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

Good practice in shared decision-making and consent

The Scottish Government’s Health and Social Care Delivery Plan contains a commitment to reviewing the consent process for patients in Scotland with the General Medical Council and Academy of Medical Royal Colleges. This report supports that work, by setting out the findings of a review on the practice of consent and shared decision-making within NHS Scotland.Research Findings 142/201

Good practice in shared decision-making and consent

The Scottish Government’s Health and Social Care Delivery Plan contains a commitment to reviewing the consent process for patients in Scotland with the General Medical Council and Academy of Medical Royal Colleges. This report supports that work, by setting out the findings of a review on the practice of consent and shared decision-making within NHS Scotland.Research Findings 142/201

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 A (A Child) and the United Kingdom Code of Practice for the Diagnosis and Confirmation of Death: Should a Secular Construct of Death Override Religious Values in a Pluralistic Society?

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological (brainstem) death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents’ religious rights and commitments when secular conceptions of death based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A (A Child) [2015] EWHC 443 (Fam). Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions