scholarly journals Competency In Critical Care Nursing With Approach Methods Journal Sharing of Critical Care (JSCC) In Nursing Profession Students

2020 ◽  
Vol 9 (2) ◽  
pp. 686-693
Author(s):  
Heru Suwardianto ◽  
Vitaria Wahyu Astuti
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Exposure Assessment ◽  
Clinical Reasoning ◽  
Nursing Care ◽  
Positive Impact ◽  
Exam Score ◽  
Reasoning Process ◽  
Airway Assessment ◽  
Primary Assessment

The results showed that most respondents had good critical nursing competency scores including primary assessment: airway assessment (53.8%); breathing assessment  (56.4%); Circulation assessment (61.5%); Disability assessment (56.4%); and Exposure assessment (59%), professionalism (56.4%), critical nursing care competencies (79.5%), Clinical reasoning process (71.8%), Patient safety (61.5%) and critical care exam score (46.2%). The result of statistical test with Pearson test obtained that the primary assessment: airway assessment (ρ = 0.038); circulation assessment (ρ = 0.029); Exposure assessment (ρ = 0.023), competence of critical nursing care (ρ = 0.049), clinical reasoning process (ρ = 0.028) and patient safety (ρ = 0.001) have a significant relationship to the critical care exam score. The implementation of learning methods for journal sharing of critical care has a positive impact on competencies and results in good student competencies.   

Enhancing Clinical Reasoning Skills through Structured Reflection Models

2020 ◽  
Author(s):  
EMAD ALI ALMOMANI ◽  
Karim Attallah
Keyword(s):  
Critical Care ◽  
Reflective Practice ◽  
Clinical Reasoning ◽  
Positive Impact ◽  
Diagnostic Errors ◽  
Reflective Learning ◽  
Cross Sectional ◽  
Hamad Medical Corporation ◽  
Reasoning Skills ◽  
Clinical Reasoning Skills

Abstract Background:Clinical reasoning is an essential skill to all health care practitioners. McGlynn et al, 2015 mention that lower level of clinical reasoning skills are associated with higher rates of medical and diagnostic errors.. To enhance the clinical reasoning through reflection Hamad Medical Corporation (HMC) – Qatar established a new educational initiative under the title of reflective learning conversation and debriefing.Method:A prospective cross sectional exploratory of mixed methodology research conducted at Qatar- Hamad Medical Corporation (HMC) – In the critical care and trauma units. Anonymous self-reported questionnaires were collected from 236 critical care and trauma nurses who attended the reflective learning conversation and debriefing activities. Semi structured Interviews conducted for 10 nurses who facilitated the reflective learning conversation and debriefing activities. Content analysis and thematic analysis were applied.Results:Attending the reflective learning conversations and debriefing educational activities have a significant positive impact on the clinical reasoning skills of the critical care and trauma nurses. Moreover, attending the group level reflection, feeling threatened, are limitations and barriers for the reflective learning conversation and debriefing. Additionally, reflective practice can be encouraged and enhanced through; having reflective conversation and debriefing models and guidelines, and reflecting on both good and bad experiences.Conclusion:There is a positive correlation between the clinical reasoning and the structured reflections in the format of reflective learning conversation and debriefing. Reflective practice can be enhanced through attending the reflective learning conversation and debriefing activities. There are some limitations and challenges to the reflective learning conversation and debriefing method.

scholarly journals Gravidade das incompatibilidades medicamentosas em pacientes críticos: Uma revisão integrativa

2019 ◽  
pp. 1907-1912
Author(s):  
Flávia Giron Camerini ◽  
Cíntia Silva Fassarella ◽  
Danielle de Mendonça Henrique ◽  
Luciana Guimarães Assad ◽  
Adriana Raineri Radighieri
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Nursing Care ◽  
National Library ◽  
Electronic Library ◽  
Safety Critical ◽  
Drug Incompatibility

Objetivo: analisar as evidências científicas acerca dos eventos adversos provocados pelas incompatibilidades medicamentosas, com foco para a identificação de estratégias de prevenção. Método: trata-se de uma revisão integrativa de literatura, realizada nos diretórios da Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PubMed) e The Scientific Electronic Library Online (ScIELO) com os descritores “drug incompatibility”, “patient safety”, “critical care”, “infusions”, “intravenous” e “nursing care”. A busca resultou em em 09 estudos, publicados entre o período de 2014 a 2019. Resultados: dos artigos selecionados possibilitaram elaborar duas categorias: gravidade dos eventos adversos ocasionados pelas reações de incompatibilidade e estratégias de prevenção para evitar as incompatibilidades. Conclusão: os eventos adversos provocados pela incompatibilidade medicamentosas mais relatados foram a terapia ineficaz e a ocorrência de oclusão do cateter. As estratégias de prevenção mais citadas foram o uso de cateteres multilúmen a consulta ao farmacêutico clínico e o treinamento da equipe de enfermagem.

scholarly journals Primary care physiotherapists ability to make correct management decisions – is there room for improvement? A mixed method study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Cecilie Rud Budtz ◽  
Helle Rønn-Smidt ◽  
Janus Nikolaj Laust Thomsen ◽  
Rikke Pilegaard Hansen ◽  
David Høyrup Christiansen
Keyword(s):  
Patient Safety ◽  
Clinical Reasoning ◽  
Questionnaire Survey ◽  
Direct Access ◽  
Management Decision ◽  
Medical Conditions ◽  
Management Decisions ◽  
Quality Audit ◽  
Reasoning Process ◽  
Musculoskeletal Conditions

Abstract Background With increasing interest in direct access to physiotherapy, it is important to consider the physiotherapists (PTs) ability to make correct management decisions, because identification of differential diagnostic pathologies and timely referral for specialist care is vital for patient safety. The aims of the study were to investigate PTs ability to make correct management decisions in patients presenting with musculoskeletal conditions and to identify explanatory factors associated with this ability. Furthermore, we wanted to explore the PTs views on the identified factors. Methods The study was a mixed methods study with an explanatory sequential design consisting of a questionnaire survey and semi-structured interviews. The questionnaire comprised 12 clinical vignettes describing patient scenarios for musculoskeletal conditions, non-critical medical conditions and critical medical conditions. Based on this, the PTs indicated whether the patient should be managed by the PT or were in need of medical referral. Associations between correct decisions and explanatory variables was analyzed by mixed- effects logistic regression. Interviews were performed with nine PTs to explore their reactions to the results. A directed content analysis was performed. Results A total of 195 PTs participated in the questionnaire survey and 9 PTs were interviewed. Overall, PTs were more likely to make correct management decisions in the musculoskeletal conditions category, whereas wrong decisions were more often chosen for underlying medical conditions categories. Positive associations between correct management decision in the critical medical category were found for experience: odds ratio (OR) 2.73 (1.33;5.57) and passed quality audit OR 2.90 (1.50;5.58). In the interviews, PTs expressed concerns about the differential diagnostic abilities. They all noted, that experience is immensely important in the clinical reasoning process because the ability to recognise diagnostic patterns evolves over time. Furthermore, the quality audit seems to address and systematize the clinical reasoning process and workflow within the clinics. Conclusion The lack of ability to make correct management decision in critical medical categories and the uncertainties expressed by PT’s should raise concern, as direct access to physiotherapy is already well-established and the results indicate that patient safety could be at risk. The findings that experience and passed quality audit was associated with correct management decisions highlights the need for ongoing awareness and education into differential diagnostics.

scholarly journals 179 Evaluating a Clinical Pharmacist Service in a Residential Care Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Claire Kavanagh ◽  
Eimear O'Dwyer ◽  
Róisín Purcell ◽  
Niamh McMahon ◽  
Morgan Crowe ◽  
...  
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Patient Outcomes ◽  
Residential Care ◽  
Clinical Pharmacist ◽  
Comparative Evaluation ◽  
Positive Impact ◽  
Standard Of Care ◽  
Pharmacist Interventions ◽  
Medication Reviews

Abstract Background This study assessed the pharmacist role in an 80 bed residential care unit by: Quantifying the number and type of pharmacist interventions made and their acceptance rate.Assessing impact of pharmacist interventions on patient care.Assessing staff attitudes towards the clinical pharmacist service. Methods This was a non-blinded, non-comparative evaluation of the existing clinical pharmacist service in the unit. All residents were included. All pharmacist interventions over a 10-week period were recorded, then graded according to the Eadon scale1 by a consultant gerontologist and an experienced pharmacist to assess their impact on patient care. Results There were 615 pharmacist interventions. The most common interventions were: Drug Therapy Review, 34% (n=209) Technical Prescription, 26.5% (n=163) Administration, 15.3% (n=94) Drug Interaction, 10.4% (n=64) Medication Reconciliation, 8.5% (n=52) 98% (n=596) of interventions were rated as having significance to patient care, of which: 48.4% (n=298) and 41.8% (n=257) of the interventions rated as ‘significant and resulting in an improvement in the standard of care’1% (n=6) and 0.5% (n=3) rated as ‘very significant and preventing harm’. There was a statistically significant agreement between the evaluators, κw = 0.231 (95% CI, 0.156 to 0.307), p < .0005. The strength of agreement was fair. Of interventions requiring acceptance by medical team (n=335), 89.9% (n=301) were accepted. 95% (n=36) of staff who responded agreed or strongly agreed that improved patient safety resulted from the pharmacist’s involvement in multidisciplinary medication reviews. Over 92% (n=35) agreed or strongly agreed that their experience of the pharmacist was positive. Conclusion The pharmacist has an important role in our residential care unit. Their involvement in the medicines optimisation process positively impacts patient outcomes and prevents harm. Staff perceived a positive impact of the clinical pharmacist service provided on patient care and patient safety.

scholarly journals Critical care nurses’ clinical reasoning about physiologic monitor alarm customisation: An interpretive descriptive study

2019 ◽  
Vol 28 (15-16) ◽  
pp. 3033-3041 ◽  
Author(s):  
Halley Ruppel ◽  
Marjorie Funk ◽  
Robin Whittemore ◽  
Shu‐Fen Wung ◽  
Christopher P. Bonafide ◽  
...  
Keyword(s):  
Critical Care ◽  
Clinical Reasoning ◽  
Descriptive Study ◽  
Critical Care Nurses

Lessons in clinical reasoning – pitfalls, myths, and pearls: the contribution of faulty data gathering and synthesis to diagnostic error

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Martin A. Schaller-Paule ◽  
Helmuth Steinmetz ◽  
Friederike S. Vollmer ◽  
Melissa Plesac ◽  
Felix Wicke ◽  
...  
Keyword(s):  
Patient Safety ◽  
Clinical Reasoning ◽  
Data Gathering ◽  
Diagnostic Errors ◽  
Diagnostic Error ◽  
Care Physician ◽  
Diagnostic Process ◽  
Myasthenic Crisis ◽  
Hospital Organization ◽  
Substantial Impact

Abstract Objectives Errors in clinical reasoning are a major factor for delayed or flawed diagnoses and put patient safety at risk. The diagnostic process is highly dependent on dynamic team factors, local hospital organization structure and culture, and cognitive factors. In everyday decision-making, physicians engage that challenge partly by relying on heuristics – subconscious mental short-cuts that are based on intuition and experience. Without structural corrective mechanisms, clinical judgement under time pressure creates space for harms resulting from systems and cognitive errors. Based on a case-example, we outline different pitfalls and provide strategies aimed at reducing diagnostic errors in health care. Case presentation A 67-year-old male patient was referred to the neurology department by his primary-care physician with the diagnosis of exacerbation of known myasthenia gravis. He reported shortness of breath and generalized weakness, but no other symptoms. Diagnosis of respiratory distress due to a myasthenic crisis was made and immunosuppressive therapy and pyridostigmine were given and plasmapheresis was performed without clinical improvement. Two weeks into the hospital stay, the patient’s dyspnea worsened. A CT scan revealed extensive segmental and subsegmental pulmonary emboli. Conclusions Faulty data gathering and flawed data synthesis are major drivers of diagnostic errors. While there is limited evidence for individual debiasing strategies, improving team factors and structural conditions can have substantial impact on the extent of diagnostic errors. Healthcare organizations should provide the structural supports to address errors and promote a constructive culture of patient safety.

Efficacy of Epidural Analgesia for Pain Management of Critically Ill Patients and the Implications for Nursing Care

1991 ◽  
Vol 2 (4) ◽  
pp. 729-740 ◽  
Author(s):  
Jeanne F. Slack ◽  
Margaret Faut-Callahan
Keyword(s):  
Critical Care ◽  
Pain Relief ◽  
Epidural Analgesia ◽  
Critically Ill ◽  
Nursing Care ◽  
Critically Ill Patients ◽  
Continuous Epidural Analgesia ◽  
Analgesic Agents ◽  
Care Problems ◽  
Critical Care Patients

Management of pain for critically ill patients has been shown to be inadequately controlled and can have serious deleterious effects on a patient’s recovery. Continuous epidural analgesia can be used to control pain in critical care patients. This mode of analgesia administration provides pain relief without the delays inherent in the as-needed administration of analgesics. Fifteen critical care unit patients were part of a multidisciplinary, prospective, randomized, double-blind study of various epidural analgesic agents in 43 thoracic and 66 abdominal surgery patients. The purpose of the study was to identify the benefits and problems associated with continuous epidural analgesia administration and the implications for the nursing care of critically ill patients. Evaluation of the effectiveness of the analgesia was based on the following measures: 1) pain measured at regular intervals in the 72-hour period with a visual analog; 2) pain as measured after 72 hours with the word descriptor section of the McGill pain questionnaire; 3) amount of supplemental systemic narcotic analgesic needed; 4) recovery of ambulatory and respiratory function, including ability to perform coughing and deep-breathing exercises; 5) occurrence of adverse effects, and 6) the type and distribution of nursing care problems associated with continuous epidural infusions. The results of this study showed that the level of pain relief and recovery of postoperative function was superior to that provided by the more widely used as-needed systemic administration of narcotics. Although some nursing care problems were identified, continuous epidural analgesia can be used for pain relief in critical care patients, if the analgesia is administered by accurate reliable infusion systems and carefully monitored by nursing staff who are knowledgeable about the pharmacologic considerations of epidural analgesic agents and the management of patient care

Perceived Patient Safety Culture in a Critical Care Transport Program

2013 ◽  
Vol 32 (4) ◽  
pp. 208-215 ◽  
Author(s):  
Cheryl Erler ◽  
Nancy E. Edwards ◽  
Steve Ritchey ◽  
Daniel J. Pesut ◽  
Laura Sands ◽  
...  
Keyword(s):  
Critical Care ◽  
Patient Safety ◽  
Safety Culture ◽  
Patient Safety Culture
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