Integration through a city-wide brain injury network and best practices project.

Integration of systems of service for individuals who have sustained a brain injury (BI) is critical to their successful recovery and reintegration into the community [6,7,33]. The Toronto Acquired Brain Injury (ABI) Network, an umbrella organization of 17 partners in the city of Toronto, Canada, is attempting to create a cost-effective, seamless, efficient, and effective integrated system of service. The ABI Network includes organizations and agencies along the full continuum, from acute care inpatient to long term care reintegration and is ultimately focused on helping clients achieve their goals. Through a variety of projects and activities, progress is being made. A significant initiative, currently underway, is the development of Network-wide best practices, related to assessment and outcomes, rooted in empirical evidence and current research. The project also integrates the perspectives of clients and families. The hope is that this initiative will result in enhanced consistency across programs, ensuring universal access to treatment and interventions following brain injury from the time of an individual's injury through integration into the community.

Ethical reasoning concerning the feeding of severely demented patients: an international perspective.

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence.

An international perspective of active euthanasia: attitudes of nurses in seven countries.

This exploratory study examines the ethical justification that cancer care and dementia care nurses gave for active voluntary euthanasia. A convenient sample of 319 nurses working in seven countries was interviewed using a structured interview guide. The great majority of the nurses could not ethically justify active voluntary euthanasia. Even if the law changed, only 96 of the total sample viewed active voluntary euthanasia as ethical. For those nurses who could ethically justify active voluntary euthanasia, the majority did so because of the patients' suffering.

Ethical reasoning associated with the feeding of terminally ill elderly cancer patients. An international perspective.

An international nursing research study examined the ethical decision-making of "good and experienced" registered nurses in eight countries. The subjects were asked about their decision to feed or not to feed a hypothetical terminally ill, mentally alert, elderly cancer patient who refuses to eat. Cultural variations were demonstrated in the decisions as well as differences in ethical justification. The majority of nurses who would not feed appeared to use the principle of autonomy, whereas nurses who would feed the patient used beneficence as justification. Conditions under which nurses would change their decision to either feed or not feed the patient against her will included doctor's orders and lack of peer support for the decision. The majority of nurses clearly experienced a dilemma.