Culturally competent care across borders: Implementing culturally responsive teaching for nurses in diverse workforces

The migration of healthcare professionals, including nurses, is a global phenomenon. It is driven by various factors, including the pursuit of better opportunities, living conditions, and professional development, as well as political instability or conflict in their home countries. The World Health Organization (WHO) has noted that high-income countries often rely on foreign-trained nurses to fill gaps in their healthcare systems [1]. For instance, as of 2021, over 40% (52 million) of all nurses in the United States (US) were expatriates [2]. In the United Kingdom (UK), the percentage of expatriate nurses was even higher, reaching approximately 18% in 2021 [3]. Owing to globalization and migration, healthcare providers must possess cultural competence to deliver improved care [4,5]. Culturally responsive teaching (CRT) is rooted in the idea that culture plays a vital role in shaping people's behaviors, beliefs, values, and communication styles [6]. Furthermore, these cultural factors influence patients' perspectives on health, illness, healing, and their preferences for care and communication [7]. By recognizing and embracing these cultural differences, nurses can provide more effective and compassionate care to their diverse patient population [8]. This paper explores the significance of CRT for nurses in diverse multinational workforces and provides examples from various countries, such as the US, Canada, Australia, the UK, Qatar, and Singapore. The previously mentioned countries represent diverse geographical regions and contain multicultural societies. They are representative examples of places where healthcare systems must adapt and cater to a culturally diverse population.Implementing CRT in diverse nursing workforces has challenges and obstacles, primarily arising from the intricacies of cultural differences and the necessity for systemic backing. Nurses may lack sufficient cultural awareness, even with the noblest intentions, leading to stereotypes, misunderstandings, or misinterpretations [28]. Language barriers can complicate crucial patient-nurse interactions, and although language services exist in many healthcare institutions, they may not be instantly accessible, and subtle language nuances could be lost in translation [29]. Balancing cultural sensitivity with evidence-based care presents a dilemma, as some traditional health beliefs and practices might conflict with scientific healthcare recommendations. Systemic barriers to CRT implementation may manifest as a lack of institutional support, limited resources, or inadequate recognition of the importance of culturally competent care.Scopu

Enhancing oncology nursing care planning for patients with cancer through Harnessing large language models

Nursing care planning is a critical and daily task in managing and treating patients with cancer. It involves the systematic nursing assessment, diagnosis, planning, interventions, and evaluation of care plans tailored to the unique needs of patients with cancer.1,2 The advent of large language models (LLMs) signifies a leap in the field of natural language processing. These advanced models, like the generative pre-trained transformer-4 (GPT-4) developed by OpenAI, can generate human-like text based on the input they receive. GPT-4 is simply a special design that uses deep learning to anticipate and generate conversational language. Therefore, this presents a transformative opportunity for oncology nursing care planning. It could revolutionize decision-making, patient education, and care coordination, thereby elevating the standard of care provided.3 The incorporation of LLMs in nursing care planning is underpinned by the model's ability to analyze vast amounts of data rapidly and efficiently. GPT-4, for instance, can be trained to understand the latest evidence-based practices in oncology, which can facilitate timely and precise clinical decision-making.4 Consequently, nurses can provide personalized care based on the most up-to-date research and guidelines without manually sifting through the ever-growing medical and nursing literature.5 Additionally, LLMs can synthesize patient data and provide predictive insights. By integrating Electronic Health Records (EHRs), LLMs can assess the patient's history and current status and then predict potential complications or treatment responses, utilizing precise clinical decisions based on the retrieved information about the patient's condition.6 This enables the formulation of proactive care plans that address current needs and anticipate and mitigate future challenges. Moreover, patient education is an indispensable element of oncology nursing care planning. LLMs can generate tailored educational materials for patients and their families, adapted to their language proficiency and comprehension levels.7 Providing easy-to-understand information regarding their condition, treatment options, and self-care strategies empowers patients to participate in self-care management effectively, improving adherence and outcomes. Furthermore, LLMs can help streamline communication and coordination among multidisciplinary teams involved in the care of cancer patients.8 With their natural language processing capabilities, these models can facilitate the translation of complex medical jargon into layperson's terms or convert textual data into visual representations. This can enhance collaborative efforts by ensuring that all team members, including those from non-medical backgrounds, clearly understand the patient's condition and care plan.Scopu

Acute pancreatitis-induced by platinum compounds in patients with cancer: a review of the literature

The purpose of this review of the literature was to describe the relationship between use of platinum-based antineoplastics and development of acute pancreatitis in patients with cancer. A literature search was conducted using PubMed, Science Direct and Google scholar databases for articles published from 1985 to 2014. The headings and/or text words (platinum compounds), (acute pancreatitis-induced by platinum compounds), and (cisplatin, carboplatin, and oxaliplatin) were entered, and the search was limited to articles describing case reports in adults with cancer. A total of 12 cases were reported between 1985 and 2012; including three platinum compounds; cisplatin, carboplatin, and oxaliplatin. In conclusion, it is highly recommended to include baseline assessment for acute pancreatitis risk factors and to consider acute pancreatitis in the differential diagnosis of abdominal pain in patients who have received platinum-based chemotherapy

Risk communication with Arab patients with cancer: a qualitative study of nurses and pharmacists

Objectives To explore pharmacist and nurse views and experiences in educating patients regarding their treatment safety and tolerability as well as the roles of other professions in this regard. Design In this qualitative study, six focus group discussions were conducted. Setting The National Center for Cancer Care and Research in Qatar. Participants Eleven pharmacists and 22 nurses providing direct patient care. Results Concepts related to three key themes were drawn from the seeding questions and included factors for determining the level of risk they communicated: the specific treatment regimen in question; the patient; and their assessment of the patient. Patient-related considerations arose from additional subthemes; both nurses and pharmacists described aspects related to the perceived psychological health status of the patient, as well as anticipated comprehension, as ascertained by demonstrated education and language abilities. In all discussions, it was noted that physician and family non-disclosure of cancer diagnosis to the patient profoundly influenced the nature of information they provided. While a high level of cohesion in safety communication prioritisation among these two health disciplines was found, a number of pharmacists asserted a more formal role compared to informal and repeated teaching by nurses. Conclusions Nurses and pharmacists in this Middle East healthcare environment were not reluctant to discuss treatment side effects with patients and draw on similar professional judgements in prioritising treatment risk information. We found that they did not always recognise each other's informal educational encounters and that there are opportunities to explore increased collaboration in this regard to enhance the patient care experience.Undergraduate Research Experience Program award (UREP 14-001-3-001) from the Qatar National Research Fund (a member of Qatar Foundation)

Understanding patient non-transport decision theories in the pre-hospital setting: a narrative review

© 2023 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/Background In pre-hospital emergency care, decisions regarding patient non-conveyance emerged as significant determinants of healthcare outcomes and resource utilization. These complex decisions became integral to the progress of emergency medical services, thus warranting an evolving exploration within the medical discourse. Objectives and methods This narrative review aimed to synthesize and critically evaluate various theoretical stances on patient non-conveyance in the pre-hospital emergency. The focus on studies published between January 2012 and August 2022 was intentional to capture contemporary practices and insights. PubMed and Google Scholar served as the primary databases for the investigation, while the AL-Rayyan® software facilitated a thorough screening process. Results and discussion Twenty-nine studies—encompassing articles, books, and theses—were discovered through our search, each presenting unique perspectives on patient non-transport, thus highlighting its criticality as a healthcare concern. Predominant factors influencing non-transport decisions were classified into patient-initiated refusals (PIR), clinician-initiated decisions (CID), and dispatcher-initiated decisions (DID). Conclusions The issue of patient non-conveyance to hospitals continues to pose a crucial challenge to the seamless operation of emergency healthcare systems, warranting increased attention from various healthcare entities. To comprehend and pinpoint potential areas of improvement, a comprehensive analysis of pre-hospital non-transport events is imperative. A well-informed, strategic approach could prevent resource waste while ensuring patients receive the required and definitive care.Peer reviewe

Iron Overload in Chronic Kidney Disease: Less Ferritin, More T2MRI.

To date, there is no consensus on the most reliable marker of iron status in patients with chronic kidney disease (CKD). Serum ferritin is used routinely, although it may be a misleading marker for iron overload. The success of T2 MRI in monitoring iron overload in patients with hemoglobinopathies can be beneficial to monitoring patients with CKD

Aggressive Fibromatosis of the Left Mesocolon Mimicking a Gastrointestinal Stromal Tumor: A Case Report

Mesenteric fibromatosis (MF) is a proliferative fibroblastic lesion of the intestinal mesentery. It constitutes 8% of all desmoid tumors, representing 0.03% of all neoplasms. It is benign histologically, although it could infiltrate locally and recur following excision; however, it is free from the potential to metastasize. It is spontaneous or associated with familial adenomatous polyposis (FAP]) mutation as a part of Gardner’s syndrome. This case report discusses the radiological, intraoperative, and histopathological findings from a 45-year-old male patient who presented with abdominal pain and a palpable mass in the left hemiabdomen. The pain was dull and aching, extending to the back and unrelated to any other gastrointestinal symptoms. There was no history of severe weight reduction. Furthermore, he is not a smoker. There were no comorbidities, severe medical diseases, or prior surgical procedures. Computerized tomography revealed a well-defined, lobulated, heterogeneously enhancing altered signal intensity mass at the mesocolon. Ultrasonography of the abdomen showed an intra-abdominal mass. Macroscopic mass characteristics include a well-defined mass measuring 22 × 14 × 11 cm connected to a small intestine segment measuring 21 × 2 × 2 cm. Histopathological and immunohistochemical examinations of the resected tumor, including positive nuclear immunostaining for beta-catenin, confirmed a postoperative diagnosis of desmoid-type fibromatosis. Based on its clinical presentation and computed tomography results, this case demonstrated how desmoid-type fibromatosis of the colon might mimic gastrointestinal stromal tumors (GISTs). Due to the varied therapies and follow-up methods used for these lesions, the differential diagnosis between desmoid-type fibromatosis and GIST is clinically significant

Assessing child satisfaction and expectations for developing a child-friendly environment at the pediatric department in a general hospital in Qatar

Background“Patient-centered” care positions the patient at the core and emphasizes fulfilling their unique needs, preferences, and values. This approach is particularly significant in the context of children. Although widely recognized as necessary, this approach is not universally implemented. The children find themselves in hospital wards where they are required to follow protocols and systems designed primarily for adults. In the appropriate atmosphere, children often express themselves more effectively through words, body language, and play, leading to a richer understanding of their needs. There is growing recognition of the importance of addressing children's concerns regarding hospital environments.AimThis study investigates children's satisfaction with the physical aspect of the hospital environment. Insights from this exploration could provide valuable input for creating hospital environments centered around children's needs and preferences.MethodsThis mixed-methods study involves children aged 6–14 years with parental consent from a premiere healthcare provider in the state of Qatar. The survey used nine items to gauge satisfaction with the existing hospital environment as a “child-friendly hospital” and another nine items to explore their expectations for such environments. The Mann–Whitney U and Kruskal–Wallis tests as well as thematic analyses were employed to assess the statistical significance of differences in satisfaction levels and children's expectations of the hospital's physical environment.ResultsA total of 398 children participated in the study. Of them, 40.3% were aged 6–8 years; 60.3% had experienced two to five hospital visits; 55.8% of children participated during their outpatient service visit; and 31.7% were Asian. Children's satisfaction levels with various aspects of the hospital environment—including its physical appearance, signage, lounge, consultant rooms, corridors, bedrooms, TV content, toys, and staff uniforms—were in the range of 42.9%–59%. The children expressed a desire for a hospital environment that is spacious, colorful, attractive, and filled with cartoon characters and toys in the children's hospital from the front lounge to the inpatient units.ConclusionThe findings underline the importance of considering the perspectives of children in evidence-based healthcare design. The study reveals that children's satisfaction with the hospital environment is generally average or below average. Ultimately, a “child-friendly hospital environment” integrates children's rights into healthcare to significantly improve outcomes

Tranexamic acid for the prevention of blood loss after cesarean section: an updated systematic review and meta-analysis of randomized controlled trials

Objective: Tranexamic acid (TXA) is a cost-effective intervention for the prevention of postpartum hemorrhage (PPH) in women undergoing cesarean section but the evidence to support its use is conflicting. We conducted this meta-analysis to evaluate the efficacy and safety of TXA in low- and high-risk cesarean deliveries. Data sources: We searched MEDLINE (via PubMed), Embase, the Cochrane Library, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform (ICTRP) portal from inception to April 2022 (updated October 2022 and February 2023) with no language restrictions. Additionally, grey literature sources were also explored. Study eligibility criteria: All randomized controlled trials (RCTs) investigating the prophylactic use of intravenous TXA in addition to standard uterotonic agents in women undergoing cesarean deliveries as compared to placebo, standard treatment, or prostaglandins were included in this meta-analysis. Methods: We used the revised Cochrane "Risk of Bias" tool (RoB 2.0) to assess the quality of included RCTs. RevMan 5.4 was used to conduct all statistical analyses under a random-effects model. Results: We included 50 RCTs (6 in only high-risk patients and 2 with prostaglandins as the comparator) evaluating TXA in our meta-analysis. TXA reduced the risk of blood loss >1000 mL, mean total blood loss, and the need for blood transfusion in both low- and high-risk patients. TXA was associated with a beneficial effect in our secondary outcomes including decline in hemoglobin levels and the need for additional uterotonic agents. TXA increased the risk of non-thromboembolic adverse events but, based on limited data, did not increase the incidence of thromboembolic events. The administration of TXA before skin incision, but not after cord clamping, was associated with a large benefit. The quality of evidence was rated as low to very low for outcomes in the low-risk population and moderate for most outcomes in the high-risk subgroup. Conclusions: TXA may reduce the risk of blood loss in cesarean deliveries with a higher benefit observed in high-risk patients but the lack of high-quality evidence precludes any strong conclusions. Additional studies, especially in the high-risk population and evaluating the timing of TXA administration, are needed to confirm or refute these findings

An Intestinal Type Gastric Neuroendocrine Tumor: A Case Report

Neuroendocrine tumors (NETs) represent a diverse set of malignancies, originating from the neuroendocrine cells dispersed throughout the body. Their symptoms are associated with the secretion of bioactive peptides by tumor cells. Five-year survival rates depend on the disease stage: 93% for local, 74% for regional, and 19% for metastatic disease. This report describes a case involving a 64-year-old male patient, who was enduring high blood pressure and anemia. His symptomatology included frequent fainting and bloody vomiting without prior bleeding, coupled with persistent abdominal pain and weight loss. A complete blood count revealed microcytic anemia. His condition improved postoperatively after the transfusion of two units of packed red blood cells, normalizing all parameters. Further biochemistry and serology tests did not provide significant insights. However, an upper endoscopy unveiled a deep ulcer below the gastroesophageal junction with ulcer desquamation. A combination of clinical, laboratory, and radiographic data initially indicated a gastric carcinoma of the intestinal type, characterized by extensive extracellular mucin secretion. The surgical intervention led to the extraction of multiple tumors from lymph nodes, culminating in a postoperative diagnosis of a gastrointestinal (GI) mesenchymal tumor. NETs predominantly manifest in the GI tract, initiating primarily in the small intestine but can also originate in the stomach, appendix, colon, and other parts of the GI tract. Their development from neuroendocrine cells enables them to produce high concentrations of hormone-like substances such as neuropeptides and amines