Practice Rationale Care Model: The Art and Science of Clinical Reasoning,Decision Making and Judgment in the Nursing Process

Jefferson Garcia Guerrero

Ph.D. NS, DNS, MAN, RN

          Saudi Arabia

Nurses must be enlightened that clinical reasoning, clinical decision making, and clinical judgment are the key elements in providing safe patient care. It must be incorporated and applied all throughout the nursing process. The impact of patients’ positive outcomes relies on how nurses are effective in clinical reasoning and put into action on clinical decision making occurs. Thus, nurses with poor clinical reasoning skills frequently fail to see and notice patient worsening condition, thus misguided decision making arises that leads to ineffective patient care and adding patients suffering. Clinical judgment, on the other hand, denotes on the outcome after the cycle of clinical reasoning. Within this context, nurses apply reflection about their actions from the clinical decision making they made. The process of applying knowledge, skills, and expertise in the clinical field through clinical reasoning is the work of art in the nursing profession in promoting patient safety in the course of delivering routine nursing interventions.  Nurses must be guided with their sound clinical reasoning to have an optimistic outcome and prevent iatrogenic harm to patients. Nurses must be equipped with knowledge, skills, attitude, and values but most importantly prepared to face the bigger picture of responsibility to care for every patient in the clinical field.

Nurse as second victim after adverse event

Essam Ezat Mahmoud

King Saud Medical City, Saudi Arabia

Background: Nurses is being a second victim after made error. They suffered from physical and psychological symptoms followed an event. Healthcare organization has a significant role in support nurses after an event. However, little attention is paid from governmental bodies, to support the second victims.

Aim: To describe nurses' experience followed adverse events and the importance of the organization to support them.

Methods: A descriptive study conducted at King Saud Medical City, a total of 355 staff nurses were selected from clinical areas. Data were collected between July, 2 to Dec 5, 2017, using a self-administered questionnaire.

Results: 33.8% of the participants were involved in an adverse event in their career, and 64.2% involved with no patient harm, while 19% with fetal harm. Also, 82% experienced physical and psychological symptoms. Flashback returned to work anxiety, difficult concentration, grief and depression were the most psychological symptoms reported. Sleep disturbances, unable to relax and Sweaty palms were the most physical symptoms reported by them. 42.3% of them spent one to three weeks till they rid all symptoms. 55.2% received informal support from Head Nurse (216%), Nurse Manager (18.9%), Director of Nursing (8%) and friend/ Family. Nurses were worried a lot about what their clinical peers would think about them after the events. They have not been adequately supported by the organization (77.6%). there was no designated member of the organization guiding them after an event.

Conclusions: Adequate support can work effectively to reduce symptoms, after an event. Lack of supports can lead to an emotional burden.

Keynote Speakers of Nursing Education 2019

 Title: Making a difference for staff and the patient

Sue Kitching

Director of Nursing
Northern Area Armed Forces Hospital
United Kingdom

  Title: Quality in decision making

Asma Hussein Rammal

Nursing Director 
Madina National Hospital 
Saudi Arabia

  Title: Critical Care Nurses' Perspectives toward Family Presence 

                                          during Resuscitation  

Abdulelah Alhaidary

Director of Nursing
king Abdul Aziz University Hospital
Saudi Arabia

  Title: Understanding and implementing EBP to foster and maintain

                                          safe and competent care

Rabie'e Al Rashdi

Planning and Development Expert
Oman Academic Accreditation Authority
Muscat

  Title: Nursing Education in Saudi Arabia: A 60 years of obstacles 

                                         and Opportunities

Adel Bashatah

Dean Of Skills Development 
King Saud University
Saudi Arabia

Making a difference for staff and the patient

Sue Kitching

Director of Nursing, Northern Area Armed Forces Hospital, Saudi

Statement of the Problem:

Taking on a new role in a Hospital that had not had much evidence based nursing utilized would for some be a step too far. For those who enjoy a challenge, it gives a great opportunity to lead and direct staff to strengthen their knowledge and more so patients outcomes. Transformational leadership is about transforming and Cummings et al 2009, 2011 have highlighted the links between patient outcomes and leadership. So how do you go about righting poor practice, limited understanding whilst leading and engaging a workforce? Well, the opportunity arose when the morning report kept highlighting pressure injuries but with no outcomes and solutions.  So, rather than being the leader I took on the role of clinical nurse with experience to go and investigate and see what change I could make. “Amazing,”  is a nice word  and one that sums up the effect of my transformation in the staffs understanding, ownership  and improvement leading to   better outcomes for their patients

Pressure injuries at Grade 4 and above are now reduced to Grade 2 and below and staffs have confidence in how to tackle pressure injury prevention and care.  Just through a leader changing focus and showing nursing skills are never lost and knowledge is a wonderful asset and what simple motivation and encouragement can do to a workforce.

Cultural influence in communication and nursing care: The case of UAE

JOHN NYAH MBOUT, SRN, BSN, HAAD-RN

UAE

The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policymakers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients.

“Culture" refers to integrated patterns of human behavior that include the language, thoughts, actions, customs, beliefs, and institutions of racial, ethnic, social, or religious groups (California Endowment, 2003). Every culture has beliefs about health, disease, treatment, and health care providers.

Health is a cultural concept because culture frames and shapes how we perceive the world and our experiences.

All cultures have systems of health beliefs to explain what causes illness, how it can be cured or treated, and who should be involved in the process. The extent to which patients perceive patient education as having cultural relevance for them can have a profound effect on their reception to information provided and their willingness to use it.

Business leaders know that intercultural savvy is vitally important – not just because they have to deal increasingly with globalization, but also because the workforce within their own national borders is growing more and more diverse.

Intercultural communication in its most basic form refers to understanding how people from different countries and cultures behave, communicate and perceive the world around them. Given the growing multicultural population in the UAE, intercultural communication research is actively being applied in healthcare settings so that doctors and their staffs can relate effectively to their patients from diverse cultural backgrounds.

The United Arab Emirates houses a diverse and vibrant community. The residing population originates from a number of Arab tribes. Over the time, the existing community has started to diversify with the arrival of the Iranians in the 1800s, followed by Indians (both Muslims and Hindus), especially in Dubai due to its prosperous pearl market, given its location on the coastline.3  The Emirati Arabic culture is a perfect blend of the Islamic, Persian and even Indian culture. This is evident in the architecture, dressing norms, cuisines, folk dances, and the usage of certain words in everyday language.  But the Arabic Islamic culture remains the strongest and the most obvious influence on the UAE community.

Delivering high-quality care to Muslim patients involves having an awareness of the ramifications of the Islamic faith and Islamic beliefs. Nurses need to understand the implications of spiritual and cultural values for clinical practice. They should be aware of the need for modesty and privacy, the appropriate use of touch, dietary requirements and use of medications.

For a better understanding, this presentation will provide a brief overview of the existing culture and beliefs in UAE, before wading into it influences in communication and nursing care.

This concept will be presented in the following sub-topics:

• The significance of the concept
• Critical analysis of the concept
• Overview of existing culture and beliefs in the UAE
• Application and influence of the concept in nursing care in the UAE: culture as a competency and influence of religion
• Way forward of the concept

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