Healthcare Institutions Research Articles

Relationship of Motivation and Supervision with Nurse Performance in Implementing Nursing Care

The performance of nurses in delivering optimal nursing care is critical to achieving quality healthcare outcomes. Motivation and supervision are key factors influencing their effectiveness. Understanding the interplay between these elements provides valuable insights into improving nursing care quality, fostering professional growth, and enhancing patient satisfaction within healthcare settings. This study investigates the relationship between motivation and supervision with nurse performance in implementing nursing care. The method used a descriptive correlation design with a cross-sectional approach; data were collected from 50 respondents selected through purposive sampling. The respondent was Irma A. inpatient room located at Sungai Dareh Hospital. Motivation, supervision, and nurse performance were measured using questionnaires, and data were analysed with the Spearman Rank test. The results revealed that most nurses exhibited moderate motivation levels (92%) and were under moderate supervision (100%). A significant relationship was found between motivation and nurse performance (p = 0.009, r = 0.368) and between supervision and nurse performance (p = 0.000, r = 0.499). These findings highlight the critical role of motivation and supervision in enhancing nurse performance. Adequate motivation fosters enthusiasm and productivity, while effective supervision provides essential guidance and support to achieve optimal care standards. This study underscores the need for sustainable programs to enhance motivation and supervision quality, aiming to improve nurse performance and the overall quality of nursing care in health facilities. The study’s contribution to nursing management and performance enhancement is significant, and its suggestions for improving motivation and supervision are valuable for healthcare institutions.

ASMENŲ SU REGOS NEGALIA Į(SI)TRAUKIMO Į SOCIALINĖS REABILITACIJOS PROGRAMAS PROBLEMA: SITUACIJA IR GALIMYBĖ

There is a wide range of rehabilitation programmes for the blind and visually impaired in Western countries, but these vary greatly in content and application, and no single ‘gold standard’ has been established, despite attempts to set such standards. In Lithuania, the policy for rehabilitation services for the blind and visually impaired began to be implemented in 2017. A qualitative research approach was chosen to determine the need for services and project activities for the blind and visually impaired, and to identify implementation shortcomings. Semi-structured interviews were conducted with five blind or visually impaired people and four of their family members. The results of the research revealed that the blind and visually impaired faced complex psychological and social problems before participating in the social rehabilitation programme for the blind. It was found that there is a lack of coordination in the transmission of information between health-care institutions, municipal social institutions and NGOs. Patients are forced to seek information on their own, which reduces accessibility, acceptability, and the effectiveness of rehabilitation interventions. Many of the research participants received services quite late, and, according to the informants, the social rehabilitation programme for the blind had quality shortcomings.

Ensuring drug safety in the outpatient department of a tertiary care hospital in Sri Lanka

Background: Medication safety is a fundamental component of patient safety, as highlighted by the World Health Organization (WHO). The Colombo South Teaching Hospital (CSTH), a major tertiary care institution in Sri Lanka, recently transitioned from a paper-based to a computer-based health information management system in its Outpatient Department (OPD) to improve medication safety and operational efficiency. This study evaluates the impact of these interventions on drug safety. Methods: This interventional study employed a pre- and post-implementation analysis at CSTH. The study combined qualitative methods, including focus group discussions (FGDs), key informant interviews, and direct observations. Participants included medical officers, pharmacists, patients, and hospital administrators. Data collection focused on challenges in the previous paper-based system, the features of the new computer-based system, and improvements in medication safety. Results: The previous paper-based system exhibited several challenges, such as illegible handwritten prescriptions, limited access to prior patient records, and lack of continuity in treatment plans. Pharmacists faced difficulties interpreting prescriptions, which affected patient counseling and drug dispensing efficiency. The newly implemented computer-based system addressed these issues effectively. Key improvements included: Accurate and Clear Prescriptions: Standardized and comprehensive prescriptions minimized errors. Patient Record Accessibility: Enhanced access to medical histories and allergy information facilitated safer prescribing practices. Medication Safety Initiatives: Pre-packed drugs, detailed labeling, and alert systems for look-alike and sound-alike drugs significantly reduced medication errors. These interventions improved patient safety, operational efficiency, and adherence to clinical governance principles. Discussion: The e-based system has demonstrated measurable benefits, aligning with global patient safety objectives. Enhanced prescription accuracy, reduced drug-related errors, and improved patient satisfaction underscore the system's effectiveness. Recommendations: Scaling these interventions across other healthcare institutions in Sri Lanka and integrating them into national policies is recommended. Regular updates to alert systems, ongoing staff training, and periodic evaluations will ensure sustainability and continued improvements. Conclusion: This study highlights the significant improvements in medication safety achieved through a comprehensive bundle of interventions in the CSTH OPD. These findings offer a framework for enhancing drug safety and patient care in broader healthcare settings.

Conversational Health Bots for Telemedicine Services: Survey

An increasing number of individuals take refuge in telemedicine systems for medical diagnosis and treatment due to their numerous benefits, including reduced healthcare costs, enhanced efficiency, and the ability to treat and prevent a wide range of physical and mental health problems. To improve the health status and clinical findings of older and underserved individuals, healthcare institutions have expanded telemedicine services, integrating them with advanced assisted living systems and environments. Conversational chatbots, or dialogue systems, are software tools designed to emulate human interaction via the Internet. These conversational bots can engage in natural conversations and can be merged into websites, mobile apps, and messaging platforms. Moreover, they can be used across various fields, such as healthcare, to support and enhance health services. An essential key feature of conversational chatbots is their ability to deliver swift and automated responses. In healthcare, these bots serve multiple purposes, including setting appointments, answering questions, and providing recommendations. Modern-day conversational chatbots leverage artificial intelligence techniques, such as machine learning and natural language processing, to understand and respond to user inquiries effectively. This study will discuss the objectives of developing chatbot systems, the fundamental methodologies and datasets used, the primary challenges and limitations of existing works, and insights into future trends in chatbot development.

Improving Social Media-Based Support Groups for the Rare Disease Community: Interview Study With Patients and Parents of Children with Rare and Undiagnosed Diseases.

The rarity that is inherent in rare disease (RD) often means that patients and parents of children with RDs feel uniquely isolated and therefore are unprepared or unsupported in their care. To overcome this isolation, many within the RD community turn to the internet, and social media groups in particular, to gather useful information about their RDs. While previous research has shown that social media support groups are helpful for those affected by RDs, it is unclear what these groups are particularly useful or helpful for patients and parents of children with RDs. This study aimed to identify what specific features of disease-related support groups (DRSGs) the RD community finds particularly useful or supportive and provide a set of recommendations to improve social media-based RD support groups based on this information. Semistructured qualitative interviews were performed with patients and parents of patients with RDs. Interview participants had to be at least 18 years of age at the time of the interview, be seen by a genetics specialist at a partner health care institution and be proficient in the English language. Social media use was not a prerequisite for participation, so interview participants ranged from extensive users of social media to those who chose to remain off all social media. All interviews were conducted by phone, recorded, and then transcribed. Interview transcripts were then coded using the 6 steps outlined by Braun and Clarke. Three researchers (TAD, SLV, and CMEH) performed initial coding. After this, the study team conducted a review of themes and all members of the team agreed upon a final analysis and presentation of data. We conducted 31 interviews (mean age 40, SD 10.04 years; n=27, 87% were women; n=30, 97% were non-Hispanic White). Thematic analysis revealed that social media DRSG users identified the informational usefulness of these groups as being related to the gathering and sharing of specific information about an RD, clarification about the importance and meaning of certain symptoms, and obtaining insight into an RD's progression and prognosis. Participants also identified that DRSGs were useful sources of practical information, such as tips and tricks about managing RD-related issues and concerns. In addition, participants found DRSGs to be a useful space for sharing their disease-related stories but also highlighted a feeling of exhaustion from overexposure and overuse of DRSGs. This study identifies the usefulness of DRSGs for the RD community and provides a set of recommendations to improve future instances of DRSGs. These recommendations can be used to create DRSGs that are less prone to splintering into other DRSGs, thus minimizing the risk of having important RD-related information unhelpfully dispersed amongst a multitude of support groups.

Availability of medical personnel and measures for their retention in public health care institutions

Availability of medical personnel and measures for their retention in public health care institutions

Organization of otolaryngological care in Ukraine: current challenges and directions of response

Annotation. Diseases of the ear, throat, and nose remain an urgent public health problem. The aim of the study was to conduct a theoretical study of the organization of otolaryngological care for the population of Ukraine; identify current problems and areas of response. Content analysis of legislative and regulatory acts, analysis of reference materials, industry statistical data and generalization of results was carried out. It was established that until 2023, otolaryngological care to the population was traditionally provided in primary care institutions by general practitioners-family doctors, as well as in multidisciplinary inpatient and outpatient healthcare institutions. In order to ensure the ability of the network of health care facilities to function not only in peacetime, but also in wartime conditions, from 2023 specialized medical care will be provided in designated facilities of hospital districts, in particular, otolaryngological care is available to the population in primary care facilities, cluster and supracluster health care institutions. From 2012 to 2022, the number of otolaryngologists in Ukraine decreased from 4.033 to 2.580 (0.63 per 10 000 population), and the supply of general practitioners-family doctors remained insufficient (3.44 per 10 000 population). As a result, the volumes of primary medical care are low (40.0-60.0% of the total number of outpatient visits), which increases the burden on specialized care facilities, including those where otolaryngological care is provided. One of the problematic issues in primary care institutions is the lack of medical equipment to help patients with ear, throat, and nose diseases. The professional level of medical workers in specialized offices of outpatient facilities needs to be increased, and it is necessary to ensure strict adherence by doctors to the standards of otolaryngological care. Thus the identified shortcomings require justification for improving the organization of otolaryngological care for the population of the hospital district in order to ensure its availability and quality, which are the prospects for further research.

An Analysis on Performance Management Systems Analysis at Apollo Hospitals, Jayanagar, Bangalore

Performance management systems play a pivotal role in enhancing organizational effectiveness by aligning employee performance with strategic goals. This study focuses on the performance management systems (PMS) at Apollo Hospitals, Jayanagar, Bangalore, a leading healthcare institution. The research aims to analyze the effectiveness of the PMS in fostering employee development, ensuring accountability, and meeting organizational objectives. Key aspects such as goal setting, appraisal mechanisms, feedback processes, and their alignment with organizational values are examined. The study employs both qualitative and quantitative methods, including surveys, interviews, and performance metrics analysis, to evaluate the PMS's efficiency and its impact on staff motivation, productivity, and job satisfaction. Results highlight the strengths of the existing system, such as structured feedback loops and competency-based assessments, while identifying areas needing improvement, including timely evaluations and more robust career development plans. The findings provide actionable insights for optimizing PMS in healthcare settings, ensuring better alignment between employee performance and patient care quality. This research underscores the critical role of well-designed PMS in achieving operational excellence in healthcare organizations. Key Words: Performance Management System, Apollo Hospitals, Employee Development, Healthcare Efficiency, Organizational Goals

Perceptions of Resilience Among Nurses: A Qualitative Study Based on the Society-To-Cells Framework.

To explore the perceptions of resilience among nurses using the Society-to-Cells Resilience Theory and examine how multilevel factors influence their ability to maintain resilience in high-stress environments. A qualitative study using semi-structured interviews. Sixteen registered nurses from various healthcare settings in the Asir region, Saudi Arabia, participated in face-to-face interviews conducted from February to April 2024. The interviews were analysed thematically to identify key factors affecting resilience at individual, familial, institutional and societal levels. Four key themes emerged: individual coping strategies, family and social support, institutional support mechanisms and societal recognition. Nurses identified personal coping methods, such as mindfulness and exercise, as essential for maintaining resilience. Family and social networks played a crucial role in emotional support. Institutional factors, such as adequate staffing and leadership support, were vital to resilience, while a lack of societal recognition negatively impacted nurses' well-being. Resilience in nursing is a multifaceted process influenced by individual, institutional and societal factors. Supportive work environments, adequate resources and recognition of nurses' contributions are critical in fostering resilience. The findings emphasise the need for healthcare institutions to implement policies and support mechanisms that address both the personal and professional challenges nurses face. Promoting resilience can improve nurse retention, job satisfaction and patient care outcomes. This study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines. No patient or public contribution.

Distributed Database Architectures for Federated Medical Training

Federated Learning (FL) has emerged as a promising approach for collaborative medical model training while preserving patient privacy. This research proposes the integration of FL with distributed database architectures to enable secure and efficient medical model training across diverse healthcare institutions. The approach addresses challenges such as real-time data synchronization, data heterogeneity, and low-latency model updates. Key innovations include hybrid SQL/NoSQL databases for structured and unstructured data, dynamic partitioning for improved data locality, and adaptive indexing for optimized query performance. The system incorporates secure data handling mechanisms like encryption and differential privacy, ensuring compliance with healthcare regulations. Scalability is achieved through decentralized database management, enabling broad healthcare node participation. The framework’s effectiveness is evaluated in real-world smart healthcare networks, focusing on model accuracy, query latency, scalability, and energy efficiency, with potential impacts on personalized medicine and collaborative healthcare analytics.

Assessment of Organizational Commitment Among Nurses: A Cross-Sectional Study

The recruitment and retention of qualified nurses are essential goals for healthcare institutions. However, various challenges can compromise nurses’ commitment. The study is a cross-sectional study conducted with 218 nurses using a sociodemographic questionnaire and an organizational commitment questionnaire and conducted through an online form. Data were analyzed using PSPP version 1.6.2-g78a33a. The sample consisted of 83.5% female participants and 43.1% were between the ages of 26-35. The proportion of singles in the sample was 46.8% and the proportion of those with postgraduate (specialist) degrees was 83.5%. Most participants had only one job (72.9%) and worked in private institutions (62.4%) in São Paulo (45.4%). The majority worked in wards (23.4%), had 1-5 years of professional experience (45.0%), and had been at their current institution for 1-5 years (61.0%). Most participants work daytime shifts (67.0%) with a weekly workload of 40-48 hours (58.7%). The majority of nurses (38.5%) had no intention of leaving their jobs in the past 12 months. Most nurses showed moderate (39.4%) or high (33.9%) levels of organizational commitment. Nurses, who had only one job, worked during the day and had no intention of leaving their job in the past 12 months, had higher organizational commitment scores. Although nurses maintain good levels of commitment even during crises, inadequate working conditions negatively affect this commitment. Healthcare institution administrators and nurse managers should aim to support nurses to strengthen their organizational commitment.

Improvement of the management system of the pharmaceutical service of the health care institution

When providing medical care, harm to patients' health associated with the use of drugs occurs in 10-40% of cases. The issue of ensuring safety in the field of health care is a global problem. The relevance of the problem of improving the quality of pharmaceutical care and estimating the costs of medical care requires research. The purpose of the work is the formation of principles for improving pharmaceutical management in a health care institution by monitoring and analyzing prescription errors at all stages of drug use. The study was conducted on the basis of LLC "Endotechnomed", surgical clinic "Garvis" in the period 01.09.2019-29.02.2024 and was approved by the commission on biomedical ethics. The bibliographic method and retrospective analysis were used. In the study, the level of errors in appointment lists was calculated, their dynamics and relationship with the costs of medical care for the corresponding period were analyzed. The method of increasing the interval was used, and statistical significance was checked using the non-parametric Mann-Whitney test. The non-parametric method of Spearman's rank correlation is used to determine the characteristics of the relationship between the level of errors in appointment lists and the amount of drug costs for one patient. Statistical processing of the results was carried out using the methods of descriptive and analytical statistics using the integrated Jupyter Notebook development environment. A value of p<0.05 was considered statistically significant when testing all statistical hypotheses. The level of errors over 4.5 years significantly (p<0.002) decreased by 78.44% compared to the initial value (from 139.62‰ to 30.10‰), which was at the global level (10%). These indicators confirm the results of research by Chinese scientists, who prove that properly organized work in an inpatient medical institution can reduce the frequency of errors when prescribing drugs from 6.94% to 1.96%. A statistically significant negative rank correlation of average strength was observed between the amount of expenses for medical care of one patient and the level of errors in prescribing medicines for the considered period (r= -0.49; 95% CI (-0.67)–(-0.26); p<0.001), which contradicts the generally accepted notion and, according to the authors, is related to the uniqueness of the situation during the considered period (first the pandemic, then the war). Therefore, it can be concluded that the introduction of new approaches to control the prescription of medicines led to a significant (p<0.002) reduction in the level of errors in appointment lists over 4.5 years by 78.44% compared to the initial value; the higher level of errors in appointment lists corresponds to lower costs for medical care, which is a consequence of the unstable situation on the drug market during the pandemic and the war in Ukraine; the improvement of pharmaceutical service management processes was directed to the following areas of work: planning, control, implementation and functioning of the information system, personnel management, performance evaluation, involvement of interested parties for the formation and implementation of decisions.

Strategies for Cost-Effectiveness in Sustainable Quality Healthcare Delivery in Emerging Economies: The Case of Healthcare Professionals Development in South Africa.

Purpose: This paper suggests strategies for professionals' continuous development in healthcare institutions to ensure quality and sustainable healthcare delivery in a cost-effective way. Background: Healthcare services are increasingly becoming expensive, and receiving quality service is often difficult. This plunges practices and healthcare institutions into the sphere of the population's mistrust. They believe in the degradation of quality due to individual experiences, with the direct corollary of reduction in life expectancy in some areas. We therefore propose strategies for enhancing the quality of those individuals for a sustainable healthcare delivery in an emerging market economy, based on the case in South Africa. Method: Cost-effectiveness analysis is chosen for the purpose of non-monetary analysis, and we make use of the qualitative methodology to explore, in detail, the need of strategies to improve healthcare delivery. Results: We propose a suitable digital ecosystem for the professionals' development, and we evaluate the proposed methodology and the challenges that come from its realization. Conclusions: We find that the application of these strategies yields efficiency and quality, which, when applied continuously, yields sustainability.

Assessment of patient’s feedback regarding services provided in healthcare in Uttar Pradesh: An observational study

Background: Patients have certain expectations provision of healthcare delivery when they approach a healthcare facility. It has been observed that satisfied patients are more likely to follow medical advice and comply with treatment recommendation. Objective: Assessment of patient’s feedback regarding services provided in healthcare facility. Methods: This was a descriptive cross sectional study. It was conducted in a healthcare institute situated in Kanpur district. The study was conducted from January 2024 to March 2024. Purposive sampling technique was used for data collection. Likert scale items. Results: Overall 92.1% of the patient rated care received during the visit as either fair, good, very good or excellent with the services given by the care providers. Similarly, majority (99%) of the participants reported satisfaction with the Attitude & communication of doctors. Conclusion: Majority of participants, both OPD and IPD, agreed that behaviour of hospital staff was good, doctors and nurses spent adequate time with patients, and detailed information about illness and treatment was provided to them by doctors. Finally, a system for patients’ feedback may be institutionalized at all health facilities to improve quality of healthcare.

Improving Development Strategy of Budgetary Institution

Background. In a competitive environment, budgetary healthcare institutions have less management tools and technologies than private organizations. Budgetary institutions are able to compete in providing advanced medical care, but not in attracting and retaining highly qualified workers.In addition, budgetary institutions have access to growing financial resources and untapped instruments, especially management technologies applied in commercial organizations. Some principles and methods of corporate governance can be implemented in the management processes of budgetary institutions in order to increase their competitiveness and performance.Purpose. To analyze the current planning of financial and operating activities at a budgetary institution and to make recommendations for expanding the managerial and commercial components in the planning of activities.Materials and methods. The comparative analysis was carried out to contrast budgetary healthcare institutions with private medical organizations in planning and management technologies used in commercial organizations and other industries. This method enabled to identify general trends and features in the management of healthcare organizations. Also, Russian full-text sources and regulatory documents on the research topic were studied using content analysis method.Conclusion. In a competitive environment and under an insufficient budget financing, it is necessary to expand the tools for planning financial and operating activities in non-profit medical institutions and the authorities of budgetary institutions’ heads.

Perceived value and pressure: drivers or barriers? A study on physicians’ continuous intentions in online health communities

PurposeThe purpose of this paper is to explore the impact of multidimensional perceived value and perceived pressure on physicians’ continuous intention to use (CIU) online health communities (OHCs) based on perceived value (PV) theory and conservation of resources (COR) theory.Design/methodology/approachThis study developed a research model to test the proposed hypotheses, and the proposed model was tested using partial least squares structural equation modelling (PLS-SEM) for which data were collected from 481 physicians with OHC experience using an online survey.FindingsThe empirical results show the following: (1) Physicians’ CIU is influenced by perceived value and perceived pressure, with attitude towards OHCs using (ATU) playing a crucial role in the pathways. (2) Additional value, work pressure, peer pressure and social pressure have a positive impact on CIU, with consultation value, relationship value, work pressure and peer pressure positively influencing CIU through ATU as a mediator. (3) Reputation value has a positive effect on CIU moderated by seniority (online seniority and offline seniority).Originality/valueThis study emphasises the importance of different dimensions of perceived value and perceived pressure in CIU. Meanwhile, we broaden the research scope of PV theory and COR theory and provide inspiration to OHC managers and healthcare institution managers.

ORGANIZATIONAL STRUCTURE OF THE IT DEPARTMENT THE INSTITUTION CARE OF HEALTH

The paper considers the problem of studying the organizational structure of the IT department of a healthcare institution. Connecting a healthcare institution to the Electronic Healthcare System is one of the mandatory conditions of the Ministry of Health of Ukraine for concluding agreements with the National Health Service of Ukraine and transitioning to cavitation, which, in turn, requires a significant amount of computer equipment that constantly uses communication technologies and works with a significant amount of information (databases). The regular work of the entire complex requires the participation of a relevant specialist, and, given the scale of the institution, a relevant structural unit responsible for the work of computer equipment and information technologies (IT services). Given the current organizational structure of the institution, it is proposed to subordinate the department to the Deputy Director General. The head of the department is responsible for the system's performance within the functional scope of the Director General and his deputies and manages the specialists of the department. Each of the specialists is responsible for the functioning of the system within the assigned department. Such a functional division allows to clearly defining the areas of responsibility of each employee. The planned organizational structure of the IT service is divided into functional and support parts. The functional part ensures the functioning of the information system within the main departments and auxiliary services and consists of relevant specialists assigned to the structural unit. The support part is responsible for the operation of the information system of the institution as a whole, the administrative and economic complex and carries out general administration and current technical maintenance of the information system of the healthcare institution. The paper proposes an organizational structure of the IT department of a healthcare institution, the functional content of which depends on a specific medical information system from the list of recommended by the Ministry of Health. The possibilities of assessing the efficiency of the department and effective indicators are determined. The directions of further research into the process of digitalization of the activities of healthcare institutions are outlined.

THE NEED FOR PROSTHETIC TREATMENT WITH DIFFERENT DENTURE DESIGNS FOR RESIDENTS OF ODESA AND THE ODESA REGION

Objective. The aim of this study is to analyze the need for orthopedic treatment with removable dental prosthetic constructions among the residents of Odesa and the Odesa region based on a retrospective analysis of outpatient dental patient records. Materials and Methods. This research was conducted using outpatient records (form 043/o) of patients who sought dental treatment with removable orthopedic constructions at healthcare institutions in the Odesa region and city dental departments from 2019 to 2023. Results. The analysis examined the proportion of removable prostheses relative to the total number of prostheses manufactured. From 2019 to 2023, 5,439 individuals (38.1%) in the Odesa region received removable dental prostheses, while 8,272 (61.9%) were from Odesa. A total of 95,237 prostheses were produced, with 65.3% (62,182) made in Odesa. In 2020, 33,488 prostheses were manufactured; in 2021, 42,026; and in 2022, 19,723. The need for prosthetic treatment in Odesa is estimated at 57% (570 individuals per 1,000 population). Patient visits were recorded as follows: 176 individuals in 2020, 212 in 2021, and 182 in 2022. In 2022, the number of visits decreased by 10,428 individuals (15.5%) compared to 2020, and by 3,001 individuals (17.95%) compared to 2021, indicating a decline in the accessibility of dental services. Conclusion. The study conducted in the Odesa region (2019-2023) revealed a high demand for orthopedic treatment, particularly for removable dental prostheses. 38.1% of patients received prostheses, with 61.9% coming from Odesa. A decrease in patient visits was observed in 2022 that was likely due to the consequences of the COVID-19 pandemic and economic difficulties. The results highlight the need for monitoring the population's demand for dental services and adapting strategies to improve accessibility and quality of treatment.

Surrogate Wars: The "Best Interest Values" Hierarchy & End-of-Life Conflicts with Surrogate Decision-Makers.

Conflicts involving end-of-life care between healthcare providers (HCPs) and surrogate decision-makers (SDMs) have received sustained attention for more than a quarter of a century, with early studies demonstrating a frequency of HCP-SDM conflict in ICUs ranging from 32-78% of all admissions (Abbott et al. 2001; Breen et al. 2001; Studdert et al. 2003; Azoulay et al. 2009). More recent studies not only acknowledge the persistence of clinical conflict in end-of-life care (Leland et al. 2017), but they have begun to focus on the ways in which these conflicts escalate to verbal or physical violence in the ICU (Slack et al. 2023; Bass et al. 2024; Berger et al. 2024; Sjöberg et al. 2024). I will argue that part of the explanation for the persistence-and even escalation-of ICU disputes is the incommensurable value systems held by many conflicting HCPs and SDMs. I will argue that a common value system among HCPs can be understood as a "Best Interest Values" (BIV) hierarchy, which I will argue is irreconcilable with the set of "Life-Continuation Values" (LCV) held by a sizable minority of families in the United States. I argue this values-conflict undergirds many ICU disputes. If I am correct that an incommensurable value system underlies many ICU conflicts, then it is not just ineffectual for HCPs to impose their BIV system on LCV families, but also wrong given the American commitment to values pluralism. I conclude that the way to navigate continuous ICU surrogate wars is for BIV-focused healthcare institutions to engage more constructively with LCV stakeholders.

Evaluating the clarity, applicability, and evaluability of an ASHP standard for international pharmaceutical practice in a Quebec healthcare institution.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. The primary objective was to assess the clarity, applicability, and evaluability of the criteria included in the ASHP accreditation standard for international hospital and health-system pharmacy services. The secondary objective was to determine the proportion of the ASHP criteria that could be matched with those of Accreditation Canada's medication management standards. For this cross-sectional descriptive study, a panel of 5 experts was recruited. Each panelist was invited, by electronic means, to consult the ASHP standard and rate its criteria in terms of clarity, applicability, and evaluability. After a 21-day consultation period, a summary grid was produced for a meeting, during which individual results were presented and, after discussion and by consensus, a rating for each criterion was determined. Regarding the primary objective, the panel of experts considered the criteria of the ASHP standard to be clear (98.8%, 82/83), applicable to pharmaceutical practice in Quebec healthcare institutions (96.4%, 80/83), and evaluable (95.2%, 79/83). Regarding the secondary objective, almost one-third (28.9%, 24/83) of the criteria within the ASHP standard could be matched completely to criteria within the Accreditation Canada medication management standards; a smaller proportion (26.5%, 22/83) could be partially matched to the Canadian standards, and the remainder (44.6%, 37/83) could not be matched. This descriptive, cross-sectional study showed that the ASHP criteria for international facilities are clear, applicable to hospital pharmacy practice in Quebec, and can be evaluated. However, only a limited proportion of the ASHP criteria could be matched with the Accreditation Canada medication management standards. The applicability to a larger cross section of hospital sites in Quebec or Canada (general hospitals as well as pediatric and specialty hospitals) could also be undertaken.