Nurse Practitioners’ Attitudes and Knowledge about Influenza Immunization

Influenza remains a leading cause of death nationally and internationally. Annual influenza immunization for healthcare workers has been recommended since 1984. Despite this, many healthcare workers do not receive the immunization. Nurse practitioners (NPs) are key primary care providers in the U.S. healthcare system. The purpose of this study was to assess the knowledge and personal beliefs of NPs as a step toward understanding the reasons for the participation or non-participation in the influenza vaccine of this professional group. A quantitative cross-sectional survey of knowledge, attitudes, NP demographics, and patient factors was carried out. Most of the 174 participants had received the vaccine. Vaccine status was not correlated with the assessed risk level of patients. Available and mandatory vaccine in the workplace was correlated with vaccination status of the NP. Vaccine status of the NP was correlated with patient counseling to receive influenza immunization. Not all NPs agree with or adhere to federal vaccine recommendations. It is critically important for healthcare providers to base decisions affecting the health of themselves and their patients on evidence-based research

Free Exercise Rights of Capital Jurors

The Supreme Court has said that the Constitution permits trial judges to exclude from the pool of potential capital trial jurors any persons whose views on the death penalty would likely substantially impair their ability to reach an impartial verdict. This Note argues that the Court\u27s analysis to date is incomplete, in that it omits close evaluation of potential conflicts between such exclusions and the Free Exercise Clause. The Note argues further that a court should apply strict scrutiny to any state action, such as exclusion for cause, that burdens the use of religious beliefs in the mental processes of jurors. The Note then weighs several possible government interests that might be offered to meet the test of heightened scrutiny, ultimately finding them each likely to fail. It concludes by suggesting a revised formulation of the present standard that provides more protection for the religious liberty of prospective jurors

Can Law Improve Prevention and Treatment of Cancer?

The December 2011 issue of Public Health (the Journal of the Royal Society for Public Health) contains a symposium entitled: Legislate, Regulate, Litigate? Legal approaches to the prevention and treatment of cancer. This symposium explores the possibilities for using law and regulation – both internationally and at the national level – as the policy instrument for preventing and improving the treatment of cancer and other leading non-communicable diseases (NCDs). In this editorial, we argue that there is an urgent need for more legal scholarship on cancer and other leading NCDs, as well as greater dialogue between lawyers, public health practitioners and policy-makers about priorities for law reform, and feasible legal strategies for reducing the prevalence of leading risk factors. The editorial discusses two important challenges that frequently stand in the way of a more effective use of law in this area. The first is the tendency to dismiss risk factors for NCDs as purely a matter of individual \u27personal responsibility\u27; the second is the fact that effective regulatory responses to risks for cancer and NCDs will in many cases provoke conflict with the tobacco, alcohol and food industries. After briefly identifying some of the strategies that law can deploy in the prevention of NCDs, we briefly introduce each of the ten papers that make up the symposium

Managing clinical uncertainty: an ethnographic study of the impact of critical care outreach on end‐of‐life transitions in ward‐based critically ill patients with a life‐limiting illness

© 2018 Crown copyright. Journal of Clinical Nursing © 2018 John Wiley & Sons LtdRapid response teams, such as critical care outreach teams, have prominent roles in managing end-of-life transitions in critical illness, often questioning appropriateness of treatment escalation. Clinical uncertainty presents clinicians with dilemmas in how and when to escalate or de-escalate treatment. Aims and objectives: To explore how critical care outreach team decision-making processes affect the management of transition points for critically ill, ward-based patients with a life-limiting illness. Methods: An ethnographic study across two hospitals observed transition points and decisions to de-escalate treatment, through the lens of critical care outreach. In-depth interviews were carried out to elucidate rationales for practices witnessed in observations. Detailed field notes were taken and placed in a descriptive account. Ethnographic data were analysed, categorised and organised into themes using thematic analysis. Findings: Data were collected over 74 weeks, encompassing 32 observation periods with 20 staff, totalling more than 150 hr. Ten formal staff interviews and 20 informal staff interviews were undertaken. Three main themes emerged: early decision-making and the role of critical care outreach; communicating end-of-life transitions; end-of-life care and the input of critical care outreach. Findings suggest there is a negotiation to achieve smooth transitions for individual patients, between critical care outreach, and parent or ward medical teams. This process of negotiation is subject to many factors that either hinder or facilitate timely transitions. Conclusions: Critical care outreach teams have an important role in shared decision-making. Associated emotional costs relate to conflict with parent medical teams, and working as lone practitioners. The cultural contexts in which teams work have a significant effect on their interactions and agency. Relevance to practice: There needs to be a cultural shift towards early and open discussion of treatment goals and limitations of medical treatment, particularly when facing serious illness. With training and competencies, outreach nurses are well placed to facilitate these discussions.Peer reviewe

Has Revenge Become a Justification to Legitimize the Death Penalty?

Revenge has played a role in criminal justice systems for thousands of years. From the Code of Hammurabi, to the Bible, to modern Supreme Court jurisprudence, revenge, or “getting even,” has been a consideration in how wrongdoers are punished, especially with respect to the imposition of the death penalty. Historically, revenge has not been viewed as a legitimate justification for punishment under American legal principles. However, in the past year, both the United States Supreme Court and the Department of Justice have signaled that revenge may well have a legitimate role in justifying the death penalty. This Note will explore the development of revenge as a justification for punishment in the American criminal justice system. It will begin by showing that recent remarks from the bench and the Department of Justice signal a willingness to consider the effects of revenge on crime victims. It will then analyze the concept of revenge as part of a criminal justice system and discuss the United States Supreme Court’s historical views on revenge as a justification for the death penalty. Next, this Note will investigate revenge’s role in the Victims’ Rights Movement, specifically how revenge factors into victim impact statements. Finally, this Note ultimately asserts that revenge is not and should not be a goal of the criminal justice system given the public policy implications