The "saddest repudiation" redux: Structural racism and the unlearned lesson of 1918.

The COVID-19 pandemic reveals how the systems and structures of racism devastate the health and well-being of people of color. The debate is an old one and the lesson we have yet to learn was tragically apparent a century ago during the 1918-1919 influenza pandemic. Any history of structural racism in America must begin with the chronicles of African Americans, Native Alaskans, and Indigenous North Americans as they were the originally enslaved and displaced people, subjected to overt and covert policies of oppression ever since. The experiences of Native Alaskans of Bristol Bay Alaska in 1918-1919 present a parallel, illuminating a wrenching example of structural racism that cost lives and impoverished society, then as now. Proven policy solutions exist to remove the structures that produce inequitable health outcomes, but implementing them will require public health officials and policymakers to take multidisciplinary policy actions, to find policy opportunities for change to be made, and, likely, a change in the political environment. The first exists now, the second is afforded because of the current pandemic and the urgent need for policy solutions, and the third is likely coming soon.

Ethical Reasoning Debriefing in Disaster Simulations.

BACKGROUND: With disasters occurring often, nurses must understand and ethically implement disaster management and patient care coordination. Yet these topics are often not discussed in nursing education curricula. Simulations are a potential solution to this ethical educational deficit, allowing students to act as professional nurses in a realistic scenario with minimal threat of harm to themselves or others. AIM: This study investigates the effect of a high fidelity, multiple-casualty disaster simulation followed by a structured faculty-led debriefing session on perceived ethical reasoning confidence on senior Bachelor of Science in Nursing (BSN) students. Additionally, the effect of the intervention on students' perceived importance of ethical reasoning and perceptions of such skills was explored. METHODS: Students were provided with preparatory materials on the START (Simple Triage and Rapid Treatment) System and The Madison Collaborative's Ethical Reasoning in Action Eight Key Questions (8KQ) frameworks one week before the simulation exercise. In total, 90 students worked in pairs during the 15-minute disaster simulation. Participants' ethical reasoning attitudes were measured before and after the exercise, employing the Survey of Ethical Reasoning (SER) to indicate the importance of each of the 8KQ in students' ethical reasoning process using a five-point Likert scale. The SER was administered electronically using Qualtrics and statistical analysis was completed using SPSS. The 8KQ was also used in the debriefing led by faculty. RESULTS: Comparative assessment of pre and post-results demonstrate significant growth in students' ethical reasoning confidence scores (t(89) = -6.609, p < 0.001). CONCLUSIONS: Simulations are shown to be effective educational approaches in developing ethical reasoning confidence and promoting the development of students' ethical preparedness.

Student ethical reasoning confidence pre/post an innovative makerspace course: A survey of ethical reasoning.

BACKGROUND: Challenges today are complex and rapid innovations are required. We instruct a transdisciplinary undergraduate course where engineering, nursing, and pre-professional health students produce tangible innovative solutions to community health challenges using MakerSpace technologies. Students receive evidence-based ethics instruction as part of the course using the 8 Key Questions for improving ethical reasoning. Design thinking, an empathy-based problem solving technique, was used to teach problem solving and provided context for instructing ethical reasoning. OBJECTIVE: The Objective of this research was to assess student ethical reasoning pre/post this course where students concurrently produce innovative products. DESIGN/PARTICIPANTS: Undergraduate students were assessed pre/post course for their perceptions of 1) the importance of, and 2) their confidence in their ability to ethically reason using a digital version of the Survey of Ethical Reasoning, an instrument previously tested in this population. RESULTS: Participants demonstrated a significant gain in their ethical reasoning confidence and maintained their high ranking of the importance of ethical reasoning concurrently to producing innovative products. CONCLUSIONS: It is possible, with deliberate instruction, for transdisciplinary undergraduate students to develop ethical reasoning confidence concurrently to developing innovative products.

Student learning outcomes from a pilot medical innovations course with nursing, engineering, and biology undergraduate students.

BACKGROUND: Preparing today's undergraduate students from science, technology, engineering, and math (STEM) and related health professions to solve wide-sweeping healthcare challenges is critical. Moreover, it is imperative that educators help students develop the capabilities needed to meet those challenges, including problem solving, collaboration, and an ability to work with rapidly evolving technologies. We piloted a multidisciplinary education (ME) course aimed at filling this gap, and subsequently assessed whether or not students identified achieving the course objectives. In the course, undergraduate students from engineering, pre-nursing (students not yet admitted to the nursing program), and pre-professional health (e.g., pre-med and pre-physician's assistant) were grouped based on their diversity of background, major, and StrengthsFinder® proficiencies in a MakerSpace to create tangible solutions to health-related problems facing the community. We then used qualitative content analysis to assess the research question: what is the impact of undergraduate multidisciplinary education offered in a MakerSpace on student attitudes towards and perceptions of skills required in their own as well as others occupations? RESULTS: We discovered these students were able to identify and learn capabilities that will be critical in their future work. For example, students appreciated the challenging problems they encountered and the ability to meet demands using cutting-edge technologies including 3D printers. Moreover, they learned the value of working in a multidisciplinary group. We expected some of these findings, such as an increased ability to work in teams. However, some themes were unexpected, including students explicitly appreciating the method of teaching that focused on experiential student learning through faculty mentoring. CONCLUSIONS: These findings can be used to guide additional research. Moreover, offering a variety of these courses is a necessary step to prepare students for the current and future workforce. Finally, these classes should include a focus on intentional team creation with the goal of allowing students to solve challenging real-world problems through ethical reasoning and collaboration.

Relationship of adverse events and support to RN burnout.

Registered nurse (RN) "second victims" are RNs who are harmed from their involvement in medical errors. This study used the conceptual model nurse experience of medical errors and found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002).

A prospective randomized blister prevention trial assessing paper tape in endurance distances (Pre-TAPED).

OBJECTIVE: Friction foot blisters are a common injury occurring in up to 39% of marathoners, the most common injury in adventure racing, and represent more than 70% of medical visits in multi-stage ultramarathons. The goal of the study was to determine whether paper tape could prevent foot blisters in ultramarathon runners. METHODS: This prospective randomized trial was undertaken during RacingThePlanet 155-mile (250-km), 7-day self-supported ultramarathons in China, Australia, Egypt, Chile, and Nepal in 2010 and 2011. Paper tape was applied prerace to one randomly selected foot, with the untreated foot acting as the own control. The study end point was development of a hot spot or blister on any location of either foot. RESULTS: One hundred thirty-six participants were enrolled with 90 (66%) having completed data for analysis. There were 36% women, with a mean age of 40 ± 9.4 years (range, 25-40 years) and pack weight of 11 ± 1.8 kg (range, 8-16 kg). All participants developed blisters, with 89% occurring by day 2 and 59% located on the toes. No protective effect was observed by the intervention (47 versus 35; 52% versus 39%; P = .22), with fewer blisters occurring around the tape on the experimental foot than under the tape (23 vs 31; 25.6% versus 34.4%), yet 84% of study participants when queried would choose paper tape for blister prevention in the future. CONCLUSIONS: Although paper tape was not found to be significantly protective against blisters, the intervention was well tolerated with high user satisfaction.

Nurses' experience of medical errors: an integrative literature review.

Medical errors are a substantial problem in health care. Understanding the effect of medical errors on health care providers as the "second victims" is necessary to maintain safe, quality patient care for the good of both patients and providers. We report an integrative literature review of the effect of medical errors on nurses. A model derived from the findings illustrates the concept of nurses' experience of medical errors. Specific recommendations for improving that experience are offered.