ABSTRACT
In Canada, there is a growing gap between the number of organs donated each year and the number of organs needed for transplant. This gap is forcing health care professionals to re-examine end-of-life care and donation practices. In 2005, a national forum created recommendations for the development and implementation of donation after cardio-circulatory death programs. In this article, the authors outline the multifaceted approach needed for change in interdisciplinary clinical practice. Clinical nurse specialist leadership, ethics consultation, partnerships with key physician colleagues and administrators, as well as comprehensive workshops are described as essential for success. Lessons learned throughout are shared.
Subject(s)
Leadership , Nurse Clinicians/organization & administration , Patient Care Team/organization & administration , Program Development/methods , Tissue and Organ Procurement/organization & administration , Benchmarking , Decision Making, Organizational , Ethics Consultation , Health Knowledge, Attitudes, Practice , Health Planning Guidelines , Health Services Needs and Demand , Heart Arrest/diagnosis , Humans , Models, Nursing , Needs Assessment , Nurse's Role , Organizational Innovation , Pilot Projects , Planning Techniques , Quebec , Tissue and Organ Procurement/ethicsABSTRACT
We describe two cases of neuromyelitis optica (NMO) with clinical and radiographically confirmed features of hypothalamic involvement, in the absence of other parenchymal brain lesions. Their course is otherwise typical of Devic's form of NMO. A review of the literature identifies additional cases of NMO in which clinical features attributable to under-recognized dysfunction of the hypothalamic-pituitary axis were present. We propose that the currently accepted criteria for the diagnosis of NMO could be revisited to recognize the possibility of lesions developing within hypothalamic structures.
Subject(s)
Hypothalamic Diseases/etiology , Multiple Sclerosis/complications , Neuromyelitis Optica/etiology , Adolescent , Adult , Female , Humans , Hypothalamic Diseases/pathology , Magnetic Resonance Imaging , Male , Multiple Sclerosis/pathology , Neuromyelitis Optica/pathologyABSTRACT
INTRODUCTION: Work-related stress in the emergency department previously has been linked to depression and burnout; however, these findings have not been extended to the development of anxiety disorders, such as posttraumatic stress disorder (PTSD). Three sets of factors have been shown to contribute to stress in ED personnel: organizational characteristics, patient care, and the interpersonal environment. The current study addressed whether an association exists between sources of workplace stress and PTSD symptoms. METHOD: Respondents were 51 ED personnel from a hospital in a large Canadian urban center. The majority of respondents were emergency nurses. Respondents completed questionnaires measuring PTSD and sources of work stress and answered a series of questions regarding work-related responses to stress or trauma. RESULTS: Interpersonal conflict was significantly associated with PTSD symptoms. The majority of respondents (67%) believed they had received inadequate support from hospital administrators following the traumatic incident and 20% considered changing jobs as a result of the trauma. Only 18% attended critical incident stress debriefing and none sought outside help for their distress. DISCUSSION: These findings underscore the need for hospital administrations to be aware of the extent of workplace stress and PTSD symptoms in their employees. Improving the interpersonal climate in the workplace may be useful in ameliorating PTSD symptoms.