Human Rights in Hospitals: an End to Routine Shackling.

Medical students (NSB, NM, JDW) spearheaded revision of the policy and clinical practice for shackling incarcerated patients at Boston Medical Center (BMC), the largest safety net hospital in New England. In American hospitals, routine shackling of incarcerated patients with metal restraints is widespread-except for perinatal patients-regardless of consciousness, mobility, illness severity, or age. The modified policy includes individualized assessments and allows incarcerated patients to be unshackled if they meet defined criteria. The students also formed the Stop Shackling Patients Coalition (SSP Coalition) of clinicians, public health practitioners, human rights advocates, and community members determined to humanize the inpatient treatment of incarcerated patients. Changes pioneered at BMC led the Mass General Brigham health system to follow suit. The Massachusetts Medical Society adopted a resolution authored by the SSP Coalition, which condemned universal shackling and advocated for use of the least restrictive alternative. This will be presented to the American Medical Association in June 2024. The Coalition led a similar effort to coauthor a policy statement on the issue, which was formally adopted by the American Public Health Association in November 2023. Most importantly, in an unprecedented human rights victory, a BMC patient who was incarcerated, sedated, and intubated was unshackled by correctional officers for the purpose of preserving human dignity.

The Creation of an Addiction Nursing Fellowship Program for Registered Nurses: A Unique Approach to Enhancing the Addiction-Treatment Workforce.

In 2020, Boston Medical Center and the Grayken Center for Addiction launched an addiction nursing fellowship to enhance registered nurses' knowledge and skills related to the care of patients with substance use disorders and to improve patient experience and outcomes. This paper describes the development and essential components of this innovative fellowship, to our knowledge the first of its kind in the United States, with the goal of facilitating replication in other hospital settings.

The Dual Epidemics of 2020: Nursing Leaders' Reflections in the Context of Whole Person/Whole Systems.

The Greater Boston Nursing Collective, a consortium composed of university nursing deans and chief nursing officers within academic medical centers and specialty hospitals in Boston, Massachusetts, was formed in 2014. Since the group's inception, our mission has been to create and reinforce whole-person/whole-system healing environments to improve the health of all communities. Through our collaboration in navigating the dual epidemics of COVID-19 and structural racism within our respective organizations, and across the United States and the world, we share experiences and lessons learned. Our common mission is clearer than ever: to create safe and joyful work environments, to protect the dignity of those we are privileged to serve, and to generate policies to advance health equity to rectify societal forces that have shaped this dual epidemic. We are humbled by the many who persist despite limited rest and respite, and whose stories, innovations, and leadership we are honored to witness and share. They have defined our generation, just as nurses in earlier crises have done: leading through service to others as our purpose and privilege.

Creating a Culture of Safety Through Integration of an Early Warning System.

This quality improvement project utilized the Tanner model to identify strategies to enhance the clinical judgment among staff nurses through the development and adoption of an early warning system for patient deterioration outside the ICU. Outcomes included improved communication, decreased variability in the assessment and interpretation of patient status, and a significant decrease in codes.