The Factors Influencing Nurses' Clinical Decision-Making in Emergency Department

Patient satisfaction with the quality of nursing care in critical care units and medical wards in West Bank Hospitals, Palestine: A cross-sectional study

INTRODUCTION

Patient satisfaction with nursing care is a crucial indicator of healthcare quality, influencing patient outcomes and experiences. In the West Bank, Palestine, understanding patient satisfaction is essential for improving healthcare services, particularly in resource-limited settings. This study aimed to evaluate patient satisfaction with nursing care in intensive care units (ICUs), coronary care units (CCUs), and medical wards within both governmental and non-governmental hospitals in the region, aligning with the revised study focus.

METHODS

A descriptive cross-sectional study was conducted in four hospitals in the West Bank, Palestine, over a three-month period (June-August 2024), involving 201 hospitalized patients selected through convenience sampling. Data were collected using the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), a validated tool assessing multiple dimensions of nursing care. Descriptive statistics, independent t-tests, one-way ANOVA, and multiple linear regression analyses were conducted to identify predictors of patient satisfaction.

RESULTS

Participants' ages ranged from 21 to 84 years (M = 38.39, SD = 14.16), with 50.7% female participants. The mean overall satisfaction score was M = 64.50 (SD = 14.16), indicating moderate satisfaction. A significant difference in satisfaction levels was found between ICU and medical ward patients (t = 2.45, p = 0.015), with ICU patients reporting higher satisfaction. Regression analysis identified age (B = 0.162, p = 0.005) and health status (B = 0.242, p = 0.001) as significant predictors of satisfaction, with older and healthier patients reporting higher satisfaction levels. Additionally, frequent hospitalizations were negatively associated with satisfaction (B = -0.107, p = 0.022). Perceived confidence in responding to deteriorating conditions significantly influenced overall perception (r = 0.342, p < 0.01).

CONCLUSION

Moderate patient satisfaction highlights the need for targeted interventions to enhance nurse-patient communication and family involvement, particularly for younger and frequently hospitalized patients. Hospitals should implement specialized training programs to improve communication and patient engagement. Policy interventions should focus on strengthening patient-centered nursing care in both governmental and non-governmental hospitals in the West Bank.

Acquisition of clinical reasoning skills by undergraduate nursing students in Malawi; towards the development of a middle-range theory: a qualitative study

INTRODUCTION

Acquiring clinical reasoning skills is essential for patient safety in nursing, and a lack of clinical reasoning skills can harm patients. However, teaching and learning clinical reasoning skills is not easy due to its complexity. Without a model, clinical reasoning is taught intuitively. Therefore, this study aimed to investigate how undergraduate nursing students acquire clinical reasoning skills towards the development of a middle-range theory.

METHODS

This study employed the grounded theory of systematic design underpinned by a social constructivism paradigm. Forty-eight (48) undergraduate nursing students were purposive, and 12 nurse educators were theoretically sampled. Nurse educators were full-time lecturers with two or more years of teaching experience who were willing to share their knowledge to promote clinical reasoning skills. Students in their third and fourth years were selected because of their completion of the three- to four-year educational process and their acquisition of essential knowledge and competencies. Twelve individual in-depth interviews and six focus group discussions were conducted with nurse educators and undergraduate nursing students, respectively. Two qualitative data analysis frameworks were employed to analyse the data: thematic analysis and grounded theory analysis. Ethical principles of respect for human dignity, beneficence and justice were observed.

RESULTS

Undergraduate nursing students reported that their clinical reasoning skills were acquired through automation while they utilized the nursing process. Through the themes, a new theory called 'a middle-range theory for the acquisition of clinical reasoning skills' was generated in the present study. The associated concepts were the environmental setting, type of curriculum, anchors and expected outcomes, which included individual and health care system indicators.

CONCLUSION

Teaching undergraduate nursing students how to reason clinically will help nurses adjust and solve problems in changing patients' situations. On the basis of the findings of this study, it is recommended that nursing students be equipped with adequate clinical reasoning skills before they graduate. Therefore, implementing the new model called 'a middle range theory for the acquisition of clinical reasoning skills' could foster the development of clinical reasoning skills from the start of the nursing training program.

Barriers and practices in pain management for intubated patients: A study of critical care nurses in Southern West Bank hospitals

INTRODUCTION

Effective pain management is vital for intubated patients in intensive care units, as these individuals cannot verbally communicate their discomfort. The knowledge, attitudes, practices, and perceived obstacles of nurses are critical factors that influence successful pain management.

OBJECTIVE

This study aimed to evaluate the knowledge, attitudes, practices, and perceived obstacles faced by critical care nurses regarding pain management in intubated patients within hospitals located in Southern West Bank.

METHODS

A cross-sectional survey was carried out with 199 critical care nurses utilizing the Nurses' Knowledge and Attitudes Survey Regarding Pain, alongside a modified tool for assessing perceived barriers to pain management. The data collected were analyzed to pinpoint deficiencies in knowledge and barriers impacting effective pain management strategies.

RESULTS

The analysis showed that 192 out of 199 nurses (96.5%) lacked sufficient knowledge regarding pain management. System-related barriers, including the lack of standardized protocols and ineffective communication with physicians, were frequently identified as obstacles, averaging a score of 2.41 out of 3. Additionally, nurse-related barriers comprised insufficient time for providing non-pharmacological interventions (73.9%) and a lack of confidence in utilizing assessment tools (43.7%). Patient-related issues, such as difficulties in communication (72.4%) and hesitancy to report pain (58.8%), were also noted. A notable difference in knowledge scores was observed based on prior education in pain management, with those having received training (41.7%) performing better.

CONCLUSION

The findings underscore the need for focused educational initiatives, the establishment of standardized protocols for pain management, and enhanced interdisciplinary communication. These improvements are essential for optimizing pain management practices and ensuring better patient outcomes. The results suggest that addressing knowledge gaps and systemic barriers could lead to significant enhancements in patient care and health policies.

Knowledge and Attitude of Emergency Nurses Regarding Work-Related Legal Issues in Erbil Hospitals: A Cross-Sectional Study, 2023-2024

Background and Aim

In Erbil, Iraq, emergency nurses frequently encounter complex legal issues in their professional practice, impacting their knowledge, attitudes, and interference with legal matters. This study aimed to analyze the level of legal knowledge, attitudes toward legal issues, and the extent of legal interference among emergency nurses in Erbil.

Methods

This cross-sectional study was conducted from January 1 to February 5, 2024, in eight major public hospitals in Erbil. Purposive sampling was used to collect data using a comprehensive questionnaire. The questionnaire included demographic information and the Emergency Nursing Legal Issues Assessment Scale (ENLIAS), which measured legal knowledge, attitudes toward legal issues, and interference with legal matters. Statistical analysis was performed using Stata version 12 (StataCorp LLC, College Station, TX). Pearson correlation analyses and multiple linear regression were conducted to assess the correlations between legal knowledge, attitudes, interference with legal issues, and demographic variables.

Results

A total of 254 emergency nurses participated in the study. The mean score for legal knowledge was 6.00 ± 3.25, indicating a moderate level of knowledge. The mean score for attitudes toward legal issues was 5.35 ± 2.08, also reflecting a moderate level. The mean score for interference with legal issues was 24.69 ± 5.16, indicating medium interference. There was a significant positive correlation between legal knowledge and good attitude (r = 0.47, p < 0.001), suggesting that higher legal knowledge is associated with a more positive attitude toward legal issues. Conversely, there was a significant negative correlation between legal knowledge and interference with legal issues (r = -0.55, p < 0.001), indicating that greater legal knowledge is associated with lower interference in legal matters.

Conclusions

The study demonstrated that emergency nurses in Erbil have moderate levels of legal knowledge and attitudes toward legal issues, with medium levels of interference in legal matters. Policymakers and healthcare providers should develop targeted educational interventions to enhance legal literacy and support nurses in effectively managing legal issues.

Career Growth as a Mediator Between Scope of Practice, Importance of Practice and Emergency Nursing Competency Among School Nurses

BACKGROUND

School nurses are sometimes the sole healthcare professionals in schools, highlighting their significant role in delivering emergency care and the vital necessity of their competence in emergency nursing care. The scope of practice and ongoing professional development are hypothesized to play significant roles in enhancing these competencies.

AIM

Investigate the direct and indirect effects of the scope of current practice and the importance of training on the emergency nursing care competency of school nurses, with career growth serving as a potential mediator.

METHODS

A multi-center cross-sectional study was conducted with a convenient sample of 219 school nurses. Data were collected using the career growth of nurses' scale, the emergency nursing care competency scale for school nurses and the scope of school nursing practice tool. Mediation analysis was used to explore the direct and indirect effects of studied variables.

RESULTS

Mediation analysis indicated that the scope of current practice had a significant direct effect on career growth (β = 0.179) and emergency nursing care competency (β = 0.389). The importance of practice also had significant direct effects on career growth (β = 0.164) and emergency nursing care competency (β = 0.220). Additionally, career growth significantly mediated the relationship between both the scope of current practice (β = 0.110) and the importance of practice (β = 0.120) with emergency nursing care competency.

CONCLUSIONS

The findings emphasis the critical role of career growth as a mediator between the scope and importance of practice and emergency nursing care competency among school nurses. Expanding the scope of practice and emphasising the importance of professional activities can enhance career growth and improve emergency nursing care competencies.

IMPLICATIONS

Nurses scope of practice and clear career advancement through mentorship, advanced certifications, further education and enforcing policies mandating regular emergency care is crucial. Establishing a regulatory framework to define and expand the scope of practice for school nurses is also important.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Factors affecting decision making among nurse managers working in government hospitals

Background

Effective nursing management and leadership are essential for the provision of desired patient care that will contribute to the improvement of any country's health indicators. However, nurses' views and experiences on the multitude of personal and organizational factors which may impact their decision-making abilities are often neglected in the literature. The study aimed to assess magnitude of poor decision making and its associated factors among nurse managers in South Wollo Zone Governmental Hospitals, Amhara Regional State, Ethiopia, 2023.

Methods

Non experimental cross-sectional study was conducted among 168 nurse managers in South Wollo Zone Public Hospitals from April 01 2023 to May 15/2023. Participants were selected by using a simple random sampling technique. The data were collected by using structured questionnaire from the study participants. Data were entered using EPI data version 4.6 and exported to SPSS version 26 for analysis. The bi-variable logistic regression analysis model was used to identify the potential predictor variable, with p-value <0.25 was fitted into the multivariable logistic regression analysis model; p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare, factors associated with the outcome variable. The model fitness was checked by using the Hosmer and Lemeshow test. Data were presented with frequency tables, graphs, and pie charts.

Results

The study found that the overall magnitude of poor decision-making among nurse managers was 35.7%. Being self-confident [AOR = 0.01, 95% CI: (00.002, 0.05)], receiving feedback [AOR = 0.24, 95% CI: 0.08, 0.76], and getting managerial support [AOR = 0.22, 95% CI: (0.06, 0.81)] were negatively associated with poor decision-making among nurse managers.

Conclusion

Self-confidence, receiving feedback, and getting managerial support were variables significantly associated with poor decision-making. Authors strongly emphasize providing managerial support for nurse managers, increasing their habit of receiving feedback from colleagues, and encouraging them to build their self-confidence.

The Relationship Between the Emotional Intelligence and Clinical Decision-Making Among Nurses in Neonatal Intensive Care Units

Introduction

Emotional intelligence (EI) is crucial for managing stress, enhancing well-being, and improving clinical decision-making (CDM). In neonatal intensive care units (NICUs), where rapid decisions, emotional demands, and complex interactions are common, understanding how EI supports CDM is key to ensuring high-quality care and effective outcomes.

Objective

This study aimed to explore the relationship between EI and CDM among NICU nurses.

Methods

The study was cross-sectional in design and used a convenience sample of 178 NICU nurses. Data collection gathered by paper-based between 10 January and 10 April 2024, employing the "Schutte Self-Report Emotional Intelligence Test" and the "CDM Scale."

Results

The analysis revealed that the average EI score among participants was 151.9 ± 1.7 (range: 33-165, CI = 151.613-152.096), reflecting a high level of EI. High EI in the NICU context is characterized by nurses' ability to manage their own stress effectively, empathize with families facing emotional distress, and maintain composure in high-pressure situations. Similarly, participants demonstrated a high level of CDM, with an average score of 179.6 ± 8.6 (range: 40-200, CI = 178.349-180.770). High CDM involves making accurate and timely clinical decisions, such as assessing neonatal conditions, prioritizing interventions, and collaborating with interdisciplinary teams to ensure optimal outcomes. A significant positive relationship was found between EI and CDM (r = 0.53, p < .001, effect size = 0.8). Furthermore, EI was a significant predictor of enhanced accuracy, timeliness, and prioritization in CDM (p < .001, CI = 1.991-3.337).

Conclusion

Nurses in NICUs demonstrated both high EI and strong CDM skills. A positive association between these two variables was evident.

Clinical reasoning skill of nurses working in teaching medical centers in dealing with practical scenarios of King's model concepts

BACKGROUND

The present study was conducted to determine clinical reasoning of nurses working in teaching medical centers in dealing with practical scenarios of King's concepts.

METHODS

The study population in this cross-sectional descriptive-analytical study comprised 133 nurses. Data were collected using scenarios based on the King's model. Data were analyzed in SPSS-16.

FINDINGS

Mean age of the participating nurses was 27.71 ± 8.1 years.The clinical reasoning score was less than average in most participating nurses, and had a significant relationship with education(P < 0.05), service ward(P < 0.001)and organizational position(P < 0.05). In the multivariate analysis of factors relating to clinical reasoning, higher education level (B = 9.5, P = 0.018) and organizational position (B = 4.3, P = 0.017) were predictors of clinical reasoning score.

DISCUSSION

Existing nursing models such as King's, which is closely related to clinical reasoning, can be used more in educational and clinical systems, and as a clinical guide for promoting the clinical reasoning of nurses and students.

The Relationship Between the Emotional Intelligence and Clinical Decision Making Among Nursing Students

Introduction

Emotional intelligence is a crucial factor in managing stress and maintaining overall well-being. Emotions are essential for clinical care quality, as they drive clinical decision making.

Objective

The purpose of this study was to assess the relationship between emotional intelligence and clinical decision making among fourth-year nursing students.

Methods

The study was a cross-sectional study done on a convenience sample of 225 fourth-year nursing students. Data collection was performed by the "Schutte Self Report Emotional Intelligence Test" (SSEIT) and the "clinical decision making scale".

Results

The analysis revealed that the emotional intelligence mean was 151.3 ± 1.9 (ranging from 33 to 165), which is high. The analysis indicated that the clinical decision making of the participants was high (177.1.3 ± 9.8) (ranging from 40 to 200). Also, the analysis showed that there was a strong positive relationship between nursing students' emotional intelligence and clinical decision making (r = .70, p = 0.001). Furthermore, the findings revealed that emotional intelligence was a predictor of clinical decision making.

Conclusion

The emotional intelligence and clinical decision making among fourth-year nursing students were high. Also, clinical decision making was found to have strong positive relationship with emotional intelligence.

Palestinian Nursing Students' Perspective of Clinical Decision-Making

Introduction

One of the most important aspects of nursing education and practice is clinical decision-making (CDM), which is also crucial to clinical competency.

Objective

The study aimed to assess the CDM of undergraduate nursing students by using the CDM nursing scale.

Method

The study was cross-sectional and involved 315 nursing student participants. Data collection utilized the Clinical Decision-Making Scale, which comprises domains such as "canvassing of objectives and values," "search for alternatives or options," "evaluation and reevaluation of consequences," and "search for information and unbiased assimilation of new information." Statistical analyses included Pearson correlation, ANOVA, and independent t-tests. Data collection occurred during the second semester of 2023.

Results

The results indicated that the mean age of the students was 21.69 (SD = 1.6) years. In terms of gender, the majority were males, constituting 216 (68.6%) of the participants. Among the participants, 105 (33.3%) were from the second year, 108 (34.3%) from the third year, and 102 (32.4%) from the fourth year. The analysis revealed that the average CDM score was 129.8 (SD = 17.5). Additionally, examination of the subscales of CDM showed that the highest subscale score was for "search for information and unbiased assimilation of new information" (M = 33.1, SD = 5.3), while the lowest subscale score was for "search for alternatives or options" (M = 31.8, SD = 6.0). Furthermore, the analysis demonstrated a significant difference between academic year level and the mean CDM scores (p < .05), along with a positive relationship between the CDM score and students' age (r = .67, p = .001).

Conclusion

The findings revealed that nursing students exhibit a moderate level of CDM. Moreover, it was revealed that students' CDM is influenced by both their age and academic year level.