Experiences of healthcare team members involved in facial transplant surgery and patient care.

BACKGROUND: Situations that highlight the healthcare team member vulnerability, present ethically laden questions, or are innovative in nature may have a long-term personal and professional impact on caregivers and, consequently, directly or indirectly affect patient care. The ethical experiences and perceptions of the healthcare team members involved in facial transplantation procedures and patient care have not been explored. OBJECTIVE: The objective of this study was to explore healthcare team member experiences of caring for facial transplantation patients, using an ethical framework. METHODS: This study used a qualitative descriptive design to explore the experiences of 26 multidisciplinary healthcare team members, including professional, ancillary, and support staff who have participated in facial transplantation procedures and patient care. Individual, private, semistructured interviews were conducted. RESULTS: Two main themes emerged: individual sense of purpose and esprit de corps. Individual sense of purpose describes the meaning of the experience that involvement in facial transplantation had for the participants and comprises three subthemes: "getting it right, "transforming a life," and "spirituality." The theme esprit de corps conveys the morale of the healthcare team members involved in facial transplantation and was expressed through three subthemes: "leadership," "teamwork," and "environment." DISCUSSION: Many potential ethical dilemmas were mitigated by an overwhelming sense of moral obligation to help patients with complex cosmetic, functional, and mechanical facial deficits. Participants in this study unanimously believed that the risk-benefit ratio of the procedure and subsequent treatment supported its implementation.

Leadership in Nursing Education for Advancing a School of Nursing-Led Center for Climate Change, Climate Justice, and Health.

BACKGROUND: This article examines innovations in the development and advancement of a school of nursing-led climate change center and innovative leadership related to climate change and health in nursing education. METHOD: The integration of health consequences of climate change in curricula and continuing education is essential to prepare nursing students and nurses for clinical practice. RESULTS: Transformational leadership is a key concept for effective leadership in nursing education to address climate change as the looming public health challenge of the 21st century. Transformational leadership strengthened one nursing program's curricula, dissemination of relevant scholarship, and achievements with public health outreach related to climate change, climate justice, and health. CONCLUSION: Nursing education leaders can influence nursing practice and improve societal health outcomes related to the health consequences of climate change across all levels of education and continuing education for professional nurses. [J Nurs Educ. 2023;62(9):528-531.].

Health Consequences of Climate Change: Continuing Education Opportunities for Health Professionals in the United States.

Climate change is a looming public health challenge. The health consequences of climate change are increasingly recognized as contributing to negative health outcomes for individuals, families, communities, and populations. The education of health professionals in academic programs and continuing education in clinical practice settings is critical in today's world. The Association of American Medical Colleges and the National League for Nursing, among other organizations, have urged academic programs to include the impact of climate change on health in health professions education and have started to integrate it into curricula. However, health professionals educated over the past several decades have received little content related to the deleterious impact of climate change on health. Therefore, continuing education programs addressing the health consequences of climate change are being developed to fill the gap in health professions education globally. This review study explicated the available continuing education opportunities for public health professionals and health care providers related to the health consequences of climate change. [J Contin Educ Nurs. 2023;54(12):561-566.].

The nurse practitioner's role in addressing chronic sequelae of Lyme disease as a climate change related disease.

ABSTRACT: A major health consequence of climate change is an increased prevalence of vector-borne diseases due to changes in temperatures and the environments in which vectors can survive and carry out transmissible activity. Because of climate change, emerging health challenges related to the warming of the planet have led to an increase in vector-borne diseases in broadening geographic areas. Individuals affected with Lyme disease may present with a variety of symptoms, which highlights the importance of illness recognition to ensure that a patient can receive timely treatment and effective support. Despite the focus on early detection and treatment of acute Lyme disease, chronic health problems associated with Lyme disease are an emerging problem in the 21st century. This article focuses on the role of nurse practitioners and members of the health professional team in the recognition, clinical care, patient education, and management of increasing rates of chronic Lyme disease.

A historical, clinical, and ethical overview of the emerging science of facial transplantation.

In the past 5 years, a total of 16 facial transplantation surgeries have been performed in France, China, Spain, and the United States. Facial transplantation has become a surgical option in clinical situations in which soft tissue and bone loss is accompanied by severe cosmetic, sensory, and functional deficiencies due to disease, trauma, or congenital malformations. With the introduction of facial tissue transplantation surgery came complex clinical, technological, and ethical patient care issues. These complex issues included determining patient selection criteria, refining donor tissue procurement techniques, predicting expected functional outcomes, appreciating the limitations of obtaining a fully informed consent for an innovative procedure, and deliberating the immunological response and postoperative immunosuppressant requirements of the recipient. In addition, psychological implications for the patient, societal consequences, and ethical concerns have been discussed. The short-term results have been positive. Results to date indicate that the clinical, technical, and immunological patient care issues in this emerging science appear to mirror those of other reconstructive and organ transplantation procedures. The long-term physical, emotional, and psychological effects on the recipient patient, as well as long-term consequences to the donor's family, are yet to be validated.

Feasibility of family member presence in the OR during breast biopsy procedures.

Family-centered care is an accepted and promoted philosophy within the health care community. Perioperative nurses are empowered to support change in the health care arena and to examine and institute policies that affect patient care. This study examined the feasibility of family presence in the OR during breast biopsy procedures performed with local anesthesia, by ascertaining perioperative nurses' attitudes toward the concept. Family presence in the OR during breast biopsy procedures is considered a novel initiative. The results of this study indicate that the feasibility of instituting this intervention would be challenged by system barriers.

Peripheral neuropathy in HIV: an analysis of evidence-based approaches.

Peripheral neuropathy is a common and vexing symptom for people living with HIV infection (PLWH). Neuropathy occurs in several different syndromes and is identified in the literature as distal sensory polyneuropathy or distal sensory peripheral neuropathy. More recently, the HIV literature has focused on the syndrome as painful HIV-associated sensory neuropathy, addressing the symptom rather than the underlying pathophysiology. Assessment of neuropathy in PLWH is critical and must be incorporated into nursing practice for each visit. Neuropathy has been attributed to the direct effects of HIV, exposure to antiretroviral medications (particularly the nucleoside reverse transcriptase inhibitors), advanced immune suppression, and comorbid tuberculosis infection and exposure to antituberculosis medications. Evidence supports the importance of addressing neuropathy in PLWH with pharmacologic treatment regimens and complementary/alternative approaches. This paper examines the pathophysiology, evidence, and approaches to managing peripheral neuropathy. A case study has been included to illustrate a patient's experience with neuropathy symptoms.

The relationship of the emotional climate of work and threat to patient outcome in a high-volume thoracic surgery operating room team.

CONTEXT: It is widely believed that the emotional climate of surgical team's work may affect patient outcome. OBJECTIVE: To analyse the relationship between the emotional climate of work and indices of threat to patient outcome. DESIGN: Interventional study. SETTING: Operating rooms in a high-volume thoracic surgery centre from September 2007 to June 2008. PARTICIPANTS: Thoracic surgery operating room teams. INTERVENTION: Two 90 min team-skills training sessions focused on findings from a standardised safety-culture survey administered to all participants and highlighting positive and problematic aspects of team skills, communication and leadership. MAIN OUTCOME MEASURES: Relationship of functional or less functional emotional climates of work to indices of threat to patient outcome. RESULTS: A less functional emotional climate corresponded to more threat to outcome in the sterile surgical environment in the pre-intervention period (p<0.05), but not in the post-intervention or sustaining period of this study. This relationship did not exist in the anaesthesia or circulating environments of the operating room. CONCLUSIONS: The emotional climate of work in the sterile surgical environment appeared to be related to threat to patient outcome prior to, but not after, a team-training intervention. Further study of the relationship between the emotional climate of work and threat to patient outcome using reproducible methods is required.