When Life-Supporting Interventions Lead to Moral Distress.

Moral distress can impact nurses and the care team significantly. A profession dedicated to the principles of caring and compassion is often subjected to patients receiving futile treatment. With the proliferation of extreme life-prolonging measures come the difficulties in the withdrawal of those medical modalities. If a prognosis is poor and care is perceived as curative rather than palliative, providers may often feel conflicted and distressed by their interventions. The American Association of Colleges of Nursing has expressed growing concern about an increase in the use of inappropriate life-support treatments related to futile care. The compelling case of a severely beaten 69-year-old homeless man who had cardiac-arrested and was resuscitated after an unknown amount of down-time, provides the contextual framework for this report. Ethical conflicts can become very challenging, which inevitably increases the suffering of the patient and their caregivers. Research findings suggest that health care organizations can benefit from enacting processes that make ethical considerations an early and routine part of everyday clinical practice. A proactive approach to ethical conflicts may improve patient care outcomes and decrease moral distress.

Blood Conservation: Exploring Alternatives to Blood Transfusions.

The conservation of blood products and the use of alternatives to blood transfusion are the best practice. Patients treated with blood conservation techniques will have a reduced risk of blood-borne diseases and a reduced risk of human error that can occur during blood processing. The bedside nurse plays a vital role in educating the patient and the caregiver regarding risks, benefits, and alternatives. A combination of techniques explored focuses on minimizing blood loss, building the patient's own blood supply, or both. Medications, herbs, and supplements can increase bleeding and place the patient at risk for a transfusion. Evidence from a variety of sources indicates that postoperative patients who receive a blood transfusion will have a harder time with wound healing and overall recovery. Allogeneic blood transfusions can induce clinically significant immunosuppression, as well as other effects in recipients, to include a re-occurrence of cancer. For the Jehovah's Witnesses patient, receiving blood transfusions against their conscience is equal to rape. Therefore, appropriate management entails an understanding of ethical and legal issues involved. Providing meticulous medical care, such as essential interventions and techniques to reduce blood loss, can minimize the risk of subsequent need for blood transfusions and decrease the financial burden to the health care system and its consumers.

Porphyria: A Rare, Complicated, and Misdiagnosed Disease.

Diagnosis of porphyria is often difficult due to the range of symptoms, which are common in many other disorders, hence frequently leading to misdiagnosis. Attacks can be triggered through sunlight and contact with diverse substances, including medications. Signs are severe, appear quickly, and tend to last from days to weeks, affecting the skin, mentation, the digestive, cardiovascular, nervous, and muscular system. Neuropathy signifies a severe and potentially life-threatening attack. Porphyria is mainly an inherited disorder, but can be acquired, and emerges in adults and children. The exact rates of porphyria are unknown and vary around the world. Diagnosis, clinical presentation, treatment, and disease management are introduced.

Clinical Simulation Learning in Critical Care.

Nurses are expected to master many skills, especially in critical care; thus, competency is crucial. Clinical educators must determine whether nurses who are new to the skill set have attained an acceptable level of achievement in performance; hence, are they capable of providing quality and safe patient care? Simulation learning is used in the hospital setting and largely in academic centers. Strategies include for the instructor to acquire an aspect of abilities and deficits as a basis upon which to create learning experiences that enable nurses to develop essential clinical competence.