Educating patients in a French cancer treatment center: How to ensure therapy safety while reckoning patients' knowledge and power to act.

In this article, we analyse how health professionals educate cancer patients to care for their condition and keep strict control over therapy safety. We study how much room for negotiation is left to patients during medical consultations so resources can still be exchanged. We pay particular attention to the trade of knowledge and powers between patients and doctors (power to act and to express oneself in an imbalanced relationship where knowledge is unequally shared). We opted for a qualitative approach with 41 interviews and several ethnological observations, first of consultations in haematology, then of pre-planned phone calls made to patients during the course of a cancer therapy follow-up scheme. The declared ambition of turning cancer patients into self-responsible patients actually re-enacts well-known procedures of control and knowledge acquisition aimed at narrowing their margin of manoeuvre for the sake of therapy safety. Even if some freedom is conceded, patients remain under the control of their medical hierarchy. Health professionals privilege two methods to keep control over patients and teach them therapy safety procedures. Which method is chosen, and how it is used, is dictated by the relationship between socially-diverse patients and health professionals. In the end, what the patient learns and the amount of control the doctor keeps over this process will depend on the distribution of power and knowledge among them, but asymmetry will always remain.

Events related to medication errors and related factors involving nurses' behavior to reduce medication errors in Japan: a Bayesian network modeling-based factor analysis and scenario analysis.

PURPOSE: This study aimed to identify the relationships between medication errors and the factors affecting nurses' knowledge and behavior in Japan using Bayesian network modeling. It also aimed to identify important factors through scenario analysis with consideration of nursing students' and nurses' education regarding patient safety and medications. METHODS: We used mixed methods. First, error events related to medications and related factors were qualitatively extracted from 119 actual incident reports in 2022 from the database of the Japan Council for Quality Health Care. These events and factors were then quantitatively evaluated in a flow model using Bayesian network, and a scenario analysis was conducted to estimate the posterior probabilities of events when the prior probabilities of some factors were 0%. RESULTS: There were 10 types of events related to medication errors. A five-layer flow model was created using Bayesian network analysis. The scenario analysis revealed that "failure to confirm the 5 rights," "unfamiliarity with operations of medications," "insufficient knowledge of medications," and "assumptions and forgetfulness" were factors that were significantly associated with the occurrence of medical errors. Conclusion: s: This study provided an estimate of the effects of mitigating nurses' behavioral factors that trigger medication errors. The flow model itself can also be used as an educational tool to reflect on behavior when incidents occur. It is expected that patient safety education will be recognized as a major element of nursing education worldwide and that an integrated curriculum will be developed.

Adverse events at the end of life of hospital patients with or without a condition relevant for palliative care: a nationwide retrospective record review study in the Netherlands.

BACKGROUND: Patient safety is crucial for quality of care. Preventable adverse events (AEs) occur in 1 of 20 patients in the hospital, but it is unknown whether this is different for patients with a condition relevant for palliative care. The majority of the limited available research on this topic is only focused on patients already receiving palliative care, and do not make comparisons with other patients at the end-of-life. We identified and compared the prevalence, preventability, nature and causes of AEs in patients with and without a condition relevant for palliative care. METHODS: A nationwide retrospective record review study was performed in 20 Dutch hospitals. A total of 2,998 records of patients who died in hospital in 2019 was included. Records were reviewed for AEs. We identified two subgroups: patients with (n = 2,370) or without (n = 248) a condition relevant for palliative care through the selection method of Etkind (2017). Descriptive analyses were performed to calculate prevalence, nature, causes and prevention strategies. T-tests were performed to calculate differences between subgroups. RESULTS: We found no significant differences between subgroups regarding AE prevalence, this was 15.3% in patients with a condition relevant for palliative care, versus 12.0% in patients without a condition relevant for palliative care (p = 0.148). Potentially preventable AE prevalence was 4.3% versus 4.4% (p = 0.975). Potentially preventable death prevalence in both groups was 3.2% (p = 0.938). There were differences in the nature of AEs: in patients with a condition relevant for palliative care this was mostly related to medication (33.1%), and in patients without a condition relevant for palliative care to surgery (50.8%). In both subgroups in the majority of AEs a patient related cause was identified. For the potentially preventable AEs in both subgroups the two most important prevention strategies as suggested by the medical reviewers were reflection and evaluation and quality assurance. DISCUSSION: Patient safety risks appeared to be equally prevalent in both subgroups. The nature of AEs does differ between subgroups: medication- versus surgery-related, indicating that tailored safety measures are needed. Recommendations for practice are to focus on reflecting on AEs, complemented with case evaluations.

Educational video for teaching safe practices in the perioperative period: randomized controlled trial.

OBJECTIVE: to assess the effectiveness of an educational video on hospitalized patients' knowledge of safe practices in the perioperative period. METHOD: randomized, double-blind controlled trial carried out in a teaching hospital in the countryside of Minas Gerais. 100 participants undergoing elective orthopaedic surgery were randomly allocated (50 participants in the experimental group and 50 participants in the control group). Patient knowledge was assessed using a questionnaire constructed by the researchers and validated by specialists, before and after the intervention (educational video) or standard guidelines were applied. Descriptive statistics were used for quantitative variables and Student's t-test for independent samples to analyze the mean difference in knowledge between the experimental and control groups (α = 0.05). RESULTS: 100 participants took part in the study, 50 participants in the experimental group and 50 participants in the control group. The experimental group showed a significantly higher gain in knowledge (t =3.72 ±1.84; p<0.001) than the control group. Cohen's d was 1.22, indicating a large magnitude of the effect. CONCLUSION: the educational video was effective in improving patients' knowledge and can contribute to nurses in the practice of health education, optimizing time and disseminating knowledge about safe practices in the perioperative period. Brazilian Registry of Clinical Trials (REBEC): RBR-8x5mfq. (1) Development of a valid patient knowledge assessment questionnaire. (2) Production of a valid educational video on perioperative safety. (3) The final version of the educational video is 7 minutes and 50 seconds long. (4) The educational video was effective in improving patient knowledge. (5) It contributes to patient involvement in safe care.

Improving quality and patient safety in surgical care through standardisation and harmonisation of perioperative care (SAFEST project): A research protocol for a mixed methods study.

INTRODUCTION: Adverse events in health care affect 8% to 12% of patients admitted to hospitals in the European Union (EU), with surgical adverse events being the most common types reported. AIM: SAFEST project aims to enhance perioperative care quality and patient safety by establishing and implementing widely supported evidence-based perioperative patient safety practices to reduce surgical adverse events. METHODS: We will conduct a mixed-methods hybrid type III implementation study supporting the development and adoption of evidence-based practices through a Quality Improvement Learning Collaborative (QILC) in co-creation with stakeholders. The project will be conducted in 10 hospitals and related healthcare facilities of 5 European countries. We will assess the level of adherence to the standardised practices, as well as surgical complications incidence, patient-reported outcomes, contextual factors influencing the implementation of the patient safety practices, and sustainability. The project will consist of six components: 1) Development of patient safety standardised practices in perioperative care; 2) Guided self-evaluation of the standardised practices; 3) Identification of priorities and actions plans; 4) Implementation of a QILC strategy; 5) Evaluation of the strategy effectiveness; 6) Patient empowerment for patient safety. Sustainability of the project will be ensured by systematic assessment of sustainability factors and business plans. Towards the end of the project, a call for participation will be launched to allow other hospitals to conduct the self-evaluation of the standardized practices. DISCUSSION: The SAFEST project will promote patient safety standardized practices in the continuum of care for adult patients undergoing surgery. This project will result in a broad implementation of evidence-based practices for perioperative care, spanning from the care provided before hospital admission to post-operative recovery at home or outpatient facilities. Different implementation challenges will be faced in the application of the evidence-based practices, which will be mitigated by developing context-specific implementation strategies. Results will be disseminated in peer-reviewed publications and will be available in an online platform.

Evaluating the content and face validity of Arabic-translated Patient Measures of Safety survey PMOS-30.

BACKGROUND: The importance of patient perception of patient safety has been proven as an active role in promoting safety and predicting harm. Patients play a vital role in the healthcare sector and the impact of patient perception of patient safety has been repetitively proven in the literature to be for its effectiveness in predicting harm and promoting safety. Nonetheless, there is limited knowledge about the specific insights patients can provide concerning safety within Arab countries. Therefore, improving and strengthening active patient participation by including patients' perceptions of safety could offer novel contributions to the realm of patient safety. OBJECTIVE: This study aims to evaluate the validity of the Arabic version of the PMOS-30. METHOD: The forward-backward translation procedure was used to translate and validate the PMOS-30. Mix methods were used to assess the validity of the translated version. The expert raters evaluated the content validity and interviews were conducted with in-patients to assess the face validity. Test-retest approach was conducted to pilot the final Arabic version. RESULTS: Data of face validity from 13 participants for the first test and 5 participants for the re-test was collected and showed an improvement in the clarity rate (71.50% and 94.66% respectively). With respect to the content validity of the final version, the CVI was 0.92, indicating excellent relevant results. CONCLUSION: The final version of the revised was approved by the expert to be a valid tool to measure patient perceptions of patient safety in Arabic-speaking patients to be utilized on patient safety improvement initiatives.

Patient safety in orthodontic care: a scoping literature review with proposal for terminology and future research agenda.

BACKGROUND: Knowledge about patient safety in orthodontics is scarce. Lack of standardisation and a common terminology hinders research and limits our understanding of the discipline. This study aims to 1) summarise current knowledge about patient safety incidents (PSI) in orthodontic care by conducting a systematic literature search, 2) propose a new standardisation of PSI terminology and 3) propose a future research agenda on patient safety in the field of orthodontics. METHODS: A systematic literature search was performed in the main online sources of PubMed, Web of Science, Scopus and OpenGrey from their inception to 1 July 2023. Inclusion criteria were based on the World Health Organization´s (WHO) research cycle on patient safety. Studies providing information about the cycle's steps related to orthodontics were included. Study selection and data extraction were performed by two of the authors. RESULTS: A total of 3,923 articles were retrieved. After review of titles and abstracts, 41 articles were selected for full-text review and 25 articles were eligible for inclusion. Seven provided information on the WHO's research cycle step 1 ("measuring harm"), twenty-one on "understanding causes" (step 2) and twelve on "identifying solutions" (step 3). No study provided information on Steps 4 and 5 ("evaluating impact" or "translating evidence into safer care"). CONCLUSION: Current evidence on patient safety in orthodontics is scarce due to a lack of standardised reporting and probably also under-reporting of PSIs. Current literature on orthodontic patient safety deals primarily with "measuring harms" and "understanding causes of patient safety", whereas less attention has been devoted to initiatives "identifying solutions", "evaluating impact" and "translating evidence into safer care". The present project holds a proposal for a new categorisation, terminology and future research agenda that may serve as a framework to support future research and clinical initiatives to improve patient safety in orthodontic care. REGISTRATION: PROSPERO (CRD42022371982).

How does robotic surgery affect gynecology patient care?

The aim of this review is to map the current research on the needs of gynecological patients treated with robotic surgery. Systematic Rapid Review. Pubmed, Web of Science, Google Scholar. Search was limited from the years 2017-2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. Rapid review is a synthesis of information produced in a shorter time than systematic reviews, which allows clinical nurses to access evidence in the decision-making process. The methodological steps implemented were the following: (1) needs assessment and topic selection, (2) study development, (3) literature search, (4) screening and study selection, (5) data extraction, (6) risk-of-bias assessment and (7) knowledge synthesis. The search yielded 815 articles, 746 were excluded after screening the title and abstract, and 69 full-text syntheses were performed. Only 10 articles were included in the final analysis. This research evaluated the effects of robotic surgery on the patient under seven themes; operative time, length of stay, complications, estimated blood loss, pain, survivor, and conversion. Five studies were on endometrial cancer, one study on gynecologic cancer, two studies on hysterectomy, one study on patient safety, and one study on cervical cancer. The results show that robotic surgery can change the needs of patients by solving ongoing problems in gynecological patients. This requires a better understanding of robotic surgery procedures while facilitating nursing care over patient care.

Does assistive technology contribute to safety among home-dwelling older adults?

BACKGROUND: Assistive technology carries the promise of alleviating public expenditure on long-term care, while at the same time enabling older adults to live more safely at home for as long as possible. Home-dwelling older people receiving reablement and dementia care at their homes are two important target groups for assistive technology. However, the need for help, the type of help and the progression of their needs differ. These two groups are seldom compared even though they are two large groups of service users in Norway and their care needs constitute considerable costs to Norwegian municipalities. The study explores how assistive technology impacts the feeling of safety among these two groups and their family caregivers. METHODS: Face-to-face, semi-structured interviews lasting between 17 and 61 min were conducted between November 2018 and August 2019 with home-dwelling older adults receiving reablement (N = 15) and dementia care (N = 10) and the family caregivers (N = 9) of these users in seven municipalities in Norway. All interviews were audio-recorded, fully transcribed, thematically coded and inductively analyzed following Clarke and Braun's principles for thematic analysis. RESULTS: Service users in both groups felt safe when knowing how to use assistive technology. However, the knowledge of how to use assistive technology was not enough to create a feeling of safety. In fact, for some users, this knowledge was a source of anxiety or frustration, especially when the user had experienced the limitations of the technology. For the service users with dementia, assistive technology was experienced as disturbing when they were unable to understand how to handle it, but at the same time, it also enabled some of them to continue living at home. For reablement users, overreliance on technology could undermine the progress of their functional improvement and thus their independence. CONCLUSION: For users in both service groups, assistive technology may promote a sense of safety but has also disadvantages. However, technology alone does not seem to create a sense of safety. Rather, it is the appropriate use of assistive technology within the context of interactions between service users, their family caregivers and the healthcare staff that contributes to the feeling of safety.

Patient safety culture in private hospitals in China: a cross-sectional study using the revised Hospital Survey on Patient Safety Culture.

Background: This study aimed to translate the revised Hospital Survey on Patient Safety Culture (HSOPSC 2.0) to Mandarin, evaluate its psychometric properties, and apply it to a group of private hospitals in China to identify the determinants associated with patient safety culture. Methods: A two-phase study was conducted to translate and evaluate the HSOPSC 2.0. A cross-cultural adaptation of the HSOPSC 2.0 was performed in Mandarin and applied in a cross-sectional study in China. This study was conducted among 3,062 respondents from nine private hospitals and 11 clinics across six cities in China. The HSOPSC 2.0 was used to assess patient safety culture. Primary outcomes were measured by the overall patient safety grade and patient safety events reported. Results: Confirmatory factor analysis results and internal consistency reliability were acceptable for the translated HOSPSC 2.0. The dimension with the highest positive response was "Organizational learning - Continuous improvement" (89%), and the lowest was "Reporting patient safety event" (51%). Nurses and long working time in the hospital were associated with lower assessments of overall patient safety grades. Respondents who had direct contact with patients, had long working times in the hospital, and had long working hours per week reported more patient safety events. A higher level of patient safety culture implies an increased probability of a high overall patient safety grade and the number of patient safety events reported. Conclusion: The Chinese version of HSOPSC 2.0 is a reliable instrument for measuring patient safety culture in private hospitals in China. Organizational culture is the foundation of patient safety and can promote the development of a positive safety culture in private hospitals in China.

Global progress and Never Events.

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, discusses some national and international reports on patient safety.

Cultura de segurança em unidades de terapia intensiva na perspectiva da equipe multiprofissional: Estudo multicêntrico / Cultura de seguridad en unidades de terapia intensiva en la perspectiva del equipo multiprofesional: Estudio multicéntrico / Safety Culture in intensive care units from multiprofessional team perspective: A multicenter study

Resumo Introdução: A Cultura de Segurança do Paciente é considerada um importante componente estrutural dos serviços, que favorece a implantação de práticas seguras e a diminuição da ocorrência de eventos adversos. Objetivo: Identificar os fatores associados à cultura de segurança do paciente nas unidades de terapia intensiva adulto em hospitais de grande porte da região Sudeste do Brasil. Método: Estudo transversal do tipo survey e multicêntrico. Participaram 168 profissionais de saúde de quatro unidades (A, B, C e D) de terapia intensiva adulto. Foi utilizado o questionário "Hospital Survey on Patient Safety Culture". Considerou-se como variável dependente o nível de cultura de segurança do paciente e variáveis independentes aspectos sociodemográficos e laborais. Foram usadas estatísticas descritivas e para a análise dos fatores associados foi elaborado um modelo de regressão logística múltipla. Resultados: Identificou-se associação entre tipo de hospital com onze dimensões da cultura de segurança, quanto à função a categoria profissional médico, técnico de enfermagem e enfermeiro foram relacionadas com três dimensões; o gênero com duas dimensões e tempo de atuação no setor com uma dimensão. Conclusão: Evidenciou-se que o tipo de hospital, categoria profissional, tempo de atuação no setor e gênero foram associados às dimensões de cultura de segurança do paciente.

Resumen Introducción: La cultura de seguridad del paciente se considera un componente estructural importante de los servicios, que favorece la aplicación de prácticas seguras y la reducción de la aparición de acontecimientos adversos. Objetivo: Identificar los factores asociados a la cultura de seguridad del paciente en unidades de terapia intensiva adulto en hospitales de la región Sudeste del Brasil. Metodología: Estudio transversal de tipo encuesta y multicéntrico. Participaron 168 profesionales de salud de cuatro unidades (A, B, C y D) de terapia intensiva adulto. Se utilizó el cuestionario "Hospital Survey on Patient Safety Culture". Se consideró como variable dependiente el nivel de cultura de seguridad del paciente y variables independientes los aspectos sociodemográficos y laborales. Fueron usadas estadísticas descriptivas y, para analizar los factores asociados, fue elaborado un modelo de regresión logística múltiple. Resultados: Se identificó asociación entre tipo de hospital con once dimensiones de cultura de seguridad del paciente. En relación a la función, personal médico, técnicos de enfermería y personal de enfermería fueron asociados con tres dimensiones, el género con dos dimensiones y tiempo de actuación con una dimensión en el modelo de regresión. Conclusión: Se evidenció que el tipo de hospital, función, tiempo de actuación en el sector y género fueron asociados a las dimensiones de la cultura de seguridad del paciente.

Abstract Introduction: Patient safety culture is considered an important structural component of the services, which promotes the implementation of safe practices and the reduction of adverse events. Objective: To identify the factors associated with patient safety culture in adult intensive care units in large hospitals in Belo Horizonte. Method: Cross-sectional survey and multicenter study. A total of 168 health professionals from four units (A, B, C and D) of adult intensive care participated. The questionnaire "Hospital Survey on Patient Safety Culture" was used. The patient's level of safety culture was considered as a dependent variable, and sociodemographic and labor aspects were the independent variables. Descriptive statistics were used and a multiple logistic regression model was developed to analyze the associated factors. Results: An association was identified between the type of hospital and eleven dimensions of the safety culture. In terms of function, the doctors, nursing technicians, and nurse were related to three dimensions; gender with two dimensions, and time working in the sector with one dimension. Conclusion: It was evidenced that the type of hospital, function, time working in the sector, and gender were associated with the dimensions of patient safety culture.

Identifying Interventions to Improve Diagnostic Safety in Emergency Departments: Protocol for a Participatory Design Study.

BACKGROUND: Emergency departments (EDs) are complex and fast-paced clinical settings where a diagnosis is made in a time-, information-, and resource-constrained context. Thus, it is predisposed to suboptimal diagnostic outcomes, leading to errors and subsequent patient harm. Arriving at a timely and accurate diagnosis is an activity that occurs after an effective collaboration between the patient or caregiver and the clinical team within the ED. Interventions such as novel sociotechnical solutions are needed to mitigate errors and risks. OBJECTIVE: This study aims to identify challenges that frontline ED health care providers and patients face in the ED diagnostic process and involve them in co-designing technological interventions to enhance diagnostic excellence. METHODS: We will conduct separate sessions with ED health care providers and patients, respectively, to assess various design ideas and use a participatory design (PD) approach for technological interventions to improve ED diagnostic safety. In the sessions, various intervention ideas will be presented to participants through storyboards. Based on a preliminary interview study with ED patients and health care providers, we created intervention storyboards that illustrate different care contexts in which ED health care providers or patients experience challenges and show how each intervention would address the specific challenge. By facilitating participant group discussion, we will reveal the overlap between the needs of the design research team observed during fieldwork and the needs perceived by target users (ie, participants) in their own experience to gain their perspectives and assessment on each idea. After the group discussions, participants will rank the ideas and co-design to improve our interventions. Data sources will include audio and video recordings, design sketches, and ratings of intervention design ideas from PD sessions. The University of Michigan Institutional Review Board approved this study. This foundational work will help identify the needs and challenges of key stakeholders in the ED diagnostic process and develop initial design ideas, specifically focusing on sociotechnological ideas for patient-, health care provider-, and system-level interventions for improving patient safety in EDs. RESULTS: The recruitment of participants for ED health care providers and patients is complete. We are currently preparing for PD sessions. The first results from design sessions with health care providers will be reported in fall 2024. CONCLUSIONS: The study findings will provide unique insights for designing sociotechnological interventions to support ED diagnostic processes. By inviting frontline health care providers and patients into the design process, we anticipate obtaining unique insights into the ED diagnostic process and designing novel sociotechnical interventions to enhance patient safety. Based on this study's collected data and intervention ideas, we will develop prototypes of multilevel interventions that can be tested and subsequently implemented for patients, health care providers, or hospitals as a system. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55357.

Risks to patient safety in remote consulting.

BACKGROUND: Remote consulting was rolled out across general practice in 2020 in response to the COVID-19 pandemic. Although most consultations are carried out safely, in some cases remote care has contributed to adverse outcomes. AIM: To understand where the risks lie in delivering primary care remotely. METHOD: Mixed method study in UK primary care settings including general practice, out of hours and 111 services. Data was collated from NHS England complaints quarterly reviews, NHS Resolution cases, 111 Wales, the HSIB report into 111 COVID services and longitudinal case ethnographic cases studies of 11 general practices. 2 reviewers coded the data and identified themes. RESULTS: There are staff, patient, and setting factors that contribute to risk in remote consulting. Staff factors include communication skills, over-reliance on a previous diagnosis made remotely, failure to recognise clinical findings or the urgency of a case, over/under prescribing/investigating and referring and safety netting. Patient factors include impaired communication, repeated telephone consultations, unstable chronic disease, and certain medical conditions such as chest and abdominal pain. Risk was encountered when settings had limited telephone lines, call handlers or clinicians, or where access to appointments was either restricted, hard to navigate, or where inappropriate layers of triage were applied. Processes had not always adapted for remote working, leading to risk in delayed access to acute prescriptions and delayed referrals. CONCLUSION: Attention to staff, patient, and setting factors can allow risk to be identified and addressed when providing care remotely. .

Simulation-based team training for healthcare professionals in pediatric departments: study protocol for a nonrandomized controlled trial.

BACKGROUND: Healthcare systems worldwide face challenges related to patient safety, quality of care, and interprofessional collaboration. Simulation-based team training has emerged as a promising approach to address some of these challenges by providing healthcare professionals with a controlled and safe environment to enhance their teamwork and communication skills. The purpose of this study protocol is to describe an intervention using simulation-based team training in pediatric departments. METHODS: Using a parallel-group, non-randomized controlled trial design, a simulation-based team training intervention will be implemented across four pediatric departments in Denmark. Another four pediatric departments will serve as controls. The intervention implies that healthcare professionals engage in simulation-based team training at a higher quantity and frequency than they did previously. Development of the intervention occurred from April 2022 to April 2023. Implementation of the intervention occurs from April 2023 to April 2024. Evaluation of the intervention is planned from April 2024 to April 2025. All simulation activity both before and during the intervention will be registered, making it possible to compare outcomes across time periods (before versus after) and across groups (intervention versus control). To evaluate the effects of the intervention, we will conduct four analyses. Analysis 1 investigates if simulation-based team training is related to sick leave among healthcare professionals. Analysis 2 explores if the simulation intervention has an impact on patient safety culture. Analysis 3 examines if simulation-based team training is associated with the treatment of critically ill newborns. Finally, Analysis 4 conducts a cost-benefit analysis, highlighting the potential return on investment. DISCUSSION: The implemented simulation-based team training intervention can be defined as a complex intervention. Following the Medical Research Council framework and guidelines, the intervention in this project encompasses feasibility assessment, planning of intervention, implementation of intervention, and rigorous data analysis. Furthermore, the project emphasizes practical considerations such as stakeholder collaboration, facilitator training, and equipment management. TRIAL REGISTRATION: Registered as a clinical trial on clinicaltrials.gov, with the identifier NCT06064045.

An Evidence-Based Review of the Safety and Efficacy of Remote Chemotherapy Verification.

In response to the nursing shortage and the emergence of telehealth opportunities, the Oncology Nursing Society used an evidence-based approach to examine current literature and trends for the two-person independent double ch.