Comparison of findings identified at traditional invasive autopsy and postmortem computed tomography in suicidal hangings.

Cases of suicidal hanging are a common death referred for medico-legal autopsy throughout the world. Although some advocate using postmortem computed tomography (PMCT) without traditional invasive autopsy (TIA) to investigate such deaths, others reject this approach. There is currently limited evidence to guide practice. In this context, the TIA reports and PMCT images of 50 cases of suspected suicidal hanging during an 11-month period were reviewed. The reviewers were blinded to the findings of the other modality. A Cohen's Kappa coefficient (K) was calculated to assess agreement between TIA and PMCT across a range of pertinent findings. This analysis demonstrated perfect agreement for identification of a ligature (K = 1.00) and a strong level of agreement for identification of a ligature suspension point (K = 0.832) but only a minimal level of agreement for overall ligature mark (K = 0.223). PMCT demonstrated a weak level of agreement for fractures of hyoid bone (K = 0.555) and thyroid cartilage (K = 0.538). Three probable fractures not identified at TIA were identified on PMCT. TIA was shown to be superior in the identification of intramuscular and laryngeal fracture-related haemorrhage/bruising whereas PMCT was superior to TIA in identifying body gas deposition. There was overall good correlation between the natural disease and trauma identified elsewhere in the body during the TIA and PMCT. The study demonstrates that PMCT can assist the investigation of suspected suicidal hangings. However, the accuracy of many findings is limited, and if it is used as an alternative to the TIA, potentially pertinent findings, such as fractures of the laryngeal cartilages, could be missed.

Emergency trauma care during the COVID-19 pandemic: A phenomenological study of nurses' experiences.

OBJECTIVE: This study aimed to explore nurses' experiences in delivering emergency trauma care during the COVID-19 pandemic at a level I trauma centre in Saudi Arabia. METHODS: A qualitative, descriptive phenomenological design was utilised, in which face-to-face, unstructured interviews were carried out with emergency and trauma nurses at a level I trauma centre in Saudi Arabia. The study included nine registered emergency and trauma nurses who were interviewed twice from February to April 2021. The collected data were analysed using Colaizzi's descriptive phenomenological method. RESULTS: The analysis of the data revealed an overarching theme that was about the inevitable change on the ground due to the pandemic and two primary themes, each containing two subthemes: 1 dealing with an interrupted path of care; 1.1 experiencing additional complexity; 1.2 encountering extra demands; 2 optimising the path of care; 2.1 modifying the steps; and 2.2 transforming the system. CONCLUSION: The COVID-19 pandemic imposed change on how trauma patients would be handled and treated. Nurses took an active and critical role in creating another form of change, which helped optimise the path of trauma care and accommodate urgent treatment needs of the injured patients.

Accountability issues in an English emergency department: A nursing perspective.

INTRODUCTION: Nurses confront doubts about their accountability and how it affects their clinical practice daily in the complex environment of an emergency department. Therefore, nurses' experiences can provide vital information about the decisions and dilemmas in clinical practice that affect both healthcare professionals and patients alike. AIM: The aim of this study was to explore the perceptions of nursing staff in an English emergency department in relation to their ethical, legal and professional accountability. METHODS: Ethnographic content analysis was used to analyse 34 semi-structured interviews from registered nurses working in an emergency department. RESULTS: There were five categories found during the coding process: nursing care, staff interactions, legal and professional accountability, decision-making process and ethics and values. CONCLUSION: Several issues related to nursing accountability were found, including the effects of nursing shortages and the reasoning behind multidiscipinary team conflicts. Different approaches of individual and institutional accountability, the evolution of Benner's nursing model and nursing value progression was also identified as key issues. All these phenomena affect nursing accountability in different ways, so their comprehension is paramount to understand and influence them to benefit both patients and nurses.

Postmortem Computed Tomography: An Overview for Forensic Nurses Involved in Death Investigation.

The traditional invasive autopsy has been considered the "gold standard" for death investigation worldwide. However, this has now been challenged by a new minimally invasive approach that utilizes cross-sectional radiological imaging to investigate the death. Globally, postmortem computed tomography is the most commonly used modality and is becoming increasingly available throughout the world. Forensic nurses working in association with coroners and medical examiners' offices, as well as mass fatality incidents, now need to update their knowledge base to understand these innovative techniques, the advantages and disadvantages to their use, and how they impact on medicolegal death investigation and the care of the deceased and bereaved. Using the example of the coroner system of England and Wales, this article provides a comparison between the traditional invasive autopsy and postmortem radiological alternatives and presents the impact postmortem radiology is now having on death investigation.

Decision-making in an emergency department: A nursing accountability model.

INTRODUCTION: Nurses who work in an emergency department regularly care for acute patients in a fast-paced environment, being at risk of suffering high levels of burnout. This situation makes them especially vulnerable to be accountable for decisions they did not have time to consider or have been pressured into. RESEARCH OBJECTIVE: The objective of this study was to find which factors influence ethical, legal and professional accountability in nursing practice in an emergency department. RESEARCH DESIGN: Data were analysed, codified and triangulated using qualitative ethnographic content analysis. PARTICIPANTS AND RESEARCH CONTEXT: This research is set in a large emergency department in the Midlands area of England. Data were collected from 186 nurses using participant observation, 34 semi-structured interviews with nurses and ethical analysis of 54 applicable clinical policies. ETHICAL CONSIDERATIONS: Ethical approval was granted by two research ethics committees and the National Health Service Health Research Authority. RESULTS: The main result was the clinical nursing accountability cycle model, which showed accountability as a subjective concept that flows between the nurse and the healthcare institution. Moreover, the relations among the clinical nursing accountability factors are also analysed to understand which factors affect decision-making. DISCUSSION: The retrospective understanding of the factors that regulate nursing accountability is essential to promote that both the nurse and the healthcare institution take responsibility not only for the direct consequences of their actions but also for the indirect consequences derived from previous decisions. CONCLUSION: The decision-making process and the accountability linked to it are affected by several factors that represent the holistic nature of both entities, which are organised and interconnected in a complex grid. This pragmatic interpretation of nursing accountability allows the nurse to comprehend how their decisions are affected, while the healthcare institution could act proactively to avoid any problems before they happen.

Philosophy and quality? TAPUPASM as an approach to rigour in critical realist research.

BACKGROUND: Philosophical principles should guide how research is designed, conducted and appraised. The more traditional and commonly used approaches to positivist (validity and generalisability) or interpretivist (trustworthiness) research do not necessarily complement the philosophical principles of post-positivist critical realism. AIMS: To discuss an approach to ensuring scientific rigour in post-positivist critical realist research using an enhanced version of the quality assurance model, TAPUPAS, that has an additional criterion: modified objectivity. DISCUSSION: The authors present examples of the quality framework TAPUPASM in the planning, design, conduct and dissemination of a realist research study. These strategies include choices about the collection and analysis of data, as well as how to disseminate findings using methods other than traditional academic approaches. They also provide a practical example of how they used TAPUPASM to ensure rigour in a critical realist ethnographic study in pre-registration nurse education. CONCLUSION: TAPUPASM provides a framework for quality in post-positivist critical realist research. IMPLICATIONS FOR PRACTICE: Nurse researchers can use the strategies provided to plan, design, conduct and disseminate critical realist research.

Ethical, legal and professional accountability in emergency nursing practice: An ethnographic observational study.

INTRODUCTION: Accountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses' working conditions. AIM: The aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice. METHODS: A qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis. RESULTS: The factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles' application. DISCUSSION: The long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses' working conditions need to be implemented to limit the workload to which an ED nurse is subjected to. CONCLUSION: ED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making.

Post mortem computed tomography: An innovative tool for teaching anatomy within pre-registration nursing curricula.

BACKGROUND: There is significant change throughout the world regarding Post Mortem Computed Tomography (PMCT) as an adjunct or a replacement to the traditional invasive autopsy. Of interest, is the ability to demonstrate visually two and three dimensional normal soft tissue, organ and skeletal anatomy, as well as natural disease and trauma pathology. OBJECTIVES: The objective was to compare formal traditional methods of teaching anatomy and pathology (pictures and diagrams) to pre-registration student nurses with supplementary PMCT 2/3D generated images, videos and printed anatomical models. The specific objective was to determine if these tools would increase the students' perception of their understanding and learning experience of the subject area. DESIGN: A quasi-experimental within-subject design was chosen. SETTING: A School of Nursing and Midwifery within a Higher Education Institution in the UK. PARTICIPANTS: Purposeful sampling of 57 voluntary informed consented pre-registration student nurses. METHOD: Students were initially exposed to teaching of normal anatomy and common fractures using traditional methods. Data was then collected following the teaching session using a questionnaire entailing both quantitative and qualitative elements. The teaching session was then repeated with the same students but with the inclusion of PMCT of all the same normal anatomy and fractures. Data was then collected again using the same questionnaire. Both questionnaires were then compared. RESULTS: The quantitative findings proved highly significantly proving (p <0.01) that the inclusion of Post Mortem Computed Tomography when teaching normal anatomy and pathology increases pre-registration nursing students' perception of their understanding and learning experience. The qualitative results revealed three positive themes concerning visual learning, realism and patient empathy. CONCLUSION: Including Post Mortem Computed Tomography imagery enables nurse academics to provide students with a virtual tour of the human body and a rich, authentic learning experience of a real individual who experienced a relevant clinical scenario that nurses are likely to encounter in their careers.

The development of a clinical policy ethics assessment tool.

INTRODUCTION: Clinical policies control several aspects of clinical practice, including individual treatment and care, resource management and healthcare professionals' etiquette. This article presents Clinical Policy Ethics Assessment Tool, an ethical assessment tool for clinical policies that could be used not only by clinical ethics committees but also by policy committees or other relevant groups. AIM: The aim of this study was to find or create a tool to identify ethical issues and/or confirm ethical validity in nursing practice policies, protocols and guidelines. METHODOLOGY: The development of Clinical Policy Ethics Assessment Tool involved first a literature review, followed by modification of the Research Protocol Ethics Assessment Tool, which was created to identify research protocols' ethical issues, and finally, a trial of Clinical Policy Ethics Assessment Tool to ensure its reliability and validity. ETHICAL CONSIDERATION: The policies analysed trialling Clinical Policy Ethics Assessment Tool were in the public domain and did not contain any confidential information. Despite that, Clinical Policy Ethics Assessment Tool also had the approval of a research ethics committee. RESULTS: Research Protocol Ethics Assessment Tool was chosen as the template for a Clinical Policy Ethics Assessment Tool, to which several modifications were added to adapt it to work within a nursing practice context. Clinical Policy Ethics Assessment Tool was tested twice, which resulted in a general test-retest reliability coefficient = 0.86, r = 0.84, α1 = 0.817, α2 = 0.824 and interclass correlation coefficient = 0.874. DISCUSSION: Contemporary nursing practice in a developed country is often ruled by clinical policies. The use of Clinical Policy Ethics Assessment Tool could confirm the ethical validity of those clinical practice policies, impacting on nurses' education, values and quality of care. CONCLUSION: Clinical Policy Ethics Assessment Tool has the potential to detect ethical issues and facilitate the correction and improvement of clinical policies and guidelines in a structured way. This is especially so as it has shown reliability in detecting issues in clinical policies involving human participants and in encouraging policymakers to consider common ethical dilemmas in nursing practice.

Successful partnerships with third sector organisations to enhance the healthcare student experience: a partnership evaluation.

There is limited research surrounding academic partnerships and more research is needed to educate universities, and the private, public and third sectors about the benefits and limitations of such partnerships. The aim of this study was to outline the unique partnership between Macmillan Cancer Support and De Montfort University and to evaluate the progress of this partnership. A qualitative approach was employed which involved interviews with nine members of the partnership's steering group. Interviews were transcribed and analysed using thematic analysis. The results showed that a partnership between a university and a third sector charity can have mutual benefits for all those involved, particularly for students and those affected by cancer. Furthermore, the module to develop volunteering among families affected cancer, created through this partnership is now being considered by other universities as a way of providing holistic and non-traditional lecture based learning experiences. Recommendations are made for future partnerships between third sector charities and universities.

Did the participants of the mass fatality exercise Operation Torch learn anything?

There are a number of reasons why facilitating and participating in a mass fatality exercise may be viewed as continuous professional development for those ultimately engaged in the response to a mass fatality incident. These include, amongst other objectives; team integration, organization and preparedness, psychological and emotional effects, developing attitudes and behavioral responses as well as testing infrastructure, equipment, command and control. The objectives of attending an exercise from a player or observers point of view however may be completely different to those planning and running an exercise. This was identified at the exercise Operation Torch. The paper illustrates this and questions whether these two separate purposes can be fully achieved in one exercise. It puts forward proposals to assist exercise planners identify, plan, exercise, evaluate and implement both capability gap or educational exercises by assisting planners to deliver the purpose of the exercise which needs to be decided at the early stage of planning. It makes recommendations for the need for a national mass fatality exercise database to ensure that the correct exercise is delivered and a wider audience can be informed of the exercise outcome.

Perceptions of near virtual autopsies.

INTRODUCTION: We present for the first time to our knowledge an insight into pathology/medico-legal practitioners' and general public perceptions' of the use of computed tomography (CT) scanning as an alterative to the invasive autopsy. SUBJECTS: The study arises from questionnaires at two professional meetings before and after an informative talk on the current use of CT in medico-legal autopsy practice. A total of 45 general public and 27 pathologists/medico-legal practitioners completed both parts of the study. A combination of open and closed questions were used to allow thematic and descriptive statistical analysis. RESULTS/CONCLUSIONS: The results show commonalities and differences of opinions between the two study groups. A desire was identified from the public to use CT scanning as an alternative to invasive autopsy if available. However, the majority of the public questioned indicated that they would not object to an invasive autopsy being undertaken on their relative if one was authorised by a coroner; it was the pathologists who questioned the need for the examination. However, although they raised this question, the pathologists still expressed the preference of the traditional invasive autopsy over a CT scan.

Does England need a new genesis of forensic nursing?

This article begins by providing a global picture of violence and the possible effects it is having on the development worldwide of the forensic nurse examiner. A debate follows as to where the boundaries of this advancing nursing practice should lie in conjunction with medicine and postulates where this evolution in nursing may or may not be an advantage to the world of forensics. An analysis is then presented concerning violence in England and whether a need exists for registered nurses to expand and advance their practices, as already developed in other countries, in order to assist in civil, coronial, and crime investigations. This article closes by putting forward implications for nursing practice in England, the consequent multiprofessional issues that need to be debated to ensure that any such developments are not detrimental to legal investigations and health care, and recommendations for future needed research.