A descriptive assessment of the informed consent document used by congenital cardiac surgery centres.

BACKGROUND: Informed consent for surgery is a complex process particularly in paediatrics. Complexity increases with procedures such as CHD surgery. Regulatory agencies outline informed consent contents for surgery. We assessed and described CHD surgical informed consent contents through survey dissemination to paediatric CHD centres across United States of America. METHODS: Publicly available email addresses for 125 paediatric cardiac clinicians at 70 CHD surgical centres were obtained. Nine-item de-identified survey assessing adherence to The Joint Commission informed consent standards was created and distributed via RedCap® 14 March, 2023. A follow-up email was sent 29 March, 2023. Survey link was closed 18 April, 2023. RESULTS: Thirty-seven surveys were completed. Results showed informed consent documents were available in both paper (25, 68%) and electronic (3, 8%) format. When both (9, 24%) formats were available, decision on which format to use was based on centre protocols (1, 11%), clinician personal preference (3, 33%), procedure being performed (1, 11%), or other (4, 45%). Five (13%) centres' informed consent documents were available only in English, with 32 (87%) centres also having a Spanish version. Review of informed consent documents demonstrated missing The Joint Commission elements including procedure specific risks, benefits, treatment alternatives, and expected outcomes. CONCLUSIONS: Informed consent for CHD surgery is a complex process with multiple factors involved. Majority of paediatric CHD surgical centres in the United States of America used a generic informed consent document which did not uniformly contain The Joint Commission specified information nor reflect time spent in discussion with families. Further research is needed on parental comprehension during the informed consent process.

Does the standard medical procedure consent process meet the criteria required for informed consent? A concept analysis.

BACKGROUND: Informed consent is a complex process that is legally required before any surgical procedure. PURPOSE: The purpose of this manuscript was to perform a concept analysis of the informed consent process. METHODS: The use of dimensional analysis identified three separate yet related perspectives of the informed consent process: legal, health care, and patients. A database search using the Cumulative Index to Nursing and Allied Health Literature and PubMed were performed. FINDINGS: A total of 27 publications were reviewed. The legal perspective addresses the requirement of informed consent, which starts with the discussion between the health care provider and the patient undergoing the surgical procedure and ends with a signature on a piece of paper. The health care perspective also addresses the legal requirement but incorporates the goals and objectives of the individual initiating the informed consent discussion. The patients' perspectives also incorporate goals and objectives; however, they differ from that of the health care provider in that they go beyond what happens in the operating room or during hospitalization. DISCUSSION: Viewing informed consent through these different yet related perspectives provides insight into this complex process and may enhance the researcher's ability to understand and improve the informed consent process.

Establishing nursing-sensitive quality indicators for pediatric oncology: An international mixed methods Delphi study.

INTRODUCTION: Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries. DESIGN/METHODS: A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings. RESULTS: Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas. CONCLUSION: Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement. CLINICAL RELEVANCE: NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.

Palliative care integration: a critical review of nurse migration effect in Jamaica.

BACKGROUND: Provision of palliative care to individuals with late-stage serious illnesses is critical to reduce suffering. Palliative care is slowly gaining momentum in Jamaica but requires a highly skilled workforce, including nurses. Out-migration of nurses to wealthier countries negatively impacts the delivery of health care services and may impede palliative care capacity-building. This critical review aimed to explore the evidence pertaining to the nurse migration effect on the integration of palliative care services in Jamaica and to formulate hypotheses about potential mitigating strategies. METHODS: A comprehensive search in the PubMed, CINAHL, and ProQuest PAIS databases aimed to identify articles pertinent to nurse migration in the Caribbean context. Grant and Booth's methodologic framework for critical reviews was used to evaluate the literature. This methodology uses a narrative, chronologic synthesis and was guided by the World Health Organization (WHO) Public Health Model and the Model of Sustainability in Global Nursing. RESULTS: Data from 14 articles were extracted and mapped. Poorer patient outcomes were in part attributed to the out-migration of the most skilled nurses. 'Push-factors' such as aggressive recruitment by wealthier countries, lack of continuing educational opportunities, disparate wages, and a lack of professional autonomy and respect were clear contributors. Gender inequalities negatively impacted females and children left behind. Poor working conditions were not necessarily a primary reason for nurse migration. Four main themes were identified across articles: (a) globalization creating opportunities for migration, (b) recruitment of skilled professionals from CARICOM by high income countries, (c) imbalance and inequities resulting from migration, and (d) mitigation strategies. Thirteen articles suggested education, partnerships, policy, and incentives as mitigation strategies. Those strategies directly align with the WHO Public Health Model drivers to palliative care integration. CONCLUSION: Emerged evidence supports that nurse migration is an ongoing phenomenon that strains health systems in Caribbean Community and Common Market (CARICOM) countries, with Jamaica being deeply impacted. This critical review demonstrates the importance of strategically addressing nurse migration as part of palliative care integration efforts in Jamaica. Future studies should include targeted migration mitigation interventions and should be guided by the three working hypotheses derived from this review.

Coping Strategies of Nurses in a Palliative Care Unit.

The aim of this qualitative study was to explore the coping strategies of staff nurses working in palliative care. Death and dying are important aspects of nurses' day-to-day work in palliative care and considered stressful, yet satisfying. The sensitive feelings of nurses and delicate emotions may lead to burnout, compassion fatigue, and overall poor clinical judgments, thus resulting in unsafe patient care. Little contemporary evidence exists regarding the effect of workplace stress on palliative care nurses or their coping strategies. In this qualitative descriptive study, 11 registered nurses working in a palliative care unit were recruited to participate using purposive sampling. Data were collected through a 10-item, open-ended survey developed by the researcher to examine the coping strategies of palliative care nurses. Analysis of the data yielded the following themes related to coping strategies: spirituality, support from colleagues and managers, and use of resources. The results of this study revealed important concerns for nurses as caregivers of dying patients in palliative care and suggested a need for nurses to discover multiple ways in which they can cope with their grief. The findings of the study illustrate that nurses use a combination of strategies to internally and externally cope with the management of patients on the palliative care unit. With a better understanding of how palliative care nurses currently cope, strategies can be recognized to improve these coping skills. This includes organizational support, and social support at work with colleagues, family, and friends.

Incorporating quality and safety education into a nursing administration curriculum.

The Quality and Safety Education for Nursing initiative is aimed at developing student competences in quality and safety. Because practicing nurses have not been exposed to this initiative, nurse leaders must be aware of these competencies to develop these competencies in existing staff members. This article provides a roadmap to curriculum development in a nursing administration graduate program focused on quality and safety.

Increasing testicular self-examination in active duty soldiers: an intervention study.

In this intervention study, the researchers assessed the knowledge of and health beliefs regarding testicular cancer and testicular self-examination (TSE) in active duty Army Soldiers.

Military nursing at the forefront: the Army Forward Surgical Team.

From World War II to current conflicts, history has validated the need for early surgical intervention to save lives and established the need for FSTs. Historically 10% to 15% of soldiers wounded in action require surgery to control hemorrhage and to provide stabilization sufficient for evacuation to a medical treatment facility where definitive care can be provided. Undoubtedly, many lives were saved in past conflicts because resuscitative surgery and care were available a short time after being wounded. The need for surgical stabilization for patients to survive a long evacuation was well-established during military operations such as Operation Desert Storm. Resuscitative surgery capability must be present on the battlefield, and this capability must be able to move with the units the FST is supporting. These two imperatives were the driving force of the creation of the US Army's FSTs: they are light, easily transportable, and able to keep pace with the supported units. FSTs are an integral and essential element in providing surgical care to save soldiers' lives on the modem battlefield. The US military has been involved in more operations and deployments since the end of the Cold War than in the preceding years. FSTs participated in many of these operations and have performed superbly. FSTs will continue to have a critical role in providing combat health service support to soldiers on the battlefield of the twenty-first century, and FST nurses will continue to be an indispensable asset.