personal health information to their instructors. Guided by Communication Privacy Management Theory, this study examined the motivating factors that contribute to students' disclosure of personal health information to their instructors. Undergraduate students (N = 52) participated in focus groups that discussed disclosing personal health information to faculty. Findings indicated that three motivating factors drive students' disclosure of personal health information to instructors: (a) grades, (b) relational development and investment, and (c) a desire to save face with their instructors. These motivations have implications for how students and faculty communicate about personal health information.

Contradictions and Predicaments in Instructors' Boundary Negotiations of Students' Health Disclosures.

Students often disclose personal health information to their instructors for a variety of reasons. This puts instructors in an awkward position where they must negotiate the students' disclosure and what to do with the information. The authors conducted in-depth individual interviews with 23 university professors and identified three recurring tensions in the ways in which participants discussed their responses and actions based on student health disclosures: (1) encouraging and discouraging student disclosure, (2) changing and maintaining the instructor-student interactions based on the disclosure, and (3) personal involvement and professional detachment in responding to students' disclosures. For instructors, communication privacy negotiation is more than a negotiation of privacy boundaries and co-ownership of information on the part of the instructor; it becomes a form of self-preservation and personal health navigation, which then dictates future interactions of instructors when students disclose personal health information.

Including Communication in the Nursing Classroom: A Content Analysis of Communication Competence and Interprofessional Communication in Nursing Fundamentals Textbooks.

The American Association of Colleges of Nursing identifies communication as one the four core competencies for interprofessional collaborative practice and teaches communication to nursing students across the United States. The purpose of this study was to examine how communication is presented in nursing fundamentals textbooks. Grounded in communication in the disciplines (CID) framework, communication was primarily presented using the interactive model, with an emphasis on nonverbal and affective communication. All the communication competencies were covered in the textbooks, with active listening featured prominently and feedback and appropriate language choice covered least. Communication competence was also featured in the textbooks, with an emphasis on knowledge. Skills was limited to multiple choice questions and motivation was absent from the textbooks. The findings offer insight and recommendations for how to better prepare nursing students for communication interactions.

Hospital Image Repair Strategies, Organizational Apology, and Medical Errors: An Analysis of the CoxHealth Brain Over-Radiation Case.

Medical errors are currently ranked the third leading cause of death in United States; however, hospital responses when one occurs have been left out of organizational crisis and image repair literature. This article reports an image repair analysis of the 2010 CoxHealth radiation medical error case, when 76 patients accidentally received fatally high doses of radiation for the treatment of brain cancer. CoxHealth used a variety of image repair strategies including shifting the blame, minimization, bolstering, and corrective action. Moreover, CoxHealth heavily used transcendence to transform the conversation from the error to activism to frame themselves as change agents championing for patient safety.

Communication Apprehension About Death, Religious Group Affiliation, and Religiosity: Predictors of Organ and Body Donation Decisions.

Communication willingness has previously been identified as an important communication factor in influencing individuals' decisions to become an organ donor. Missing from this conversation is the role of communication apprehension about death and its impact on donation decisions. The purpose of this study was to examine the relationships between communication apprehension about death, religiosity, religious affiliation, and donation decisions. Three hundred and thirty-three individuals participated in an online survey. Findings suggest that communication apprehension about death, especially communication avoidance about death, negatively impact donation decisions. In addition, religiosity and affiliation with a specific religion also negatively impact donation decisions. These variables were also predictors of organ and body donation. The findings show a need for more research on what prevents conversations about donation. In addition, the stark difference between organ donation likelihood and body donation likelihood underscores the need for communication scholars to examine communication about body donation.

Students' Perceptions of Provider Cultural Competence and Communication with Providers: Predictors of University Health Center Patient Satisfaction.

As student populations become more diverse, understanding university health center (UHC) providers' cultural competence is important for providing students with quality care. Student satisfaction with UHC provider care is influenced by a number of factors, including interpersonal communication between patients and providers. The emphasis on culture, however, suggests that providers' cultural competence should also be an important factor. Guided by communication accommodation theory, this study examined the relationships between patients' willingness to communicate with providers, communication apprehension with providers, and perceptions of providers' cultural competence and if they predicted patient satisfaction with UHC care. Results suggest that willingness to communicate, communication apprehension, and some elements of perceived provider cultural competence were significantly related. Willingness to communicate, communication apprehension, and patient-centeredness were predictors of patient satisfaction. These findings have implications for how UHCs can focus on culturally competent care while meeting the healthcare needs of students.

"You Never Forget Your First Mistake": Nursing Socialization, Memorable Messages, and Communication About Medical Errors.

As nurses' communication is essential to prevent, intercept, and resolve medical mistakes, it is important to understand how they learn to communicate about medical errors. In this study, we identify memorable messages about communicating about mistakes that nursing students receive during their training and how they make sense of these messages. Data were acquired through individual interviews with 68 nursing students. The data were analyzed using a thematic constant comparative method. While open and honest communication about medical errors was the overarching message participants formally and informally learned, for nursing students, communicating about medical errors is a much more complex process than using open and honest communication. When dealing with medical errors, nursing students relied on three major memorable messages to guide their communication: (a) Not everyone hears about errors, (b) hierarchy matters, and

Narrativizing Nursing Students' Experiences With Medical Errors During Clinicals.

The ways providers story their mistake experiences help to explain how providers understand medical errors and how they communicate about those errors. Communication scholars have slowly begun to explore the communicative nature of medical error experiences, with communication research becoming more abundant over the past few years. Missing from this discussion is how students in health professions, in this case nursing students, tell medical errors narratives and how the stories help them determine how to respond to mistakes. In this article, we explore how nursing students narrativize their medical errors experiences during clinicals. Qualitative interviews were conducted with 68 nursing students. The interviews were transcribed and resulted in a total of 1,261 single-spaced pages of data. We found that nursing students told three different narratives: (a) the "save the day" narrative, (b) the "silence" narrative, and (c) the "not always right" narrative. Finally, we discuss the implications of these narratives and their impact on nursing education.

Healing the healer: stress and coping strategies in the field of temporary medical work.

Temporary medical workers provide a vital role for the medical profession. These individuals, however, occupy a unique work arrangement as professional-specific temporary workers. Temporary medical workers often find themselves bearing the burdens of both medical workers and temporary workers. In partnership with the largest medical temporary agency in the United States, we content analyzed the responses of 86 medical temporary workers, geared at uncovering the primary stressors and coping strategies this sample enacted. Our findings concluded that temporary medical workers experienced stressors associated with both their medical and temporary roles, although more stressors were associated with temporary work than with medical care. Participants also relied heavily on coping strategies that allowed them to avoid these stressors.

A Cycle of Redemption in a Medical Error Disclosure and Apology Program.

Physicians accept that they have an ethical responsibility to disclose and apologize for medical errors; however, when physicians make a medical error, they are often not given the opportunity to disclose and apologize for the mistake. In this article, I explore how one hospital negotiated the aftermath of medical mistakes through a disclosure and apology program. Specifically, I used Burke's cycle of redemption to position the hospital's disclosure and apology program as a redemption process and explore how the hospital physicians and administrators worked through the experiences of disclosing and apologizing for medical errors.

"It may not be pretty, but it's honest": examining parental grief on the Callapitter blog.

Following the death of a child, parents are turning to alternative means of communication to express their grief In this instrumental case study, the authors explore how 1 woman, Amy Ambrusko, communicates her grief experience on her blog, emotionally negotiating loss and parental grief. Guided by M. S. Miles's (1984) parental grief model, the authors argue that the Callapitter blog serves as a case study illustration of online parental grief. Specifically, Ambrusko displays parental grief in three ways: (re)questioning reality, experiencing discursive and corporeal guilt, and rationalizing a "new normal." This analysis highlights the changing nature of communicating about grief and underscores how grief blogs challenge contemporary social death rules.

Exploiting loss?: ethical considerations, boundaries, and opportunities for the study of death and grief online.

More people are turning to the Internet to communicate about dying, death, and grief experiences. This theoretical article explores the ethical dilemmas, challenges, and opportunities presented to researchers interested in exploring how death and grief are communicated online. Weaving together the literatures of computer-mediated communication and thanatology (dying and death), we discuss the ways in which many common ethical dilemmas uniquely manifest related to death and grief. We also explore the emotional impact studying death and grief online has on researchers and the importance of thinking about researcher emotions on scholars who study these issues. We end with recommendations of how to move forward in the dialogue about ethics and studying death and grief online.

Bearing witness to the ethics of practice: storying physicians' medical mistake narratives.

Medical mistakes are often referred to as the "hidden epidemic" of health because doctors, patients, and hospital administrators remain silent about mistakes. This study relies on in-depth interviews to explore how physicians story their medical mistake experiences. Narrative theory is used to understand how these physicians story the complexity of medical mistakes, highlighting how these physicians bear witness to medical mistakes by sharing and listening to medical mistake narratives. Moreover, this study showcases the implications of how practitioners and scholars bear witness to the oft-times emotional telling and retelling of health narratives.

"What happens on the van, stays on the van": the (re)structuring of privacy and disclosure scripts on an Appalachian mobile health clinic.

Over the past two decades, mobile health clinics have emerged to address the health needs of underserved populations. Mobile clinics offer curbside care in the primary settings of people's lives: churches, parking lots, grocery stores, and community centers. Drawing on 18 months of ethnographic fieldwork, I explore how physical and symbolic space helps shape the (re)writing of traditional health care scripts of provider-patient confidentiality and medical disclosure in a mobile clinic serving residents of 21 counties in southeastern Ohio. This analysis centered on how clinic staff members blurred the symbolic and physical space of privacy, merged personal and professional discourses, and triaged multiple patient disclosures in the face of social and spatial constraints.

Narrative constructions of health care issues and policies: the case of President Clinton's apology-by-proxy for the Tuskegee syphilis experiment.

The Tuskegee Syphilis Experiment (TSE) has shaped African Americans' views of the American health care system, contributing to a reluctance to participate in biomedical research and a suspicion of the medical system. This essay examines public discourses surrounding President Clinton's attempt to restore African Americans' trust by apologizing for the TSE. Through a narrative reading, we illustrate the failure of this text as an attempt to reconcile the United States Public Health Service and the African American public. We conclude by noting the limitations of rhetoric when equal prominence is not given to policy proposals in national apologies.