Revista de Enfermagem e Cuidados

Objective: The intention of this systematic literature review is to describe and explore the existing eminence of research evidence about clinical decision-making skills in undergraduate nursing students.
Methods: A review was conducted to determine the current knowledge approximately the chosen topic. PubMed and Science Direct online databases or systematic engine search were utilized to obtain the research articles relevant to this systematic review. The data consisted of 46 research articles about clinical decision-making skills using inclusion and exclusion criteria. The researcher used content and thematic analysis as a qualitative approach in reviewing the articles. Data analysis was implemented from November 10, 2018 to January 21, 2019.
Results: This systematic literature review revealed three major themes emerged in this study. Such major theme includes pre-requisite skills, clinical decision making skills and clinical judgment. The first theme emerged is the pre-requisite skills. Sixteen studies have cited pre-requisite skills in clinical decision-making. Under pre-requisite skills, the following sub-themes emerged which includes knowledge, skills, self-confidence, and self-efficacy. The second theme emerged is the clinical decision-making skills. In here, twenty-four studies have supported that decision-making is an important clinical skill for undergraduate nursing students. Last major theme emerged is the nursing clinical judgment. Under this theme, eleven studies have supported nursing clinical judgment. Three sub-themes were identified that influence nursing students' clinical judgment. These include reflection, the learning environment and clinical teachers.
Conclusion: In general, the need to assist undergraduate nursing students in anticipating and exercising prerequisite skills, clinical decision making and professional nursing judgment is needed in their clinical placement setting.

Background: Many baccalaureate nursing programs in Ontario, including X, ask their consolidating students to address a persistent clinical issue with a corresponding quality improvement solution. Nursing leadership often manifests as a unique combination of advocacy skills and abiding professional commitment. To succumb to complacency in a workplace where client safety is constantly vulnerable is neither a viable or caring option.
Methods: The CHAT Communication Guide was developed as a change initiative targeting transitions in care between care-provider units and diagnostic or procedural departments. This tool is to be used by both the sending and returning health care provider to communicate critical patient information regarding current situation, history, assessment, and treatment.
Results: The goal of this implement is to improve patient safety, promote patient-centered care, and provide a standardized tool accessible to all health care team members.
Conclusion: Clinical innovation represents a professional obligation where transitions in care are a priority concern.

Surgical patients perceived the day of surgery as highly terrifying in their lives. Patients manifest different levels of anxiety states in relation to what is expected in future and these are associated with many factors which may be type and extent of the proposed surgery, gender, age, previous surgical experiences, and personal tendency for unpleasant events. The study aimed to assess baseline anxiety and effect of nursing intervention on post-operative anxiety states among surgical patients.

Two-group pre-test, post-test quasi-experimental study was adopted and thirty surgical patients were included. Sample size was determined using Leslie Kish formula and purposive sampling technique was adopted to select 15 surgical patients in to the experimental and control groups respectively. The intervention group had structured nursing information but control group did not. Data was processed using statistical package for social science version 21. Two research questions were answered using descriptive statistics of percentages and one hypothesis was tested using inferential statistics of student t-test at 0.05 level of significance.

This study shows that anxiety states are common to all surgical patients. The surgical patients (in both experimental and control groups) (33%) experienced high anxiety state preoperatively. The percentage reduction in the number of respondents that expressed high level of anxiety state in the experimental group (40% reduced to 26.7%) as they move from preoperative to postoperative periods as compared with the control group (26.7% increased to 33.3%). This shows the relative impart of the nursing intervention, but the mean differences of anxiety of the experimental group was 0.08; while that of the control group was 0.15 respectively. Result reveals no significant difference in anxiety level among participants in the experimental and control groups (p=0.514).

Surgical patients should be assessed of anxiety states in the perioperative environment. The information needed and provided to each surgical patient should be assessed and patient-centered to prevent failure of preoperative information.

Aim and objectives: This study aimed to determine the efficacy of nurse led insulin protocol to control blood glucose among critically ill patients.
Background: Hyperglycemia is a common problem among critically ill patients in the ICUs that consistently linked with worsened clinical outcomes in various groups of patients. Thus, ensuring effectiveness, safety and a high-quality glycemic control can be achieved with a protocol that combining continuous intravenous insulin with frequent bedside blood glucose monitoring.
Design: Quasi-experimental design was used in this study.
Methods: This study was conducted in the ICU departments at Alexandria Main University Hospital on 60 newly admitted hyperglycemic critically ill patients. They randomly assigned into two groups; control group and intervention group. The nurse led insulin protocol was applied among the study group, while the control group managed by the routine ICU management.
Results: The hyperglycemic mechanically ventilated patients who were managed by the nurse led insulin protocol experienced lower mean blood glucose level and lower glucose variability than those who were managed by routine management of the ICUs.
Conclusion: The nurse led insulin protocol was an effective to control blood glucose level among critically ill patients. Relevance to the clinical practices: nurses’ led insulin protocol has strongly and consistently linked with better glycemic control and improved clinical outcomes in various groups of patients. Implementation of nurse led protocols increases nurses’ autonomy; a concept that has been associated with increasing their perceptions of improved quality of care and job satisfaction.

Objective: The aim of this study was to know about knowledge and practices of nurses regarding CPR in private tertiary care hospital, Peshawar, KP.
Methodology: A descriptive-cross-sectional study was conducted among nurses in private tertiary care hospital Peshawar, KP. Participants were selected from different units by using random sampling technique. The data was collected through self-developed questionnaire.
Results: The study consisted of 55 participants including 7.3% male and 92.7% female. The overall knowledge and practices of participants were calculated in percentage that revealed that the mean knowledge of participants was 82.02% with standard deviation 12.347%, while the mean practice was 42.42% with standard deviation 10.948%. Independent t-test was applied to compare the association of participants practice with those who attend BLS course, that was significant p=0.010.
Conclusion: The current study, conducted in private tertiary care hospital, focused on knowledge and practices of nurses regarding CPR. The results significantly appeared to show that nurses had poor practices of CPR as compared to knowledge. The study also highlighted that nurses need to be properly trained on CPR.

Background: Recent years have witnessed an upsurge in the interest in the correlation between nutritional condition and rehabilitation of stroke patients. Dysphagia is one of the neurological manifestations, which markedly affects the nutrient intake of stroke patients. However, previous studies did not consider dysphagia as a variable. If the presence of dysphagia correlated with the serum albumin level and activities of daily living (ADL) of stroke patients, these studies could have contributed to enhancing nursing care for rehabilitation stroke patients. This study aims to investigate the correlation between dysphagia with the serum albumin level and the functional independence measure (FIM) of stroke rehabilitation patients.

Methods: In this retrospective study, we reviewed medical records in a rehabilitation hospital located in the Kanto area of Japan, from November 1, 2018 to January 31, 2019. From medical records, we collected data about age and sex, type of stroke, location of the stroke, serum albumin level, and the presence or absence of dysphagia. Using the univariate analysis, we evaluated the correlation between dysphagia and two variables-serum albumin level and FIM score.

Results: The study cohort comprised 22 stroke patients (presence of dysphagia (dysphagia group), 16; and absence of dysphagia (no dysphagia group), 6). Regarding the serum albumin level, no significant was noted between groups. However, the dysphagia group’s FIM score and variation were markedly higher than the no dysphagia group.

Conclusions: Regarding stroke patients in a recovery phase rehabilitation ward, comparison of patients with dysphagia and no dysphagia reveals the following: FIM scores are markedly higher; serum albumin levels are not markedly different groups; and dysphagia stroke patients’ average serum albumin level declines after 1 month.

Purpose: The purpose of this study is to ascertain in Nigeria context the perceived barriers to basic nursing students’ academic performances in weeding examination.
Methods: One hundred (100) newly admitted students into the Oyo State College of Nursing and Midwifery, Eleyele, Ibadan, Nigeria were used for the study. Survey research method was deployed. The research instrument used was questionnaire which was distributed to each student in order to get their responses.
Results: The study highlights that 80.9% of the respondent’s purpose for studying nursing is to be self-reliant, (68.1%) were not professionally proud, while, (68.1%) of the respondents were dissatisfied with the basic nursing student lecture mode, (53.2%) of the respondents were anxious about course layout, (49.0%) of the respondents said that rigorous and overloaded course work affects their performances, (85.1%) of the respondents were satisfied with library staff and services.
Conclusion: Conclusively, majority of the students were of the opinion that, extra curricula activities distracts, do not accept nursing as a professional calling, parent persuasion hinders them, lecture mode was not right for learning, had anxiety on course layout, rigorous and overloaded course and inadequate facilities was a bane of failure. Further studies needed to be conducted on curriculum and teaching methods for nursing students.

Background: The purpose of this study is to explore the cultural aspects of client care are satisfactory included in the nursing curriculum in Sultanate of Oman. This concept will be examined through reviewing the Omani Ministry of Health’s (MoH) approach to designing, developing, and implementing a general nursing curriculum.
Method: This case-study, qualitative design explored whether nursing education addressed cultural congruent care adequately through the review of educational policy documents, semistructured qualitative individual interviews and focus groups. The data was collected from the MoH’s nursing education decision makers, educators, students and service users (public) over a period of six months. To identify themes, data was analysed using Ritchie and Spencer’s five-stage analytical framework. Using purposeful sampling to select study participants from the MoH nursing education decision makers, educators, students and service users.
Results: The study reveal that the MoH’s current approach to nursing curriculum falls short of what Denis Lawton considers a culturally competent curriculum.
Conclusion: The study proposes to re-examine the cultural care content in the nursing education in Oman.

Background: During the course of health care of patients, thousands of health care workers suffer occupational exposures among which nurses have high chances of exposure to blood-borne pathogens as they are the primary health care providers to patients in hospitals. Post-exposure prophylaxis has become routine following the occupational exposure of HCWs to HIV and HBV. So it is important that nurses keep their knowledge updated regarding handling of HIV and HBV patients and how to manage occupational exposure.
Method: A training programme for nurses was conducted by a tertiary care hospital and their knowledge regarding occupational exposure management and handling of HIV and HBV patients was assessed through pre-test and post-test questionnaire.
Result: Total 36 clinically registered nurses participated. The mean score of pre-test was 8.7 which increased to 10.1 in post-test. The knowledge related to PEP and handling of HIV and HBV patients improved significantly after the training class (p=0.0001 and 0.002 respectively).
Conclusion: The nurses are quite prone for occupational exposure to HIV and HBV and the findings of this study highlight the importance of continuous training of nurses so that they have a comprehensive understanding of PEP and standard precautions. Thorough orientation to the PEP procedure will help them access appropriate medical advice in a timely manner.

Background: The expeditious management of hypotension of emergency department (ED) patients is crucial to prevent hypoxia and in-hospital mortality. This study aimed to identify in-hospital mortality rate, hospital admission rate, and intensive care unit admission rate in Thai ED patients with Non-Traumatic Hypotension (NTH).
Methods: Retrospective chart review of 796 patients with non-traumatic injuries admitted in ED within 3 months in two tertiary hospitals was conducted. A systolic blood pressure less than or equal to 100 mmHg was defined as NTH. A total of 318 (39.95%) ED records of patients with NTH were retrieved. The main outcome measures were mortality rate, length of intensive care unit stay, and hospital admission rate.
Results: The mortality rate and hospital admission rate were significantly higher in NTH patients than in those patients with normative systolic blood pressure. The results of this review study showed that hypotension in ED significantly influenced in-patient mortality (p=0.002) and hospital admission rate (p<0.001).
Conclusion: These findings suggest nurse’s work in the ED to provide effective care to restore hypotensive conditions in non-traumatic patients in order to prevent further adverse effects and also reduce the mortality rate.