Hospice and Palliative Care-Men and Gender-Specific Roles.

All people face end of life as the final health outcome. When a person's health focus shifts from quantity to quality of life, palliative care comes into view. Clinicians serving patients across the health care spectrum must be aware of the nature and efficacy of palliative and hospice care, indications for referral to services, and current best practices. Creating an end-of-life trajectory requires an individualized and global personal plan, which palliative and hospice care can provide. Gender-specific care that includes gender minorities provides special and unique challenges to those seeking palliative and hospice care.

Men in Female-Dominated Nursing Specialties.

While numbers of men in the nursing profession have slowly increased, men in female-dominated specialty areas have not changed. Male nurses and nursing students encounter gender bias and discrimination in certain specialty nursing environments. This has implications for the quality of care provided, parental engagement, and job satisfaction. By diversifying the nursing workforce, there is a potential to enhance patient comfort, improve satisfaction, and promote a more inclusive, creative, and patient-focused health care environment.

Horizon scanning, rapid reviews and living evidence to support decision-making: lessons from the work of the Critical Intelligence Unit in New South Wales, Australia during the COVID-19 pandemic.

The COVID-19 pandemic has seen an increase in rapidly disseminated scientific evidence and highlighted that traditional evidence synthesis methods, such as time and resource intensive systematic reviews, may not be successful in responding to rapidly evolving policy and practice needs. In New South Wales (NSW) Australia, the Critical Intelligence Unit (CIU) was established early in the pandemic and acted as an intermediary organisation. It brought together clinical, analytical, research, organisational and policy experts to provide timely and considered advice to decision-makers. This paper provides an overview of the functions, challenges and future implications of the CIU, particularly the Evidence Integration Team. Outputs from the Evidence Integration Team included a daily evidence digest, rapid evidence checks and living evidence tables. These products have been widely disseminated and used to inform policy decisions in NSW, making valuable impacts. Changes and innovations to evidence generation, synthesis and dissemination in response to the COVID-19 pandemic provide an opportunity to shift the way evidence is used in future. The experience and methods of the CIU have potential to be adapted and applied to the broader health system nationally and internationally.

The Role of Nurses in Fetal Cardiology Programs: An Integrative Review.

BACKGROUND: Fetal cardiology programs are evolving quickly and include multiple interdisciplinary health care professionals whose roles could benefit from clear definition. Nurses provide an essential function in this field; however, descriptions or definitions of nursing practice, education and knowledge requirements, and responsibilities are limited and vary across institutions and disciplines. PURPOSE: To conduct an integrative review summarizing the literature to determine the role of nurses in fetal cardiology programs. METHODS: We conducted an integrative review as per Whittemore and Knafl's (2005) methodology of current literature to reveal strengths and opportunities in describing nursing practice as fetal cardiology nurses. The search strategy included five electronic databases: CINAHL, Medline, PsycINFO, Web of Science, and Google Scholar. Peer-reviewed English-language articles discussing nursing practices in fetal cardiology published between 2015 and 2022 were selected. Data extraction and analysis were completed on a final sample of 26 articles. RESULTS: Four themes were identified on fetal cardiac nursing practice from nursing and medical perspectives: multidisciplinary key team member, psychosocial family support and counselor, coordinator or navigator, and role description. CLINICAL IMPLICATIONS: More discussion in the literature is needed to better understand and define fetal cardiac nursing practice. Although most experts agree nurses are an important member of the interdisciplinary fetal cardiology team, their roles and educational requirements are poorly described and defined. Quality metrics and benchmarks are needed to ensure safe and effective fetal cardiology care.

More than a cultural experience: Assessing the impact of a medical-surgical international clinical on nursing students' academic performance.

A review of the extant literature suggests that there remains a dearth of evidence regarding the evaluation of well-defined outcomes related to international nursing clinical experiences. The purpose of this study was to explore the relationship between students' clinical experience (traditional versus international) and a number of academic outcomes including final medical-surgical course grades, performance on relevant Assessment Technologies Institute (ATI) proctored exams, and National Council Licensure Examination (NCLEX) pass rates. A non-experimental design was implemented using retrospective data obtained from a small university in the Midwest. Students complete a medical-surgical clinical in India during the interim of their third semester in the nursing program. Results of the t-tests show a statistically significant difference in final grades for Adult Health II theory when comparing students who completed a traditional clinical (M = 83.1, SD = 3.8) with those who completed an international clinical (M = 81.6, SD = 5.2); t(100) = 2.0, p = .043. The difference in mean scores for traditional clinical students (M = 70.3, SD = 6.6) versus international clinical students (M = 66.2, SD = 7.2) for the Adult Medical-Surgical proctored exam reached statistical significance, t(119) = 4.5, p ≤ .001. In contrast, there was no significant difference in means scores between the two groups with regard to scores on the Comprehensive Predictor proctored exam (traditional clinical, M = 76.1, SD = 5.9; international clinical, M = 75.2, SD = 6.4); t(121) = 1.0, p = .316. Finally, a chi square test of independence found that the relationship between clinical status and performance on NCLEX was not statistically significant, χ2 (1, N = 197) = 0.132, p = .716. Further research is needed to examine the impact of international clinicals on a broader range of outcomes including academic, cultural competency, and clinical performance measures.

A Cost-Benefit Analysis of A Community Free Clinic.

Uninsured patients lacking access to primary and preventive care continues to be an issue. The purpose of this analysis is to describe operating costs surrounding a nurse-driven freestanding community clinic and to calculate quality of life benefits using clinically preventable burden scores. A retrospective records review of patients (n = 200) receiving care at a free clinic were used. Annual costs were $387,252. The benefit gained in quality-adjusted life years is estimated to be 57.47-203.94 yielding a return on investment ranging from $1,200,264-$8,948,184. Free clinics have sustained cost savings over time. Policies addressing this form of care are imperative.

Professional nursing values: A concept analysis.

AIM: The aim of this concept analysis is to clarify the meaning of professional nursing values. BACKGROUND: In a time of increasing ethical dilemmas, it is essential that nurses internalize professional values to develop and maintain a professional identity. However, nursing organizations and researchers provide different conceptions of professional nursing values, leading to a lack of clarity as to the meaning and attributes of this construct. DESIGN: Walker and Avant's (2011) method was used to guide an analysis of this concept. DATA SOURCE: Resources published from 1973 to 2016 were identified via electronic databases and hand-searching of reference lists. REVIEW METHODS: A review of the literature was completed and the data were analyzed to identify uses of the concept; the defining attributes of the concept; borderline, related, contrary, and illegitimate examples; antecedents and consequences; and empirical referents. RESULTS: Professional nursing values were defined as important professional nursing principles of human dignity, integrity, altruism, and justice that serve as a framework for standards, professional practice, and evaluation. CONCLUSIONS: Further research is needed in the development and testing of professional nursing values theory, and the reassessment of values instruments. Core professional values that are articulated may help unify the profession and demonstrate the value of nursing to the public.

Interprofessional communication in healthcare: An integrative review.

The link between miscommunication and poor patient outcomes has been well documented. To understand the current state of knowledge regarding interprofessional communication, an integrative review was performed. The review suggested that nurses and physicians are trained differently and they exhibit differences in communication styles. The distinct frustrations that nurses and physicians expressed with each other were discussed. Egos, lack of confidence, lack of organization and structural hierarchies hindered relationships and communications. Research suggested that training programs with the use of standardized tools and simulation are effective in improving interprofessional communication skills. Recommendations include education beyond communication techniques to address the broader related constructs of patient safety, valuing diversity, team science, and cultural humility. Future directions in education are to add courses in patient safety to the curriculum, use handover tools that are interprofessional in nature, practice in simulation hospitals for training, and use virtual simulation to unite the professions.

Predictive value from pediatrician plusoptix screening: impact of refraction and binocular alignment.

BACKGROUND: The positive predictive value (PPV) of conventional preschool acuity screening is about 50% whereas previous Polaroid photoscreening with experienced interpretation can achieve PPV greater than 85%. The Plusoptix photoscreener has immediate computer interpretation and a CPT code available to pediatricians. METHODS: Two Plusoptix SO9 were used in two pediatric group practices with previously validated refractive criteria and new manufacturer's binocular alignment criteria. CPT billing was monitored. Referred patients had prior gold-standard AAPOS examinations. RESULTS: 12% of 675 photoscreened preschoolers were referred. Of the 39 with AAPOS gold-standard exams, the PPV from strabismus referrals was 17%, while 26 of 27 refractive referrals had true amblyopia risk factors (PPV 96%). Screening CPT code 99174 reimbursement rose from zero to half of insurers in 15 months. CONCLUSION: Plusoptix photoscreening is valid after adjusting the binocular alignment criteria. Such photoscreening should be employed by pediatric practices to detect and ultimately to reduce amblyopia vision impairment in children.