Suchergebnisse

This paper examines the role of school leadership in centering the rights, wellbeing, and identities of Latinx, immigrant students and their families. It is guided by the following questions: How do school leaders envision and articulate their roles and responsibilities in sites serving immigrant youth? How does this orientation influence the policies and practices they enact in their schools? Drawing on a three-year case study of a public high school that almost exclusively serves Latinx, immigrant students, this paper illustrates how a school's leadership can apply an advocacy approach and notions of critical care to more holistically serve students and their families. As a "site of possibility," this school and its leadership suggest important considerations for policy and practice in other contexts, especially in a political environment that is hostile to immigrants and in the aftermath of a pandemic that has taken a disproportionate toll on immigrant youth and their families.

Pandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, guidance and legislation to justify support for a waiver of consent followed by deferred proxy consent, when possible, in urgent research after death to inform current and future care to contain the pandemic in the public interest.

Intro -- Title page -- Table of Contents -- Copyright -- Contributors -- Forthcoming Issues -- Preface -- Sensory Overload and Technology in Critical Care -- Key points -- Introduction -- Methods -- Results -- Discussion -- Critical Care Nurses' Cognitive Ergonomics Related to Medical Device Alarms -- Key points -- Introduction -- Theoretic framework -- Methods -- Results -- Discussion -- Summary -- Nurse-Technology Interactions and Patient Safety -- Key points -- Introduction -- Historical perspectives -- Current challenges related to nurse-technology interactions -- Enhancing the future of nurse-technology interactions -- Summary -- Intravenous Smart Pumps: Usability Issues, Intravenous Medication Administration Error, and Patient Safety -- Key points -- Introduction -- Overview: intravenous infusion error -- Error prone programming tasks: multiple infusions, secondary infusions, and bolus dosing -- Usability issues and clinical use -- Human factors design and intravenous smart pump usability -- Need for innovation -- Summary -- Human Factors in Medical Device Design: Methods, Principles, and Guidelines -- Key points -- Introduction -- Human factors -- Usability -- User-centered design -- Design principles -- Information processing stages, design principles, and guidelines -- Discussion -- Informatics Solutions for Application of Decision-Making Skills -- Key points -- Introduction -- Background -- Informatics tools in critical care -- Discussion and recommendations -- Summary -- Advocating for Greater Usability in Clinical Technologies: The Role of the Practicing Nurse -- Key points -- Introduction and background -- Objectives -- Assessing and advocating for usability within health care organizations: what can practicing nurses do? -- Testing in controlled clinical conditions within a health care organization -- Summary

Pandemics challenge clinicians and scientists in many ways, especially when the virus is novel and disease expression becomes variable or unpredictable. Under such circumstances, research becomes critical to inform clinical care and protect future patients. Given that severely ill patients admitted to intensive care units are at high risk of mortality, establishing the cause of death at a histopathological level could prove invaluable in contributing to the understanding of COVID-19. Postmortem examination including autopsies would be optimal. However, in the context of high contagion and limited personal protective equipment, full autopsies are not being conducted in South Africa (SA). A compromise would require tissue biopsies and samples to be taken immediately after death to obtain diagnostic information, which could potentially guide care of future patients, or generate hypotheses for finding needed solutions. In the absence of an advance written directive (including a will or medical record) providing consent for postmortem research, proxy consent is the next best option. However, obtaining consent from distraught family members, under circumstances of legally mandated lockdown when strict infection control measures limit visitors in hospitals, is challenging. Their extreme vulnerability and emotional distress make full understanding of the rationale and consent process difficult either before or upon death of a family member. While it is morally distressing to convey a message of death telephonically, it is inhumane to request consent for urgent research in the same conversation. Careful balancing of the principles of autonomy, non-maleficence and justice becomes an ethical imperative. Under such circumstances, a waiver of consent, preferably followed by deferred proxy consent, granted by a research ethics committee in keeping with national ethics guidance and legislation, would fulfil the basic premise of care and research: first do no harm. This article examines the SA research ethics framework, ...

Abstract Background Intensive care physicians often must rely on substitute decision makers to address all dimensions of the construct of "best interest" for incapable, critically ill patients. This task involves identifying prior wishes and to facilitate the substitute decision maker's understanding of the incapable patient's condition and their likely response to treatment. We sought to determine how well such discussions are documented in a typical intensive care unit. Methods Using a quality of communication instrument developed from a literature search and expert opinion, 2 investigators transcribed and analyzed 260 handwritten communications for 105 critically ill patients who died in the intensive care unit between January and June 2006. Cohen's kappa was calculated before analysis and then disagreements were resolved by consensus. We report results on a per-patient basis to represent documented communication as a process leading up to the time of death in the ICU. We report frequencies and percentages for discrete data, median (m) and interquartile range (IQR) for continuous data. Results Our cohort was elderly (m 72, IQR 58-81 years) and had high APACHE II scores predictive of a high probability of death (m 28, IQR 23-36). Length of stay in the intensive care unit prior to death was short (m 2, IQR 1-5 days), and withdrawal of life support preceded death for more than half (n 57, 54%). Brain death criteria were present for 18 patients (17%). Although intensivists' communications were timely (median 17 h from admission to critical care), the person consenting on behalf of the incapable patient was explicitly documented for only 10% of patients. Life support strategies at the time of communication were noted in 45% of charts, and options for their future use were presented in 88%. Considerations relevant to determining the patient's best interest in relation to the treatment plan were not well documented. While explicit survival estimates were noted in 50% of charts, physicians infrequently documented their own predictions of the patient's functional status (20%), anticipated need for chronic care (0%), or post ICU quality of life (3%). Similarly, documentation of the patient's own perspectives on these ranged from 2-18%. Conclusions Intensivists' documentation of their communication with substitute decision makers frequently outlined the proposed plan of treatment, but often lacked evidence of discussion relevant to whether the treatment plan was expected to improve the patient's condition. Legislative standards for determination of best interest, such as the Health Care Consent Act in Ontario, Canada, may provide guidance for intensivists to optimally document the rationales for proposed treatment plans.

Background Intensive care physicians often must rely on substitute decision makers to address all dimensions of the construct of "best interest" for incapable, critically ill patients. This task involves identifying prior wishes and to facilitate the substitute decision maker's understanding of the incapable patient's condition and their likely response to treatment. We sought to determine how well such discussions are documented in a typical intensive care unit. Methods Using a quality of communication instrument developed from a literature search and expert opinion, 2 investigators transcribed and analyzed 260 handwritten communications for 105 critically ill patients who died in the intensive care unit between January and June 2006. Cohen's kappa was calculated before analysis and then disagreements were resolved by consensus. We report results on a per-patient basis to represent documented communication as a process leading up to the time of death in the ICU. We report frequencies and percentages for discrete data, median (m) and interquartile range (IQR) for continuous data. Results Our cohort was elderly (m 72, IQR 58-81 years) and had high APACHE II scores predictive of a high probability of death (m 28, IQR 23-36). Length of stay in the intensive care unit prior to death was short (m 2, IQR 1-5 days), and withdrawal of life support preceded death for more than half (n 57, 54%). Brain death criteria were present for 18 patients (17%). Although intensivists' communications were timely (median 17 h from admission to critical care), the person consenting on behalf of the incapable patient was explicitly documented for only 10% of patients. Life support strategies at the time of communication were noted in 45% of charts, and options for their future use were presented in 88%. Considerations relevant to determining the patient's best interest in relation to the treatment plan were not well documented. While explicit survival estimates were noted in 50% of charts, physicians infrequently documented their own predictions of the patient's functional status (20%), anticipated need for chronic care (0%), or post ICU quality of life (3%). Similarly, documentation of the patient's own perspectives on these ranged from 2-18%. Conclusions Intensivists' documentation of their communication with substitute decision makers frequently outlined the proposed plan of treatment, but often lacked evidence of discussion relevant to whether the treatment plan was expected to improve the patient's condition. Legislative standards for determination of best interest, such as the Health Care Consent Act in Ontario, Canada, may provide guidance for intensivists to optimally document the rationales for proposed treatment plans.

Clinical judgement is the foundation of nursing practices and recognized as essential skills for all nurses and serves as a distinguishing factor between professional nurses and those in strictly technical roles. Hence, the goal of this study was to evaluate of academic nurse's clinical judgement skills. A cross-sectional quantitative design is used to conduct this study. The data was gathered during a period of time that started on July 10, 2021, and ended on September 20, 2021, using a non-probability purposive sampling approach that recruited (ninety-one) critical-care nurses from three public governmental hospitals in Babylon City, Iraq. The data was obtained through using a questionnaire format and amended by the researcher, data analyzed was through using (SPSS -version 25). More than half (56.0 %) of the study's participants are between the ages of 25 and 29, and more than two-thirds (61.5 %) are female, single, have a degree of Baccalaureate in nursing, within (1-5) years graduated from nursing, experience in nursing was (1-5 years), and live in urban regions. The results indicated that the majority of participants had average clinical judgement abilities, overall mean was (1.56).

Clinical judgement is the foundation of nursing practices and recognized as essential skills for all nurses and serves as a distinguishing factor between professional nurses and those in strictly technical roles. Hence, the goal of this study was to evaluate of academic nurse's clinical judgement skills. A cross-sectional quantitative design is used to conduct this study. The data was gathered during a period of time that started on July 10, 2021, and ended on September 20, 2021, using a non-probability purposive sampling approach that recruited (ninety-one) critical-care nurses from three public governmental hospitals in Babylon City, Iraq. The data was obtained through using a questionnaire format and amended by the researcher, data analyzed was through using (SPSS -version 25). More than half (56.0 %) of the study's participants are between the ages of 25 and 29, and more than two-thirds (61.5 %) are female, single, have a degree of Baccalaureate in nursing, within (1-5) years graduated from nursing, experience in nursing was (1-5 years), and live in urban regions. The results indicated that the majority of participants had average clinical judgement abilities, overall mean was (1.56).

The Affordable Care Act was intended to address systematic health inequalities for millions of Americans who lacked health insurance. Expansion of Medicaid was a key component of the legislation, as it was expected to provide coverage to low-income individuals, a population at greater risk for disparities in access to the health care system and in health outcomes. Several studies suggest that expansion of Medicaid can reduce insurance-related disparities, creating optimism surrounding the potential impact of the Affordable Care Act on the health of the poor. However, several impediments to the implementation of Medicaid's expansion and inadequacies within the Medicaid program itself will lessen its initial impact. In particular, the Supreme Court's decision to void the Affordable Care Act's mandate requiring all states to accept the Medicaid expansion allowed half of the states to forego coverage expansion, leaving millions of low-income individuals without insurance. Moreover, relative to many private plans, Medicaid is an imperfect program suffering from lower reimbursement rates, fewer covered services, and incomplete acceptance by preventive and specialty care providers. These constraints will reduce the potential impact of the expansion for patients with respiratory and sleep conditions or critical illness. Despite its imperfections, the more than 10 million low-income individuals who gain insurance as a result of Medicaid expansion will likely have increased access to health care, reduced out-of-pocket health care spending, and ultimately improvements in their overall health.

Abstract
Gender and ethnicity biases are pervasive across many societal domains including politics, employment, and medicine. Such biases will facilitate inequalities until they are revealed and mitigated at scale. To this end, over 1.8 million caregiver notes (502 million words) from a large US hospital were evaluated with natural language processing techniques in search of gender and ethnicity bias indicators. Consistent with nonlinguistic evidence of bias in medicine, physicians focused more on the emotions of women compared to men and focused more on the scientific and bodily diagnoses of men compared to women. Content patterns were relatively consistent across genders. Physicians also attended to fewer emotions for Black/African and Asian patients compared to White patients, and physicians demonstrated the greatest need to work through diagnoses for Black/African women compared to other patients. Content disparities were clearer across ethnicities, as physicians focused less on the pain of Black/African and Asian patients compared to White patients in their critical care notes. This research provides evidence of gender and ethnicity biases in medicine as communicated by physicians in the field and requires the critical examination of institutions that perpetuate bias in social systems.