Ethical Decision Making in Online Graduate Nursing Education and Implications for Professional Practice

Academic dishonesty is an issue in academic institutions, which is escalating due to digital cheating. Cheating in online courses is a challenge in health science disciplines where high ethical standards are expected in professional practice. Unethical behaviors may begin in the academic career and persist into the professional career. The purposes of this article are to examine academic dishonesty within the online learning environment, transference of unethical behavior into professional practice, and strategies to reduce academic dishonesty in online graduate nursing education. In order to maintain high academic and professional standards, the individual must feel a moral obligation to engage in ethical behaviors in academia using online instructional technologies and in professional practice. Educators that teach in online courses are obligated to develop pedagogical and instructional designs that discourage dishonesty and encourage ethical decision making in the academic and professional setting. This article provides a glimpse of online cheating in academia and its implications for graduate nursing education and professional practice

Global IPE: Challenges and Opportunities

A description of global interprofessional education and practice, highlighting real world examples from the work of Partners In Health in West Africa and Haiti

Difficult IV Access (DIVA) Tool’s Impact on Assisting RNs in Determining When to Call the Vascular Access Team (VAT) RN for Assistance

The Vascular Access Team: Joey Guinto, BSN, RN, VA-BC; Chynna Vu, RN; SabelaBarrios, RN, VA-BC; Summer Cortinas, BSN, RN, VA-BC; Jeremy Tan, BSN, RN; Lynda Fenton, RN, VA-BC; VinhLe, RN, VA-B

The George Floyd of healthcare

Authors explore the infamous murder of an unarmed black man, George Floyd, and juxtaposition it to systemic racial practices in healthcare as documented by the Institute of Medicine Report: Unequal Treatment. The current COVID-19 pandemic is presented as a situation which has the potential to ignite unresolved discriminatory healthcare practices. Proposed are policies which could possibly mitigate this phenomenon

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people

Purpose: Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. / Methods: Hospitalised patients aged ≥ 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. / Results: In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93–1.12) and controls (HR 1.99, 95% CI 1.46–2.72), with an interaction term (HR 0.51, 95% CI 0.37–0.71) in multivariable models. / Conclusions: Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients

Functional and cognitive outcomes after COVID-19 delirium

Purpose: To ascertain delirium prevalence and outcomes in COVID-19. / Methods: We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. / Results: In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium − 50 out of 166 points (95% CI − 83 to − 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. / Conclusions: Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term

Outcomes of a Positive Patient ID Campaign at a Pediatric Quaternary Care Center

Introduction. Positive patient identification (PPID) is critical to safe and accurate labeling of patient lab specimens. Accurate PPID is also an important priority of The Joint Commission’s National Safety Goals. Inadequate PPID compromises may lead to waste of time and resources, and in the worst-case scenario can lead to significant patient morbidity and mortality. With a focus on PPID, this initiative examined the occurrence of mislabeled and unlabeled lab specimens as well as compliance with wearing ID bands in a cohort of hematology/oncology and bone marrow transplant inpatients at a large pediatric quaternary care center. Methods. Using the Plan-Do-Study-Act Model, this initiative details educational interventions directed at staff, caregivers, and patients. Results. While nursing education and posted reminders did not reduce reported unlabeled or mislabeled lab specimens, we document an increase in the percent of patients wearing ID bands from 67.5% to 95.6% following both parent education and a patient-friendly poster campaign. This work identified that older children were more likely to wear ID bands. The median age of those correctly wearing ID bands was 12 years old versus median age of 1.9 years of non-compliant children. Conclusion. The PPID initiative identified a problem with mislabeled lab specimens and poor ID band compliance. ID band compliance improved with educational measures. Younger children may need additional measures to promote these patients wearing ID bands and they should be examined as a special population in future projects evaluating PPID

Formative Debriefing in Team Observed Simulation Encounters to Promote Team Performance

To bridge the gap between interprofessional education (IPE) and interprofessional collaborative practice (IPCP), educators need to foster innovation in healthcare education. Students need opportunities and experiences to practice team skills prior to patient encounters. One innovation includes the use of high-fidelity interprofessional simulation in the form of Team Observed Structured Clinical Encounters (TOSCEs) with standardized patients (SP) and realistic case scenarios. The primary objective of this study was to demonstrate the impact of formative debriefing on team-based performance during TOSCEs. At a large academic medical center, 49 health profession students from the College of Medicine, College of Nursing, College of Health Sciences, and Graduate College volunteered to participate in an interprofessional education program. Prior to participating in TOSCEs students completed two interactive student workshops on: 1) Interprofessional Education and Collaborative Practice (IPEC) domains and 2) chronic disease self-management with motivational interviewing. Fourteen interprofessional student teams (IPST) were formed. Teams consisted of 2-3 students representing a minimum of two disciplines. They were assigned to participate in two separate TOSCEs. The IPST evaluated their individual and team’s performance using the McMaster-Ottawa and the Jefferson Teamwork Observation Guide (JTOG), respectively. Facilitators with established inter-rater reliability guided a formative debriefing session and evaluated the teams’ performance after both TOSCE 1 and 2. Paired t-tests documented improvement in pre-post McMaster-Ottawa and JTOG scores for participants across all four IPEC domains. A comparison between mean ratings of TOSCE 1 and 2, given by students and facilitators, showed a significant difference (p Learning objectives: The learners will be able to define the IPEC domains The learners will be able to list tools for evaluating interprofessional team members and team functionality. The learners will be able discuss the debriefing process as a formative learning experience to increase competencies in the IPEC domains

Gene Transfer of Engineered Calmodulin Alleviates Ventricular Arrhythmias in a Calsequestrin-Associated Mouse Model of Catecholaminergic Polymorphic Ventricular Tachycardia

BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a familial arrhythmogenic syndrome characterized by sudden death. There are several genetic forms of CPVT associated with mutations in genes encoding the cardiac ryanodine receptor (RyR2) and its auxiliary proteins including calsequestrin (CASQ2) and calmodulin (CaM). It has been suggested that impairment of the ability of RyR2 to stay closed (ie, refractory) during diastole may be a common mechanism for these diseases. Here, we explore the possibility of engineering CaM variants that normalize abbreviated RyR2 refractoriness for subsequent viral-mediated delivery to alleviate arrhythmias in non-CaM-related CPVT. METHODS AND RESULTS: To that end, we have designed a CaM protein (GSH-M37Q; dubbed as therapeutic CaM or T-CaM) that exhibited a slowed N-terminal Ca dissociation rate and prolonged RyR2 refractoriness in permeabilized myocytes derived from CPVT mice carrying the CASQ2 mutation R33Q. This T-CaM was introduced to the heart of R33Q mice through recombinant adeno-associated viral vector serotype 9. Eight weeks postinfection, we performed confocal microscopy to assess Ca handling and recorded surface ECGs to assess susceptibility to arrhythmias in vivo. During catecholamine stimulation with isoproterenol, T-CaM reduced isoproterenol-promoted diastolic Ca waves in isolated CPVT cardiomyocytes. Importantly, T-CaM exposure abolished ventricular tachycardia in CPVT mice challenged with catecholamines. CONCLUSIONS: Our results suggest that gene transfer of T-CaM by adeno-associated viral vector serotype 9 improves myocyte Ca handling and alleviates arrhythmias in a calsequestrin-associated CPVT model, thus supporting the potential of a CaM-based antiarrhythmic approach as a therapeutic avenue for genetically distinct forms of CPV