Evaluation of the Application of Critical Thinking Skills of Students in the Context of Nursing Process in the College of Nursing of a Private University

   Dr. Gracila V. Ucag-Decena

   Philippines

Statement of the Problem: This study aimed to evaluate the application of critical thinking skills in the context of the nursing process of nursing students.  It sought answers to the following specific problems: (1) What are the frequency applied in critical thinking skills as perceived by the student-respondents and as evaluated by clinical instructor-respondents in the context of Assessment; Diagnosis; Planning; Implementation; and Evaluation? (2) Is there any significant difference between the student-respondents ‘perceptions and the evaluation of the clinical instructor-respondents on the application of the critical thinking skills in the context of the nursing process? (3) What measures can be proposed to enhance the application of critical thinking skills of nursing students?

Methodology & Theoretical Orientation: This study applied the mixed method of research and utilized the descriptive design for each quantitative aspect and content analysis for each qualitative aspect. This research was based on the humanistic nursing theory combined with the elements of critical thinking from the more recent studies. It adopted the Transactional Model of Critical Thinking (TMCT) which had successfully integrated humanistic nursing theory into a model of critical thinking.

Findings: Based on the quantitative data, student-respondents perceived that they ALWAYS APPLY critical thinking skills and clinical instructor-respondents evaluation showed students only OFTEN APPLY critical thinking skills needed in all phases of the nursing process (assessment, diagnosis, planning, implementation, and evaluation). Based on the qualitative data (NCP analysis), student-respondents need to enhance assessment process skills to ensure a complete database; formulated inappropriate diagnosis; need to enhance skills in formulating goals and outcomes; have the skills in identifying appropriate nursing but need to know how to prioritize each identified nursing intervention, and with skills in evaluating the effectiveness of interventions.

Conclusion & Significance: There is a significant difference in the application of critical thinking skills in the context of the nursing process as perceived by student-respondents and as evaluated by clinical instructor-respondents. Specific measures must be proposed to enhance the application of the critical thinking skills of nursing students in the context of the nursing process.

Understanding the need, value and role of Midwives in Healthcare

Increasing women’s access to quality midwifery has become a focus of global efforts to realize the right of every woman to the best possible health care during pregnancy and childbirth (WHO, 2018).

Midwifery is one of the most ancient practices in the world. It even features in early Egyptian and Roman scrolls. Its popularity had decreased and is now seeing an increase in global attention.

Globally, there have many reports on the increased demand for midwives as well the shortage of these midwives.  In 2018, the department of health and social care in the UK reported that more than 3000 training course places would be created over the next 4 years in the “largest ever” investment in midwifery training, as part of the plans to meet NHS staffing demands.  The Royal College of Midwifery chief executive and general secretary Gill Walton said:” This is a very long overdue acknowledgment by the government that England’s maternity services need more midwives.”  In addition to this, the World Health Organization has stated on numerous occasions that more midwives are needed to improve maternal and newborn survival.

In 2011, the United Nations Population Fund (UNFPA) published a report – The state of the world’s midwifery 2011: delivering health, saving lives- that offered a comprehensive look at midwifery around the globe.  The report's analysis of 58 countries showed that there was a global shortage of an estimated 350 000 midwives, at least a 3^rd of whom were needed in the world’s poorest countries.

Midwifery has come to the fore since maternal and newborn health was made the focus of the two Millennium Development Goals (MDG’s).  In 2006, the World Health Organisation estimated that the world needs 4.2 million more health workers, with 1.5 million of those needed in African countries alone.  The State of the World’s Midwifery (SoWMy) 2014 report, which examines the global midwifery landscape across 73 low-and-middle -income countries, calls for urgent investment in high- quality midwifery to prevent about two-thirds of all maternal and newborn deaths- saving millions of lives every year.  Therefore, one can gather that the world is facing an acute shortage of healthcare workers.

However, midwifery experts say that for a profession that is so old, it is remarkably poorly understood.  Midwives do far more than just catching babies. The impact that midwives have is not just on pregnancy outcomes, but extends to newborn care, breastfeeding, family planning, and sometimes also cervical and breast cancer screening.  Decades of neglect of the role of midwives, either because of the over-medicalization of pregnancy care or a lack of resources, has left a legacy of high rates of maternal and newborn mortality in developing countries (Bulletin of the World Health Organisation, 2013).

According to ITV News report in n2018, women who use the continuity model of care in the UK are 19% less likely to miscarry and 16% less likely to lose their baby and 24% less likely to give birth prematurely.  This report was based on the provision of a dedicated team of midwives that will be with the mother from pregnancy to labor to new parent.  In addition, statistics are clear that having a dedicated team of midwives reduces the occurrence of stillbirths, miscarriages and neonatal death.

- Ntombi Khaya Msimango

Deputy Chief Nursing Officer

Muscat Governorate, Oman

Quality in Decision Making

    Asma Hussein Rammal

Nursing Director at Madina National Hospital in Saudi Arabia

Quality in decision-making is very crucial issue in nursing. Since nurses have the voice to lead, strong leaders should support this leading. In order to have strong leaders they should have the proper knowledge and enough experience in the field. Multiple factors affect the decisions; outside factors and inside factors. The outside factors include the rules and regulations of MOH, Labor law, accredited organizations and the other hospital (competitors). Inside Factors; like policies and procedures of the hospital, the shortage of staff and the support of the higher management. Despite of all these factors the quality of care and patient safety should have the priority when make the decision otherwise; it will affect the health of patient. For instance, when decision was made to transfer patients from ICU to medical ward because their health status was improved a little, but they did not reach the level of being in normal ward. Their health status was deteriorated, and they were sent back to ICU. This type of decision has lots of side effect; 1- It did not take the quality of care in consideration. 2- This decision will affect the reputation of the hospital other than the legal situation that will affect the hospital. Other decision can be taken by higher management to increase the ratio of patient to nurse specially in critical areas other than the ward patient. In this situation, Nursing Director can stop this decision. In order to prevent medical mistakes, work overload on nurses, which in turn will increase the sick leave.

Nursing Directors who considered the leaders for the new nurses should present strong leadership with justified decisions that reflect the quality of care that should have the priority.

Maternity Nursing

What is Maternity Nursing?

The skills that nursing students learn in this course prepare them with a high level of specialized skills. Maternity nurses provide both pre-birth and post-birth care for mothers and their new-born babies. Nursing students receive training to prepare them to help mothers and their families know what to expect throughout the pregnancy.  Nurses provide mothers with caring for their babies and themselves after delivery.

Maternity nurses also care for those who suffer miscarriages and those who choose abortion.  They provide these women with assistance to care for themselves.  Maternity nursing courses also train nursing students in medication administration for patients.  Other skills learned include identifying the sign of complications during delivery, checking the patient’s vital signs, checking the patient’s dilation level, and evaluating and managing pain.

How a Labor and Delivery Nurse Uses Maternity Nursing on the Job

Labor and delivery nurses use the skills learned in their courses to care for mothers and their newborns. Their concern is not only the physical well-being of their patients; they also provide emotional care for their patients. Labor and delivery nurses use their skills to help the mothers learn the best was to dress, feed, and change the babies.  They also use the skills they learn to help mothers wash their babies and feel a high level of comfort when holding their babies. Labor and nurse pass their knowledge on to mothers to help them determine the pros and cons of various baby-related issues.

Labor and delivery nurses use their skills to identify the appropriate technology and tools needed for a successful delivery.  They also must understand how to read monitors and reports as well as perform certain procedures to maintain the good health of the mother and baby. Labor and delivery nurses also learn how to monitor the mother and baby during all stages of the pregnancy and report any changes to the head nurse and doctor.

Critical Care Nurses' Perspectives toward Family Presence during Resuscitation

 

   Abdulelah Alhaidary

   Director of Nursing

   king Abdul Aziz University Hospital

   Saudi Arabia

Introduction: Most of our hospital in Saudi Arabia are not allowing the family members to be presented during resuscitation of their loved one, because of many reasons, specifically the traumatic experience for the family members when they witness the resuscitation of their loved one and the unavailability of the space in the patient's room during the resuscitation, although in North America, Australia, and Europe there was a new movement has evolved gradually because of subjective evidence from family members supporting the notion of family presence during resuscitation in addition to emerging evidence from research by health professional,   add to that,  it was never investigated in Saudi Arabia , and if it will be done, it will diffidently add a lot to the practice and to the family members satisfaction.

Objectives: To answer the following: What is the profile of the respondents, to what extent of the perspective of critical care nurses toward family presence during resuscitation, is there a significant relationship between the level of perspectives of the respondents and their profiles, and to propose a well-established family presence during resuscitation guidelines. 

Methods: the study was conducted in the Intensive Care Unit, Prince Sultan Military Medical City, Kingdom of Saudi Arabia, from January to December 2016, this study involved 150 critical care nurses. it utilized the descriptive and qualitative methods of research. questionnaires were distributed, and data obtained were assessed statically and presented with interpretation.

Result: the tabulated data were subjected to a percentage, weighted mean, analysis of variance and t-test for two independent sample. results supported the family presence during resuscitation as a right not an option, permission should be secured, spiritually showed benefit. trauma was considered inevitable.