Ethical considerations for the nursing care of Transgender patients in the Intensive Care Unit.

There is more discussion than ever surrounding the health and care needs of Transgender communities. However, there is limited research on the care of Transgender patients in the Intensive Care Unit which can contribute to knowledge gaps, inconsistencies and uncertainties surrounding health care practices. This article is not intended to address all of the specific needs of Transgender patients in ICU, but to explore the ethical considerations for caring for a Transgender woman in the ICU. In doing so, this article will explore some specific considerations around gender affirming care, challenging discrimination, physiological changes, and systems change to enhance care.

Authentic allyship for gender minorities.

The visibility and discussion on the rights and needs of Trans and Non-Binary communities in relation to healthcare have seen growing prominence in recent years. Despite an overall improvement in access to legal protections, civil rights, and in many jurisdictions specialist provision of healthcare for gender minorities, there remain poorer health outcomes in many areas and ongoing experiences of discrimination and transphobia. In this article, we set out the prerogative for nurses to step up as authentic allies for Trans and Non Binary people and put forward strategies to enhance the experience of gender minorities in healthcare through practice, education, and systems change.

Training nurses to support greater patient engagement in haemodialysis.

BACKGROUND: Evidence supports the view that people with long term conditions who are encouraged to take a greater interest in their treatment can experience a range of health benefits. Traditionally centre-based haemodialysis patients have been passive recipients whilst nurses have been deliverers of care. The Shared Haemodialysis Care (SHC) programme changes this relationship. OBJECTIVE: Our aim was to initiate a programme of education in SHC across Yorkshire and Humber in North England, with its objective to support centre-based patients to take on aspects of their own treatment. DESIGN & PARTICIPANTS: A three tiered training model was designed to educate all grades of nursing staff. Central to this approach was the development of a four day competency based course aimed at training 25% of junior sisters/charge nurses, staff nurses and Level 3 health care assistants (unqualified nurses). MEASUREMENTS/APPROACH: We measured the number of staff trained and assessed staff knowledge using a pre and post course questionnaire. Individual course day evaluations and 'Light bulb moment 'sessions captured qualitative data and a census form relating to interest in and uptake of SHC captured patient engagement data. RESULTS: The pre and post delegate questionnaires from every cohort have demonstrated significant positive shifts in all the objectives of the training programme. The target of 25% of staff trained has been reached in all but one group of units. A third of all patients across Yorkshire and Humber are significantly engaged in their haemodialysis care. CONCLUSION: A nurse-led education programme can provide nurse participants with the tools to encourage and support patients to become more engaged in their haemodialysis treatment.

Reducing haemodialysis access infection rates.

Infections are the second most common cause of vascular access loss in the long-term haemodialysis patient, and recent years have seen an increase in healthcare-associated infections (HCAIs) associated with vascular access (Suhail, 2009). There have been a number of drivers including publication guidelines (Department of Health, 2006; 2007) and local protocols providing evidence-based recommendations that, when implemented, can reduce the risk of these infections. In England, the selection of bloodstream infections caused by methicillin resistant staphylococcus aureus (MRSA) as a significant clinical outcome has led to a vast amount of work in this area. Root cause analysis of individual infections (by the clinical teams when these occur) in many specialities identified areas where practice could be improved, including practice relating to vascular access within the renal setting. Manufacturers have also supported this work by focusing on developing products that are designed to reduce the likelihood of infections occurring. One product identified and used within the NHS is Chloraprep.