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This article explores emerging ethical questions that result from knowledge development in a complex, technological age. Nursing practice is at a critical ideological and ethical precipice where decision-making is enhanced and burdened by new ways of knowing that include artificial intelligence, algorithms, Big Data, genetics and genomics, neuroscience, and technological innovation. On the positive side is the new understanding provided by large data sets; the quick and efficient reduction of data into useable pieces; the replacement of redundant human tasks by machines, error reduction, pattern recognition, and so forth. However, these innovations require skepticism and critique from a profession whose mission is to care for and protect patients. The promise of technology and the new biological sciences to radically and positively transform healthcare may seem compelling when couched in terms of safety, efficiency, and effectiveness but their role in the provision of ethical nursing care remains uncertain. Given the profound moral and clinical implications of how today’s knowledge is developed and utilized, it is time to reconsider the relationship between ethics and knowledge development in this new uncharted area.

Key Points Question Were resource constraints due to the COVID-19 pandemic associated with a delay in urgent fracture surgery beyond national time-to-surgery benchmarks? Findings In this cohort pre-post study that included 3589 patients, there was no association between time to surgery and COVID-19 in either open fracture or closed femur/hip fracture cohorts. Meaning Despite concerns that the unprecedented challenges associated with the COVID-19 pandemic would delay acute management of urgent surgery, many hospital systems within the US were able to implement strategies in keeping with time-to-surgery standards for orthopedic trauma.

Introduction Pragmatic trials in comparative effectiveness research assess the effects of different treatment, therapeutic, or healthcare options in clinical practice. They are characterized by broad eligibility criteria and large sample sizes, which can lead to an unmanageable number of participants, increasing the risk of bias and affecting the integrity of the trial. We describe the development of a sampling strategy tool and its use in the PREPARE trial to circumvent the challenge of unmanageable work flow. Methods Given the broad eligibility criteria and high fracture volume at participating clinical sites in the PREPARE trial, a pragmatic sampling strategy was needed. Using data from PREPARE, descriptive statistics were used to describe the use of the sampling strategy across clinical sites. A Chi-square test was performed to explore whether use of the sampling strategy was associated with a reduction in the number of missed eligible patients. Results 7 of 20 clinical sites (35%) elected to adopt a sampling strategy. There were 1539 patients excluded due to the use of the sampling strategy, which represents 30% of all excluded patients and 20% of all patients screened for participation. Use of the sampling strategy was associated with lower odds of missed eligible patients (297/4545 (6.5%) versus 341/3200 (10.7%) p < 0.001). Conclusions Implementing a sampling strategy in the PREPARE trial has helped to limit the number of missed eligible patients. This sampling strategy represents a simple, easy to use tool for managing work flow at clinical sites and maintaining the integrity of a large trial.

Objectives Study objectives were to: (1) Determine the value of a COVID-19 universal preprocedural screening program; and (2) Using the results of asymptomatic positive screens, determine the safety of resuming elective procedures. Design This was a descriptive study detailing the process and findings from implementation of a COVID-19 universal preprocedural screening program. Setting An adult academic tertiary center in Indiana. Patients Patients were included in the analysis if they were screened 96 hours prior to or within 24 hours after undergoing a procedure in the operating room, cardiac catheterization lab, or endoscopy. Methods A report was generated from the electronic health record of patients undergoing procedures from a six week period of time (May 4th-June 14th, 2020). Health records for positive screens were reviewed and classified as symptomatic if they met either criteria: (1) screen performed due to presence of COVID-19 symptoms; (2) documentation of symptoms at the time of the screen. Patients with a positive screen that did not meet symptomatic criteria were classified as asymptomatic. Descriptive statistics were used to calculate frequencies and percentages for the included sample. Results The initial sample included 2,194 patients, comprised of 46 positive and 2,148 negative screens. Out of the 46 patients who had a positive test, 17 were asymptomatic, resulting in an asymptomatic rate of 0.79% (17/2165). Conclusion Findings validated the value of the program through identification of a low rate of asymptomatic positive screens and procedural team adoption and sustainment. Findings may help inform decision making of like organizations attempting to enhance safety while resuming elective procedures.