Nursing strike, America, 2019: Concept analysis to guide practice.

BACKGROUND: In 2018 a nursing 'sympathy strike' occurred. Although unionized nurses were directed to participate, many expressed questions about what a strike or sympathy strike was. Literature revealed no seminal article to define the term. A concept analysis for the nursing workforce was created. METHOD: The Hybrid Method of Concept Analysis, (theoretical literature analysis, qualitative stakeholder interviews; applicability) was used. 33 articles and 7 books were reviewed. Nine interviews took place. RESULTS: The literature and interviews agreed on the definition, antecedents, and consequences of a nursing strike. Strikes in the United States were defined as "a last resort effort, after significant bargaining on the issue between nurses and management has not allowed for agreement, where a work stoppage occurs and nurses leave the bedside." Interviews alone introduced the concept of duty to patients. A model case, contrary case and borderline case are offered. CONCLUSION: This study contains recommendations for practice.

The hospital ethics committee and the nurse.

This article discusses all aspects of the hospital ethics committee. The nurse's use of the committee and participation on the committee are delineated. Neonatal examples are given.

Reconsidering do-not-resuscitate orders in the perioperative setting.

Many of our elderly have now signed advance directives or physicians' order sets of life-sustaining treatment forms. Frequently, choices have been made for no life-sustaining interventions at the end of life or do-not-resuscitate (DNR) orders. As the proportion of elderly grows and more patients seek surgical intervention for comfort or to improve their quality of life, the medical and ethical issues of DNR orders in the perioperative setting become increasingly more complex. Many health care providers neither recognize the complexity and significance of the DNR order during the perioperative period nor have hospitals established actions toward resolution of this situation. This article will discuss how this complex issue should be explored, definitions established, and positions recommended.

Considering boundaries in nursing: what the staff nurse needs to know.

This article considers the ethics of boundaries and nursing practice. The nurse's role as a "carer" is reflected in the context of boundary setting, boundary crossing, and boundary violation. This issue is redeveloped within the new perspective of the nurse's use of social media and boundary crossing. National and international regulations are discussed and individual cases assessed. The Nurses Code of Ethics is used as a framework. The American Nurses Association material on social media is reviewed.

Transition from curative efforts to purely palliative care for neonates: does physiology matter?

OBJECTIVE: To isolate the threshold point in which the goal of care for an infant with life-limiting conditions transitions from curative efforts to purely palliative care. DESIGN: Descriptive Web-based survey of 285 neonatal physicians and nurses who had participated in care of dying infants. METHOD: Researcher-developed tool measured multiple palliative care concepts related to transition to purely palliative care, such as identification of infants for whom purely palliative care should be offered; physician and nurse satisfaction with and barriers to the transition process; physiological factors that indicated that the infant was ready for transition to purely palliative care; publication knowledge to guide palliative care; and factors influencing decision making. RESULTS: The study aim was to identify the physiology involved in coming to the end of life and indicating a transition need for palliative care. But although the respondents were able to identify physiological factors or lethal conditions leading to a transition to purely palliative care, they stated that these factors were not how the goals of care were established. Respondents (96%) stated that parental agreement was the determinant to palliative care transition, and, regardless of neonatal physiological condition, without agreement, curative technological efforts continued. Respondents felt that more education on the palliative care process for both staff and families was necessary to move dignified end-of-life care forward. CONCLUSIONS: Parents must be our partners when the burden of care to the infant is greater than the benefit. Suggestions to assist both parents and providers are offered. CLINICAL RELEVANCE: Although this study is based on end-of-life decision making for newborns, the findings may resonate to nurses who care for dying patients of any age group, with any diagnosis, cared for in any type of medical-surgical or critical care unit. The findings describe the American concept of patient and family autonomy and problems that have arisen from the implementation of autonomy in end-of-life decision making regarding withholding/withdrawing therapies that provide artificial life support.

Care of the child with the desire to change gender--Part I.

This is Part I of a three-part series on children and young adults who desire to live as a gender different from which they were born. The series depicts the psychosocial, medical, and surgical components of transitioning from one gender to another. The medical and psychosocial issues of transgender change are complex, and ethical questions may be raised by those who would challenge these choices. Nurses will be best able to care for these patients with awareness of the multiple dimensions of these procedures and the ramifications of caring for these children and their families.

Care of the child with the desire to change genders--Part III: Male-to-female transition.

This is Part II of a three-part series on children and young adults who desire to live as a gender different from which they were born. The series depicts the psychosocial, medical, and surgical components of transitioning from one gender to another. The medical and psychosocial issues of transgender change are complex, and ethical questions may be raised by those who would challenge these choices. Nurses will be best able to care for these patients with awareness of the multiple dimensions of these procedures and the ramifications of caring for them and their families.

Care of the child with the desire to change genders - part III: male-to-female transition.

In Part I of this three-part article, the psychological and medical care of the child wishing to change gender was described. In Part II, preparation for surgery for young adults who were genetically female and undergo surgery to transition to male identity was presented. This third part presents the surgical treatments for gender reassignment procedures for a genetic male wishing to reassign as female. Discussion is included about how parents are responding to these wishes from their prepubescent and teenage children.

Care of the child with the desire to change gender--Part I.

This article is the first in a three-part series describing the nursing and medical care of a child wishing to change genders. Part I will depict the psychological and hormonal treatment for children who express a desire to change genders. Part II will describe surgical treatments and nursing care for gender reassignment from female to male. Part III will present the surgical needs of transition from male to female.

Five incredible babies, five paradigm cases that greatly influenced neonatal ethics: what do their parents say today?

As the National Association of Neonatal Nurses celebrates its 25th year, we look back at 5 cases that reflect the times in which these babies were born and whose stories have impacted the development of neonatal ethics. These 5 stories take us through the periods of "all must be done" to "parents can choose" and to "are we overdoing?" Neonatal nurses can receive guidance from these wise parents today.

Perinatal bereavement and palliative care offered throughout the healthcare system.

The aims of this article are twofold: (I) provide a general overview of perinatal bereavement services throughout the healthcare system and (II) identify future opportunities to improve bereavement services, including providing resources for the creation of standardized care guidelines, policies and educational opportunities across the healthcare system. Commentary is provided related to maternal child services, the neonatal intensive care unit (NICU), prenatal clinics, operating room (OR) and perioperative services, emergency department (ED), ethics, chaplaincy and palliative care services. An integrated system of care increases quality and safety and contributes to patient satisfaction. Physicians, nurses and administrators must encourage pregnancy loss support so that regardless of where in the facility the contact is made, when in the pregnancy the loss occurs, or whatever the conditions contributing to the pregnancy ending, trained caregivers are there to provide bereavement support for the family and palliative symptom management to the fetus born with a life limiting condition. The goal for respectful caregiving throughout an entire hospital system is achievable and critically important.

Determining the Needs of Family Caregivers of Stroke Patients During Inpatient Rehabilitation Using Interview, Art, and Survey.

The purpose of this study is to explore the needs of family members at the bedside of stroke patients (n = 12) admitted to an inpatient rehabilitation facility (IRF). Family members' needs were determined through semistructured interviews, "Draw a Bridge" art therapy technique, and the Family Inventory of Needs. Family members described a family-centered approach to care that addressed the following needs: assistance with preparing for discharge, staff caring for family members, communication about the plan of care and what to expect postdischarge, and trusting the care provided by IRF staff. Art therapy revealed that stroke was a crisis with many unmet needs for the interviewer to explore. Descriptive statistical analysis of the Family Inventory of Needs revealed that both met and unmet needs were consistent with the interviews and the interpretations of the drawings. These findings inform the need for interventions during IRF to enhance communication, support, and effective caregiver education amidst the crisis of stroke.

Effect of a noise reduction program on a medical-surgical unit.

This quasi-experimental study tested an intervention to reduce sound levels in an acute care hospital. A parallel pre- and posttest design with control group was used; patients and employees completed the Topf Adapted Sound Disturbance Scales, and environmental sound levels were recorded on a Quest 2900 Sound Level Meter. Treatment interventions included an educational PowerPoint presentation for employees, minor environmental acoustical alterations, and the use of a Quest 261 Sound Detector/Controller for behavioral modification. None of these interventions produced statistically significant changes in sound levels. Patients and employees reported slightly less disturbance due to noise postintervention on the treatment unit. The findings of this study support Philbin and Gray's suggestion that the use of sound-absorbing materials in the hospital's physical structure may be the most effective measure to reduce sound levels in the hospital setting.

Issues and ethics related to embryo placement: a national discussion.

There is growing debate over the transfer, or "placement," of embryos. During the first national conference on embryos (Emerging Issues in Embryo Adoption and Donation), funded by the U.S. Department of Health and Human Services, Thomas C. Atwood, President and CEO of the National Council for Adoption, expressed his views and concerns regarding embryo "adoption." This article will highlight Mr. Atwood's presentation, offering a chance to examine and reflect on the scientific questions and moral implications of this new procedure.

The Groningen Protocol: what is it, how do the Dutch use it, and do we use it here?

In this article, a sensitive, complex and provocative issue is discussed. It will undoubtedly stimulate a variety of opinions. What do you think? Post your comments about this topic on the Pediatric Nursing Web site and read what others have to say as well. Visit our homepage at www.pediatricnursing.net and click on "Discussions." The opinions and assertions contained herein are the private views of the contributors and do not necessarily reflect the views of Pediatric Nursing or the publisher.

Interdisciplinary Guidelines for Care of Women Presenting to the Emergency Department With Pregnancy Loss.

In April 2016, the National Perinatal Association and Kaiser Permanente Northern California Nursing Research Community Benefits Grant sponsored an interdisciplinary summit to explore the needs of women who present with actual or potential pregnancy loss to the emergency department (ED). Thirty-two experts in the field of pregnancy loss, 17 of whom represented their professional organizations, participated. These experts, which included nurses, physicians, social workers, counselors, authors, and parents, worked together to create guidelines for care of women with a pregnancy loss in the ED. Recommendations for ED healthcare providers are included. Emergency department personnel agreed that improvements in care could be offered and were willing to endorse education for their staff. The guidelines delineate how to better provide physical, emotional, and bereavement support at any stage of gestational loss. Administrative support for policies in the ED is essential to ensure the delivery of family-centered, culturally sensitive practices when a pregnancy ends.