Wisdom Shared: Health System Nurse Executives Share Success Strategies for Building High-Performing Nursing Organizations

With the evolution from single healthcare entities to health systems, the role of the system chief nurse executive (SCNE) has evolved. The SCNE leads at the highest executive level in the system and has continuum of care accountability. To effectively support the scope and breadth of the SCNE role, the organizational structure must contain key elements to ensure success. This article outlines the key elements of a system nursing organization and serves to aid in the development, improvement, and sustainability of successful system nursing structures.

Ethical Perspectives on Body Donation Following Physician-Assisted Death

The increasing availability of physician-assisted death (PAD) has opened up a novel means of making donated bodies available for anatomical dissection. This practice has come to the fore in Canada, but is unlikely to be confined to that country as legislation changes in other countries. The ethical considerations raised by this development are placed within the framework of the ethical guidelines on body donation promulgated by the International Federation of Associations of Anatomists. The discussion centers on understanding the ethical dimensions of moral complicity, and whether it is accepted or rejected. If rejected it is possible to separate ethical concerns regarding PAD from subsequent use of donated bodies, as long as there is fully informed consent and complete ethical and procedural separation of the two. Openness about the origin of bodies for dissection is essential. Students should be instructed on the nuances of moral complicity, and consideration be given to those with moral doubts about PAD. Two issues are raised in considering whether these moves represent an ethical slippery slope: the attraction represented by obtaining relatively "high quality" bodies, and the manner in which organ donation following PAD has led to challenges to the dead donor rule. Although body donation raises fewer concerns, the ethical dimensions of the two are similar. The ethical constraints outlined here have the capacity to prevent an ethical slippery slope and constitute a sound basis for addressing an innovative opportunity for anatomists.

Social Media Guidelines for Anatomists

Social Media has changed the way that individuals interact with each other - it has brought considerable benefits, yet also some challenges. Social media in anatomy has enabled anatomists all over the world to engage, interact and form new collaborations that otherwise would not have been possible. In a relatively small discipline where individuals may be working as the only anatomist in an institution, having such a virtual community can be important. Social media is also being used as a means for anatomists to communicate with the current generation of students as well as members of the public. Posting appropriate content is one of the challenges raised by social media use in anatomy. Human cadaveric material is frequently shared on social media and there is divided opinion among anatomists on whether or not such content is appropriate. This article explores the uses and challenges of social media use in the field of anatomy and outlines guidelines on how social media can be used by anatomists globally, while maintaining professional and ethical standards. Creating global guidelines has shown to be difficult due to the differences in international law for the use of human tissue and also the irregularities in acquiring informed consent for capturing and sharing cadaveric images. These nuances may explain why cadaveric images are frequently shared on social media. This article proposes that as standard practice, anatomists obtain informed consent from donors before sharing images of cadaveric material on social media and ensure posts include a statement stating the same.

Alpha Omega Alpha Honor Medical Society: A Commitment to Inclusion, Diversity, Equity, and Service in the Profession of Medicine

With a motto of "Be Worthy to Serve the Suffering," Alpha Omega Alpha Honor Medical Society (AΩA) supports the importance, inclusion, and development of a culturally and ethnically diverse medical profession with equitable access for all. The underrepresentation of minorities in medical schools and medicine continues to be a challenge for the medical profession, medical education, and AΩA. AΩA has worked, and continues to work, to ensure the development of diverse leaders, fostering within them the objectivity and equity to be inclusive servant leaders who understand and embrace diversity in all its forms.Inclusion of talented individuals from different backgrounds benefits patient care, population health, education, and scientific discovery. AΩA values an inclusive, diverse, fair, and equitable work and learning environment for all and supports the medical profession in its work to achieve a welcoming, inclusive environment in teaching, learning, caring for patients, and collaboration.The diversity of medical schools is changing and will continue to change. AΩA is committed to continuing to work with its members, medical school deans, and AΩA chapters to assure that AΩA elections are unbiased and based on the values of AΩA and the profession of medicine in service to patients and the profession.Progress toward diversity, inclusion, and equity is more than simply checking off a box or responding to criticism-it is about being and developing diverse excellent physicians. AΩA and all those in the medical profession must continue to guide medicine to be unbiased, open, accepting, inclusive, and culturally aware in order to "Be Worthy to Serve the Suffering."

Where do we stand? Recent AEA member views on professionalization

The professionalization of evaluation continues to be debated at numerous conferences in the U.S. and abroad. At this time, AEA member views on the potential benefits and negative side effects of professionalization are essential as the discussion evolves. This study provides recent views on major topics in professionalization, including potential benefits, negative side effects, processes, competencies, and procedures. Results from in-depth interviews and an online survey demonstrate that AEA members view potential benefits of professionalization to be stakeholder trust, evaluator reputation and identity, while concerns about a potential negative side effect known as the "narrowing effect" (i.e., some evaluators will be alienated based on their background, competencies, etc.) were expressed by participants. These recent findings can inform the ongoing discussion of professionalization, and suggest new directions for future research on evaluation.

Modelling the emergence of an egalitarian society in the n-player game framework

Unlike other primates, human foragers have an egalitarian society. Therefore, the evolution of egalitarian behaviour has been the subject of long-standing debate in a wide variety of disciplines. A recent hypothesis states that a social control against potentially dominant individuals played an important role in the emergence of an egalitarian society. In the present study, we modelled this hypothesis based on the n-player game framework, in which the owner, who may attempt to monopolise resources, could be punished by a coalition of other group members. Our results suggest that a potentially despotic payoff structure can promote the evolution of egalitarian behaviour. Besides, large group size, small cost of competition, and variation in the strengths of individuals can promote the evolution of egalitarian behaviour. Our results suggest the importance of both social control against dominant individuals and benefits of a coalition for the evolution of egalitarian behaviour.

Best Practices in Bridging Education: Multiple Case Study Evaluation of Postsecondary Bridging Programs for Internationally Educated Health Professionals

AIMS

Bridging education for internationally trained professionals has grown in popularity, but little is known about promising practices for bridging education in allied health professions. This paper addresses this gap by examining the expected outcomes of effective bridging programs, the key features that contribute to their effectiveness, challenges faced by bridging programs, and the appropriate role of regulatory colleges, government, employers, and professional associations in bridging education.

METHODS

We conducted a mixed-methods multiple case study analysis of seven bridging programs in Ontario, Canada, in five allied health professions: medical laboratory technology, medical radiation technology, diagnostic medical sonography, respiratory therapy, and physical therapy.

RESULTS

Effective bridging programs are accessible and flexible in content and format. The key challenges include developing curricula tailored to participants' needs, identifying appropriate format for program delivery, obtaining clinical placements for participants, and achieving financial sustainability. Government, professional, and educational stakeholders should play a central role in bridging education planning and delivery.

CONCLUSION

The success of a bridging program relies on two key components-program design and infrastructure. Partnerships with government, professional, and educational stakeholders facilitate the development of good bridging programs.

Analysis of pharmacy student motivators and deterrents for professional organization involvement

INTRODUCTION

The purpose of this study was to determine motivators and deterrents impacting a student pharmacist's decision to join professional organizations. The goal was to create a list of meaningful factors that organizations can use for membership recruitment.

METHODS

This descriptive study utilized a blinded electronic survey sent to eight accredited pharmacy schools in Ohio, Michigan, Wisconsin, Indiana, Illinois, and Kentucky. The survey assessed motivating and hindering factors, as well as demographic data.

RESULTS

Eight-hundred fifty-six students completed the survey, a 15.05% participation rate. Professional development and networking were the top two endorsed motivational factors, selected as significant by 88.0% and 87.5% respectively. Upon chi-square analysis, networking (p<0.001), involvement opportunities (p=0.01), and scholarships (p=0.02) were motivating factors with which membership was found to be significantly influenced. Networking and involvement opportunities were more significant for members while scholarships were a greater motivator among nonmembers. Time required for involvement and cost were the most commonly selected hindrances with 78% and 76% respectively identifying these as significant barriers. The hindering factor found to be significantly different between active members and nonmembers was bylaws/rules of the organization (p=0.032), with non-members rating this as a greater consideration than current members.

DISCUSSION AND CONCLUSIONS

Multiple factors contribute to a student's decision to join a professional organization. Those active members find greater significance in networking involvement opportunities. Non-member students found scholarships more motivating and recognize bylaws as a consideration for membership more than current members. These results emphasize the multifactorial nature of membership and may direct future membership initiatives.

Encourages and guides, or diagnoses and monitors: Woman centred-ness in the discourse of professional midwifery bodies

OBJECTIVE

the purpose of this study was to conduct a preliminary exploration of the language used by midwifery professional bodies to define the scope of practice of midwives in relation to woman-centred care.

DESIGN

this is a qualitative study in which Critical Discourse Analysis and Transitivity Analysis from the Systemic Functional Linguistics tradition were used. Data were sampled from nine international midwifery professional bodies.

FINDINGS

three general types of definitions of scope of practice were identified; a formal type which focused on midwifery practice in which the midwife and woman were largely absent as agents, a second, less formal type which focused on the midwife as agent, from which the woman was largely absent as an active participant and one exception to the pattern which featured the woman as agent. The main type of verb used in the definitions was Doing Processes such as monitor, diagnose. Saying (advise), Sensing (identify), and Being (be able to) processes were much less frequent in the data. The definitions of scope of practice explored in this study (with one exception) revealed a general lack of woman-centeredness and more of a focus on an orientation to birth as a medically managed event.

KEY CONCLUSIONS

definitions of scope of practice statements by professional bodies are systematically developed through much conscious thought and discussion by the writers on behalf of a community of practice and are formulated specifically for the purpose of being available to the general public as well as midwives. It can be assumed that the choices of wording and content are carefully constructed with public dissemination in mind. These ideologies communicated via the professional body texts emanate from a socio-cultural context that varies from country to country and professional bodies construct the definitions by drawing on the available, circulating discourses. Although woman-centred care is a key focus in contemporary maternity care, many definitions of scope of practice reveal a continuing orientation to a medical model of pregnancy and birth and a synonymisation of midwife-led care with woman centred care.

IMPLICATIONS FOR PRACTICE

by analysing statements of scope of practice by professional bodies and the contexts in which they are produced, we can continue to reveal the underlying social, political, and historical forces that influence midwifery practice. This paper examines some key examples of the professional discourse of midwifery in relation to the definition of the midwife and scope of practice in order to reflect on what these examples may tell us about the professional culture of midwifery and the implications for woman-centred care.

'More nurses at the NMC would boost profession's confidence in it'

The Nursing and Midwifery Council has been urged to appoint more nurses in senior roles to boost its credibility with the profession.

Ensuring accountability through health professional regulatory bodies: the case of conflict of interest

How do self-regulated health professions' regulatory bodies address financial conflict of interest (coi) and ensure accountability to the public? using document analysis, we examined how four ontario regulatory colleges (physicians, nurses, physiotherapists, audiologists/speech-language pathologists) defined coi and the education, guidance and enforcement they provided for coi-related issues. These colleges are upholding the mandates to define, identify and address financial coi by providing regulations or standards and guidelines to their membership; they differed in the amount of educational materials provided to their registrants and in the possible coi scenarios they presented. Although there were few disciplinary hearings pertaining to financial coi, findings for the hearings that did occur were documented and posted on the college public registers (the listing of all registered college members along with all relevant practice information), informing the public of any limitations or restrictions placed on a member as a result of the hearing.

Physician assistants and the disclosure of medical error

Evolving state law, professional societies, and national guidelines, including those of the American Medical Association and Joint Commission, recommend that patients receive transparent communication when a medical error occurs. Recommendations for error disclosure typically consist of an explanation that an error has occurred, delivery of an explicit apology, an explanation of the facts around the event, its medical ramifications and how care will be managed, and a description of how similar errors will be prevented in the future. Although error disclosure is widely endorsed in the medical and nursing literature, there is little discussion of the unique role that the physician assistant (PA) might play in these interactions. PAs are trained in the medical model and technically practice under the supervision of a physician. They are also commonly integrated into interprofessional health care teams in surgical and urgent care settings. PA practice is characterized by widely varying degrees of provider autonomy. How PAs should collaborate with physicians in sensitive error disclosure conversations with patients is unclear. With the number of practicing PAs growing rapidly in nearly all domains of medicine, their role in the error disclosure process warrants exploration. The authors call for educational societies and accrediting agencies to support policy to establish guidelines for PA disclosure of error. They encourage medical and PA researchers to explore and report best-practice disclosure roles for PAs. Finally, they recommend that PA educational programs implement trainings in disclosure skills, and hospitals and supervising physicians provide and support training for practicing PAs.

The use of deep tables in the treatment of decompression illness: the Hyperbaric Technicians and Nurses Association 2011 Workshop

In August 2011, a one-day workshop was convened by the South Pacific Underwater Medicine Society and the Hyperbaric Technicians and Nurses Association to examine the use of deep recompression treatment tables for the treatment of decompression illness in Australia and New Zealand. The aim of the workshop was to develop a series of consensus statements to guide practice around the region. The workshop chose to focus the discussion on the use of 405 kPa (30 msw) maximum depth tables using helium-oxygen breathing periods, and covered indications, staffing and technical requirements. This report outlines the evidence basis for these discussions and summarises the series of consensus statements generated. These statements should assist hyperbaric facilities to develop and maintain appropriate policies and procedures for the use of such tables. We anticipate this work will lead to the formulation of a standard schedule for deep recompression to be developed at a future workshop.

The features of the synovium in early rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria

Objectives

It has been shown in early arthritis cohorts that the 2010 ACR/EULAR criteria for rheumatoid arthritis (RA) enable an earlier diagnosis, perhaps at the cost of a somewhat more heterogeneous patient population. We describe the features of synovial inflammation in RA patients classified according to these new criteria.

Methods

At baseline, synovial tissue biopsy samples were obtained from disease-modifying antirheumatic drug (DMARD)-naïve early RA patients (clinical signs and symptoms <1 year). Synovial tissue was analyzed for cell infiltration, vascularity, and expression of adhesion molecules. Stained sections were evaluated by digital image analysis. Patients were classified according to the two different sets of classification criteria, autoantibody status, and outcome.

Findings

Synovial tissue of 69 RA patients according to 2010 ACR/EULAR criteria was analyzed: 56 patients who fulfilled the criteria for RA at baseline and 13 who were initially diagnosed as undifferentiated arthritis but fulfilled criteria for RA upon follow up. The synovium at baseline was infiltrated by plasma cells, macrophages, and T cells as well as other cells, and findings were comparable to those when patients were selected based on the 1987 ACR criteria for RA. There was no clear cut difference in the characteristics of the synovium between RA patients initially diagnosed as undifferentiated arthritis and those who already fulfilled classification criteria at baseline.

Conclusion

The features of synovial inflammation are similar when the 2010 ACR/EULAR classification criteria are used compared to the 1987 ACR criteria.

The 2002 PhRMA Code and Pharmaceutical Marketing: did anybody bother to ask the reps?

After marketing tactics resulted in $1.2 billion fines, the 2002 PhRMA Code attempted to standardize marketing and sales practices. Self-regulation had varied success by other industries and by pharmaceutical industries in other countries. Similarly, the Code addressed negative responses about pharmaceutical's practices but had no provisions for monitoring violations. Representative's (reps) perspectives were assessed using an 18-item instrument with 72 reps from 25 companies. Analyses indicated that reps from bigger companies, PhRMA and non-PhRMA, adhered better. The way reps adhered was split between adhering reluctantly and following faithfully. Two thirds felt it was more difficult to do their jobs, resulting from prior entertainment-based relationships with physicians.

Dental education in a flat world: advocating for increased global collaboration and standardization

Globalization is a broad term referring to the increasing connectivity, integration, and interdependence of economies, societies, technologies, cultures, and political and ecological spheres across the world. This position paper was developed by a working group of the 2007 American Dental Education Association (ADEA) Leadership Institute. The authors explore the effect that globalization has had on dentistry and dental education to date and hypothesize what dental education could look like in the years ahead. While the paper is written from a North American perspective, some of the authors bring international expertise and experience to the topic of global dental education in a flat world. Specific issues and barriers addressed in this position paper include variations in accreditation and licensure requirements in dental education throughout the world; the historical development of dental education models (odontology and stomatology) and the need for congruency of these models in the global environment; the competency-based model of education and its relevance to development and implementation of global dental competencies; and the slow adoption of technological advances in dental education for promoting collaborations and encouraging resource sharing among countries. These challenges are discussed as they affect the implementation of a standardized global dental education that can lead to improved access to oral health care services and better oral and overall health for the citizens of the world.

The Northwick Park tragedy ? protecting healthy volunteers in future first-in-man trials

The development of potentially powerful drugs which may become effective in the treatment for disorders currently difficult to manage presents the pharmaceutical industry and the scientific community with a major challenge. Such drugs with novel modes of action and the capacity to modify the body's immune system could also be very toxic. The possibility became a tragic reality on March 13th 2006 when TGN1412 was given to six healthy volunteers at Northwick Park hospital. All six became seriously ill. Fortunately none died but some were left with serious residual defects. The British Secretary of State for Health set up an Expert Scientific Group to investigate this tragic event. The report had to make recommendations designed to prevent a recurrence whilst not unduly delaying or discouraging the development of new drugs designed to treat cancers and other serious disorders. They made 22 recommendations. The drug TGN1412 had been shown to be well tolerated by non-human primates. A recent report on non-human primates in research recommended their continued use in some forms of research, for example on brain disorders. However, they also recommended that non-human primates should be used sparingly and only when justified scientifically. Their treatment should be optimal and research on them should be restricted to selected centres of expertise. The tragedy at Northwick Park should encourage the Pharmaceutical Industry to rethink their use of non-human primates in drug toxicity testing and hopefully to reduce their use and treat them better.

The Certification Board of Infection Control and Epidemiology white paper: the value of certification for infection control professionals

In its Vision 2012: A Strategic Plan, the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC) states that APIC will be recognized as the leader in infection prevention and control. However, if the APIC Strategic Plan is to be advanced by its members, infection control professionals must choose a leadership role by becoming certified, validating their competency and setting a standard of excellence. Certification by the Certification Board of Infection Control and Epidemiology, Inc. (CBIC) validates an infection control professional's competence to the public, the profession, employers, and regulators. The White Paper presented here by the CBIC provides a rationale for certification and recertification in infection prevention and control practice.

The effects of vehicles on the human dermal irritation potentials of allyl esters

Allyl esters, frequently used in the fragrance industry, often contain a certain percentage of free allyl alcohol. Allyl alcohol is known to have a potential for delayed skin irritation. Also present in the finished product are different solvent systems, or vehicles, which are used to deliver the fragrances based upon their intended application. This study was conducted to determine whether different vehicles affect the skin irritation potential of five different allyl esters. The allyl esters tested were allyl amyl glycolate, allyl caproate, allyl (cyclohexyloxy)acetate, allyl cyclohexylpropionate, and allyl phenoxyacetate in the vehicles diethyl phthalate, 3:1 diethyl phthalate:ethanol, and 1:3 diethyl phthalate:ethanol at concentrations of 0.1%, 0.5%, 1.0%, and 2.0% (w/w). A modified cumulative irritation test was conducted in 129 human subjects. Test materials (0.3 ml) were applied under occlusion to skin sites on the back for 1 day (24 h) using Hill Top chambers. Irritation was assessed at 1, 2, 4, and 5 days following application of test materials. Cumulative irritation scores varied considerably among test materials. There were no delayed irritation observations. The highest irritation scores were observed at the 2.0% concentration for all test materials. The irritation scores for allyl amyl glycolate, allyl (cyclohexyloxy)acetate, and allyl phenoxyacetate were highest in 1:3 diethyl phthalate:ethanol, thus the resulting calculated no-observed-effect levels, 0.12%, 0.03%, and 0%, respectively, were much lower for this vehicle compared to the diethyl phthalate vehicle, 0.33%, 0.26%, 0.25%, respectively. These data showed a trend for lower concentration thresholds to induce irritation when higher levels of ethanol were used in the vehicle.