Modifiable factors influencing parental decision making and organ donation: A scoping review

A global shortage of organs from children and adults available for transplantation is compounded by the failure of next of the kin to consent for organs to be donated after death. There are both non-modifiable and modifiable factors which influence decision-making. Modifiable factors can though be influenced and are therefore of interest when examining families’ decision making surrounding the donation of organs from their deceased child. A scoping review was undertaken to determine how modifiable factors influence parental decision-making in cadaver organ donation. Following thematic analysis two themes were identified, these were ‘interaction with healthcare professionals’ and ‘pre-disposition to organ donation’. Satisfaction with experiences of hospital care, the information provided and the way it was communicated as well as interactions pertaining to emotional support were all found to be modifiable factors that influenced decision-making. Likewise, a predisposition to organ donation and knowing the wishes of the deceased, are highly associated with the consent decision. Nurses working in critical care environments need to be able to support parents during this difficult time. This paper therefore aims to raise awareness of modifiable factors that influence decision-making, highlighting their relevance for children’s nursing practic

Family bereavement: A case study of controlled organ donation after circulatory death

Deceased organ donation represents a major source of organs for human transplantation practice. In the United Kingdom as well as other parts of the world, donation after circulatory death accounts for a proportion of all deceased organ donors. Organ and tissue donation emotively takes place in the context of dying, death and bereavement, yet little is known about the family experience of donation after circulatory death. This paper presents a case study of the phenomenon of controlled donation after circulatory death in intensive care. We present a critical analysis of care processes through the lens of a British donor family who participated in a national study of organ and tissue donation. Anonymised family quotes are applied to illustrate specific case issues, and with reference to relevant national guidance and international research. The case portrayed intimate detail of the moment in time when the family experienced the potential for controlled donation after circulatory death, factors that appeared to influence family consent, and the perceived expectations and outcomes arising from the donation decision. Case analysis revealed local compliance with best practice guidance and compassionate end-of-life care whilst supporting organ retrieval. Caring for the grieving family of potential organ donors requires sensitivity and skill. Of importance is a sound professional knowledge and understanding of the clinical care pathway, together with effective teamwork, optimal communication, family and staff support. Further research is required to determine the impact of controlled donation after circulatory death on family grief and bereavement

Introducing quality improvement teaching into general practice undergraduate placements

Quality Improvement skills are deemed essential for future clinical practice of doctors by professional regulatory bodies. This paper presents the challenges of a curriculum development initiative to ensure that all medical students have involvement with a quality improvement project during a general practice placement in their fourth year. The curriculum development is described within a 'Plan-Do-Study-Act' framework. The learning is presented as a reflective discussion with conclusions and recommendations on how potential current barriers to implementing authentic participation in quality improvement projects for undergraduate medical students might be met. The key barriers include lack of opportunities within the curriculum structure to allow sufficient time for authentic quality improvement projects and a lack of confidence amongst placement tutors to support medical students with quality improvement projects

Medical Leadership and Management in the United Kingdom

Objective: This article aims to outline the historical development of medical leadership in the United Kingdom (UK), present recent advances, discuss professional development and future prospects. Conclusions: With increasing involvement of medical professionals in top managerial roles in the UK over the last 30 years, leadership development initiatives have been growing steadily and there is increasing recognition of the need for leadership and management skills for doctors. Such skills can help to greatly improve patient care as well as enhance organisational effectiveness and productivity. The central involvement of professional bodies such as the UK Faculty of Medical Leadership and Management, and the establishment of medical fellowship schemes, have provided a solid foundation for a new generation of aspiring medical leaders but there is still a long way to go to achieve a higher degree of professionalism for clinical leadership in the UK. The evidence base is weak such that integrated efforts by clinicians and management academics have much to offer in achieving the vision of socially responsible, clinically relevant and research-informed medical leadership training

Applying the trigger review method after a brief educational intervention: potential for teaching and improving safety in GP specialty training?

<p>Background: The Trigger Review Method (TRM) is a structured approach to screening clinical records for undetected patient safety incidents (PSIs) and identifying learning and improvement opportunities. In Scotland, TRM participation can inform GP appraisal and has been included as a core component of the national primary care patient safety programme that was launched in March 2013. However, the clinical workforce needs up-skilled and the potential of TRM in GP training has yet to be tested. Current TRM training utilizes a workplace face-to-face session by a GP expert, which is not feasible. A less costly, more sustainable educational intervention is necessary to build capability at scale. We aimed to determine the feasibility and impact of TRM and a related training intervention in GP training.</p> Methods We recruited 25 west of Scotland GP trainees to attend a 2-hour TRM workshop. Trainees then applied TRM to 25 clinical records and returned findings within 4-weeks. A follow-up feedback workshop was held. <p>Results: 21/25 trainees (84%) completed the task. 520 records yielded 80 undetected PSIs (15.4%). 36/80 were judged potentially preventable (45%) with 35/80 classified as causing moderate to severe harm (44%). Trainees described a range of potential learning and improvement plans. Training was positively received and appeared to be successful given these findings. TRM was valued as a safety improvement tool by most participants.</p> <p>Conclusion: This small study provides further evidence of TRM utility and how to teach it pragmatically. TRM is of potential value in GP patient safety curriculum delivery and preparing trainees for future safety improvement expectations.</p&gt

(Re)imagining the ‘backstreet’:Anti-abortion campaigning against decriminalisation in the UK

The risk of death or serious injury from ‘backstreet abortions’ was an important narrative in the 20th century campaign to liberalise abortion in the UK. Since then, clinical developments have reduced the overall health risks of abortion, and international health organisations have been set up to provide cross-border, medically safe abortions to places where it is unlawful, offering advice and, where possible, supplying abortion pills. These changes mean that pro-choice campaigns in Europe have often moved away from the risks of ‘backstreet abortions’ as a central narrative when campaigning for abortion liberalisation. In contrast, in the UK, anti-abortion activists are increasingly using ideas about ‘backstreet abortions’ to resist further liberalisation. These claims can be seen to fit within a broader shift from morals to risk within moral regulation campaigns and build on anti-abortion messages framed as being ‘pro-women’, with anti-abortion activists claiming to be the ‘savers’ of women. Using a parliamentary debate as a case study, this article will illustrate these trends and show how the ‘backstreet’ metaphor within anti-abortion campaigns builds on three interconnected themes of ‘abortion-as-harmful’, ‘abortion industry’, and ‘abortion culture’. This article will argue that the anti-abortion movement’s adoption of risk-based narratives contains unresolved contradictions due to the underlying moral basis of their position. These are exacerbated by the need, in this case, to defend legislation that they fundamentally disagree with. Moreover, their attempts to construct identifiable ‘harms’ and vulnerable ‘victims’, which are components of moral regulation campaigns, are unlikely to be convincing in the context of widespread public support for abortion

A longitudinal study of well-being, confidence and competence in junior doctors and the impact of emergency medicine placements.

OBJECTIVES: To measure levels of, and change in junior doctor well-being, confidence and self-reported competence over their second postgraduate training year and the impact of emergency department (ED) placements on these outcomes. DESIGN: A longitudinal study using an online survey administered at four time points (2010-2011). SETTING: 28 Acute Hospital Trusts, drawn from nine participating Postgraduate Deaneries in England. PARTICIPANTS: Junior doctors who had a placement in an ED as part of their second postgraduate training year. MAIN OUTCOME MEASURES: Levels of anxiety, depression, motivation, job satisfaction, confidence and self-reported competence, collected at four time points spread over the period of the doctor's second training year (F2). RESULTS: 217 junior doctors were recruited to the study. Over the year there was a significant increase in their overall job satisfaction, confidence and self-reported competence. Junior doctors also reported significantly increased levels of motivation and anxiety, and significantly decreased levels of extrinsic job satisfaction when working in ED compared with other specialties. There were also significant increases in both junior doctor confidence and self-reported competence after their placement in ED relative to other specialties. CONCLUSIONS: While elements of junior doctor well-being worsened in their ED placement compared with their time spent in other specialties, the increased levels of anxiety and reduced extrinsic job satisfaction were within the normal range for other healthcare workers. These deficits were also balanced by greater improvements in motivation, confidence in managing common acute clinical conditions and perceived competence in performing acute procedures compared with benefits offered by placements in other specialties