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Background Because of migration patterns to the United States over the past 250 years, there has always been cultural and religious diversity. Health care providers must have the knowledge, skills, and attitudes necessary to care for patients whose beliefs differ from their own, particularly during critical life events such as birth or death. An end-of-life care simulation experience for bachelor of science in nursing students involving standardized patients representing three well-known religious groups was implemented. Method Fifty-four students participated in this quasi-experimental study comparing a treatment group (n = 30) that experienced a simulation activity with a control group (n = 24). Results/Conclusions The results supported the hypotheses that participants in the treatment group would have higher scores for knowledge and confidence than the control group.

Background Baccalaureate nursing students rarely have the opportunity to practice emergency response skills. Simulation gives students the ability to practice emergency procedures in an environment that is safe. Method Nursing students' skills accuracy and confidence ratings were assessed before and after an instructional module that incorporated a mnemonic, named ABCD-COPIME, to improve emergency response techniques to a simulated code blue scenario. Seven nursing students completed 7 trials of responding to a code blue simulation. After each trial, skill accuracy was assessed with a skills checklist, and after Trials 1, 4, and 7, each student's confidence was measured by self-report. A 20-minute intervention introducing the ABCD-COPIME mnemonic was inserted after Trial 3. Results Both skills accuracy and self-reported confidence ratings significantly increased after introduction of the mnemonic (95% improvement in mean skills accuracy scores). Furthermore, analyses revealed that these changes were not due to practice effects. Conclusion This study supports the accumulating body of evidence that suggests that simulated training exercises are important for improving skills and confidence in responding to emergency situations. Moreover, results suggest that the ABCD-COPIME mnemonic training technique substantially improves both the skills accuracy of students and their self-reported confidence when responding to a code blue simulation.

The purpose of this article was to share a process where practicing nurses and student nurses engaged in a learning experience concerning the safe process of chemotherapy administration and care of the cancer patient.

Background: Medication errors continue to be a major problem in health care settings in the United States. Research investigating factors contributing to medication errors continues in an attempt to reduce the incidence and save lives. Although electronic medical records and electronic prescribing technology have been reported to reduce the incidence, errors are continuing, some with significant impact on patient safety. A near miss is an incident that could potentially cause harm, was identified early and a mistake prevented. Little is known about near misses including the identification, intervention, prevention, and recovery. Nurses’ perceptions, what led up to the incident, and how they went about correcting these incidents (recovery) provides insight to understanding what near misses are, where they take place, and how. Poor communication is directly linked to medication errors and near misses. In nursing, one communication variable that relates to errors and near misses concerns the concept of Power Distance and how it affects communication between nurses, colleagues and families. Power distance is based on a perception of inequality existing between individuals. This perception of power inequality may contribute to errors associated with communication such as near misses, actual errors, poor adherence to treatment and poor compliance with medications. Objectives: The aim of this study was to investigate nurse’s experiences of errors, recovery processes, the concept of Power Distance and poor communication that have led to near-miss incidents. Methods: An on-line survey, developed for this mixed-methodological study, was completed by a total of 110 participants. Results: Analysis of the descriptive data demonstrated three general themes of types of near misses experiences: wrong medication to wrong patients; error caught just before reaching patient; and recognition of error, correction made before implementation. Thematic analysis disclosed six themes related to actual examples of near misses: patient identified the near miss; medication was already administered by another nurse; a systems error occurred with the computerized dispending unit; the five rights were breeched; timing of administration was incorrect; and the wrong medication was dispensed directly from the pharmacy. Three themes emerged concerning miscommunication and near misses: between healthcare team members; between shifts; and pharmacy verifying and approving wrong med/wrong dose. Power distance was only minimally found to be of concern to the participants in relation to near misses. Conclusions: Nurses’ experiences with near misses, recovery and Power Distance illuminate the need to further investigate what recovery behaviors and prevention practices are taking place. Further knowledge in this area may improve communication, reduce errors and ultimately increase patient safety.

When parents apply religious or cultural beliefs concerning spiritual healing, faith healing, or preference for prayer over traditional health care for children, concerns develop. Medical care is considered one of the most basic of all human needs, and yet parents may elect to apply religious or cultural beliefs in place of traditional Western medical care for their children. Because memberships in religious groups that have beliefs concerning prayer and health care for children are increasing, the topic is of great importance for pediatric health professionals. This article describes parental refusal of medical care, and it discusses the legal, ethical, and clinical implications.

Cancer is the second leading cause of death in the United States, surpassed only by heart disease [1] . Approximately 1.6 million Americans will receive treatment for a variety of cancers annually [2] . This increase in oncology nursing care opportunities highlights the need to ensure that nurses have the skills, knowledge, and tools that allow them to safely provide care. Because Undergraduate nursing education often does not provide in-depth coverage of the principles of safe oncology nursing care required for children or adults, this study addressed protocols used when caring for chemotherapy pediatric patients using a chemotherapy mnemonic. The purpose of this pilot study (N=85), using quasi experimental methods, was to investigate the effect of a teaching intervention using a “safety” mnemonic and high fidelity simulation to investigate the effect of the teaching intervention and mnemonic on students’ reported confidence, knowledge of oncology nursing care content, and skills accuracy. The CHEMO SAFE SOUND mnemonic was evaluated by oncology expert nurses for construct and content validity, and for accuracy of chronology (steps). Results demonstrated that students’ confidence was increased by the activity and the use of the mnemonic. Students scored high on the knowledge pre-test. Only 55% of the students (N=70) were able to perform a sterile procedures and 85% of the students (N=108) were able to state the full safety mnemonic accurately. Further research is needed to investigate how students perform on the skills prior to the simulation. An expansion of the methods should include a pre-intervention assessment of chemotherapy skills. A larger sample size should be used and repeated measures to capture retention should be implemented.

Pediatric nurses working in acute care settings serving religious and culturally diverse families may encounter parents whose beliefs influence treatment decisions. Previous literature describes how these complex situations lead to emotional distress and strained relationships between health care provider and family members. An ethnographic study was conducted to investigate the impact of parental treatment refusal on the bedside interactions between pediatric nurses and parents. Twenty in-depth interviews with nurses were conducted, and extensive field notes were taken during data collection. Emotional feelings associated with possible loss of guardianship and subsequent mandated treatment, the impact of the situation on the nurses’ health and stress levels, and functional status were all explored. Three themes were identified following interpretive narrative analysis of transcriptions and field notes: weathering the storm of moral conflict, closeness and involvement versus distance and retreat, and battles between the supportive and oppositional groups. The findings of the study lead to a deeper understanding of the complexities of the ethical dilemma surrounding treatment refusal in pediatrics.