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.

Mental Illnesses

Who Becomes Mentally Ill?

• It can affect anyone, regardless of age, ethnic background, income or gender.
• One in five Canadians has or will develop a mental illness.
• Sometimes mental illness is complicated by drug and alcohol use

Depression:

Refers to severe and prolonged feelings of discouragement, frustration and even a sense of despair. Multiple causes such as specific, distressing life events, a biochemical imbalance in the brain or persistent psychological factors such as a negative or pessimistic view of life. Common symptoms of depression:

• Irritability.
• Anxious mood.
• Trouble sleeping or sleeping too much.
• Loss of energy and excessive fatigue.
• Physical aches and pains.
• Diminished ability to think and concentrate.
• Feeling bored and not interested in many aspects of your life.
• Imagining you have an illness such as cancer when there are no physical indications.
• Feelings of worthlessness, hopelessness
• Possibility of suicidal thoughts
• Changes in personal grooming
• Isolation and withdrawal
• Inability to experience joy or pleasure

Bi-Polar Disorder:

Refers to the two poles of the continuum of mood with alternating periods or cycles of mania highs and depression lows as described previously. Common symptoms of mania:

• Persistently high or irritable
• Decreased need for sleep.
• Appetite disturbance.
• Excessive spending.
• Reckless and impulsive behaviour.
• Inflated ideas about what you are capable of doing – grandiose thoughts.
• Delusional and psychotic thinking.
• Hyper sexuality
• Heightened senses to colour, noise, and smell
• Accelerated thoughts and speech.

Psychosis:

The word psychosis is used to describe conditions that affects the mind, in which there has been some loss of contact with reality. When someone experiences the symptoms of psychosis, their condition is referred to as a psychotic episode. It affects an individual’s thoughts, feelings and behaviours. Some people experience psychosis as a part of their mental illness or because of using or withdrawing from drugs and alcohol. It is most likely to occur in young adults. About 3 out of every100 people experience a psychotic episode in their lifetime. It occurs equally in males and females and across all cultures and levels of socio-economic status. Most people make a full recovery from the experience. Common signs and symptoms of psychosis:

• Disorganized or confused thinking.
• Reduced concentration, attention
• Reduced drive and motivation, lack of energy
• Sleep disturbance
• Anxiety
• Social withdrawal
• Behavioural changes, irritability
• Hallucinations or delusions
• Disorganized speech

Anxiety Disorders

• A group of disorders which affect behaviour, thoughts, emotions and physical health. Caused by biological and situational circumstances. Heightened and continuing response to a perceived threat. Types of anxiety disorders:

General Anxiety Disorder

• Repeated and excessive worries lasting at least six months pertaining to routine life events and activities like work, relationships, finances and family.

Panic Attacks

• Fear of imminent death leading to heart palpitations, choking, nausea, faintness, dizziness, chest pain and sweating.

Panic Disorder

• Fear of situations which may cause a panic attack.

Phobias

• Overwhelming feelings of terror in response to a specific object, situation or activity.

Obsessive-Compulsive Disorder (OCD)

• Repetitive actions used to cope with recurring or unwanted thoughts.

Post-traumatic Stress Disorder (PTSD)

• A sense of re-experiencing a traumatic event for months and sometimes years after the incident.

Treatment & Recovery

Treatment for any mental illness, whether or not it is complicated by drug and alcohol misuse, should occur as soon as symptoms appear. Recommended treatment involves a combination of approaches:

1. EDUCATION – To help you and your family/support system understand the illness, its causes and effects and ways of dealing with symptoms.
2. MEDICATION – New ones are now available with fewer unpleasant side effects than older medications.
3. PSYCHOLOGICAL THERAPY OR COUNSELLING - To help you understand what is happening, change your lifestyle to optimize the chances for recovery and learn new skills such as problem solving and relaxation techniques.
4. SOCIAL, EMPLOYMENT AND EDUCATION SUPPORT – You may need support to stay at your job, or in school. This is important, so you maintain skill development and continuation of income and do not become cut off from friends and workmates. Research has shown that people who experience mental illness have fewer relapses when their family or other support system is involved in their care and treatment. The same is true when substance misuse is involved. If friends and family are knowledgeable and informed, they are in a better position to support you.

Top 10 places to visit in Dubai

Burj Khalifa: Among the various places to visit in Dubai, Burj Khalifa is a highly exotic one. It has been the tallest structure and building in the world

Dubai Aquarium: It is one of the world’s largest suspended aquariums in Dubai. The underwater zoo has a huge collection of sand tiger sharks and many other endangered species which are being conserved in their natural habitat. 

Desert Safari with BBQ Dinner: Desert Safari is undoubtedly one of the most exclusive activities to try in Dubai. Exploring the endless deserts while on your Dubai trip is an adventure you must not miss.

Wild Wadi Water Park: It is an outdoor water park in Dubai which is being operated by the Jumeirah International. It is a place which will quench the thirst for all your water sports adventures. 

Dubai Marina: Dubai Marina contains ten regions each created as an unmistakable group. The Dubai Marina Walk, which lines the waterfront, has a choice of cosmopolitan eateries.

Ferrari World: Ferrari World is Abu Dhabi’s largest theme park, founded back in 2010. The park’s indoor activities are centered around everything you can do with a Ferrari. At Ferrari World, there’s something for everyone to do, whether you go with your kids or by yourself.

Dubai Creek: Dubai Creek zone that associates the ocean exchanging port to the leave as it goes through the heart of Dubai. This Dubai attraction is a saltwater brook situated in Dubai, United Arab Emirates and it closes at Ras Al Khor Wildlife Sanctuary.

Dubai Dolphinarium: Located within the picturesque Creekside Park in Dubai at Umm Hurair, Dubai Dolphinarium has become one of the city’s greatest amusement venues including Coral Reef Aquarium, Fish Farm, Gatorville and a research therapy center.

Ski Dubai: Ski Dubai, a 22,500 square meter indoor resort dedicated to snow and skiing. The resort is covered in snow where you can enjoy all types of indoor snow activities and be in the winter wonderland you could only dream of in the Alps.

Dubai Miracle Garden: The lush gardens are a treat to your senses and will leave you with a pleasant and happy feeling throughout. This Dubai attraction is the worlds’ largest natural flower garden and what makes it more miraculous is that it happens to be put up in the city of deserts.

Nursing Education 2019 Conference : Workshop

ICU, acquired pneumonia and ventilator: Is Ventilaor-associated Pneumonia an Independent Risk Factor for Death? By Fatma Slem, RN, New Mwasat Hospital, Kuwait 

  

Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs 48-72 hours or thereafter following endotracheal intubation, characterized by the presence of a new or progressive infiltrate, signs of systemic infection (fever, altered white blood cell count), changes in sputum characteristics, and detection of a causative agent. VAP contributes to approximately half of all cases of hospital-acquired pneumonia. VAP is estimated to occur in 9-27 % of all mechanically ventilated patients, with the highest risk being early during hospitalization. It is the second most common nosocomial infection in the intensive care unit (ICU) and the most common in mechanically ventilated patients. VAP rates range from 1.2 to 8.5 per 1,000 ventilator days and are reliant on the definition used for diagnosis. Risk for VAP is greatest during the first 5 days of mechanical ventilation (3 %) with the mean duration between intubation and development of VAP being 3.3 days. This risk declines to 2 %/day between days 5 to 10 of ventilation, and 1 %/day thereafter. Earlier studies placed the attributable mortality for VAP at between 33-50 %, but this rate is variable and relies heavily on the underlying medical illness. Over the years, the attributable risk of death has decreased and is more recently estimated at 9-13 % largely because of implementation of preventive strategies. Approximately 50 % of all antibiotics administered in ICUs are for treatment of VAP. Early onset VAP is defined as pneumonia that occurs within 4 days and this is usually attributed to antibiotic sensitive pathogens whereas late onset VAP is more likely caused by multidrug resistant (MDR) bacteria and emerges after 4 days of intubation. Thus, VAP poses grave implications in endotracheally intubated adult patients in ICUs worldwide and leads to increased adverse outcomes and healthcare costs.

Keynote Talk : Nursing Education 2019

Understanding and implementing EBP to foster and maintain safe and competent care by Dr.Rabie’e Al Rashdi, Oman Academic Accreditation Authority, Oman

Abstract: Several definitions exist for the ‘Evidence Based Practice’ (EBP) concept, but the most commonly cited definition, according to Boyce et al (2018), comes from Dr. David Sackett in his 1996 letter in BMJ on what evidence-based medicine is and is not. In the letter, he described EBP as “the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients (Sackett, et al, 1996). According to Mackey and Bassendowski (2017), Evidence Based Practice evolved from Florence Nightingale in the 1800s to medical physicians in the 1970s and the nursing profession in the late 1990s. It began as an idea to provide better outcomes for patients who experienced deplorable, unsanitary, conditions and developed from this foundation to a widely communicated and critically needed practice for fostering and maintaining safe and competent care. The critical need of Evidence Based Practice stems from the fact that, despite its development and wide interest to adapt it in nursing and other healthcare professions, there is still a wide variation in health care practices that ultimately lead to unnecessary wastage of resources, wasted care delivery time and efforts, as well as poor treatments and nursing care outcome (Youngblut and Brooten, 2001). In response to the aforementioned status quo of Evidence-Based Practice, commissioners and providers of health care were encouraged to implement it in order to utilize resources, improve the outcome of treatment and care delivery and meet public demands for cost-effective and high standards of care. In this keynote presentation, the author aims to answer the following key questions: what is Evidence Based Practice and what is it not?; why is Evidence Based Practice needed in healthcare?; what is the best way of implementing Evidence Based Practice?; what are the hindering factors in the implementation of Evidence Based Practice?; and how to overcome the hindering factors and enhance the implementation of Evidence Based Practice?.