Triage; a literature review of key concepts

The emergency department (ED)--sometimes termed the emergency room (ER), or the accident & emergency (A&E) department--in a hospital or primary care facility that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening or requiring immediate attention. The earliest patients-physician encounter is the triage doctor/nurse who completes the preliminary evaluation before transferring care to another area of the ED or a different department in the hospital. A strong triage system is the backbone of an efficient ED. It indicates that the staff is capable of differentiating critically ill from the sick, and, consequently, of segregating patients who may need admission from those who will not. Thus it is essential for the health professionals to be well-versed with the concepts of triaging. This paper intends to review the basic definitions and the common types of triaging that is used commonly in hospitals

Can rote learners be transformed into critical thinkers through a concept – mapping intervention?

Critical thinking is an important outcome of higher education in any discipline. International literature reveals that teaching strategies—such as reflections, self-directed learning, questioning, and concept mapping—which ask for active engagement of students in their learning, foster critical thinking. Social context of the learning environment, and the instructor’s competence and approach to teaching also influence students’ critical thinking abilities. Contrary to the required teaching practices, didactic teaching and rote learning are still prevalent in most teaching institutions and disciplines in Pakistan. The focus of this paper is to report on the process and findings of a quasi-experimental study in which students at Aga Khan University School of nursing were taught and encouraged to use concept mapping as a way for knowledge acquisition. A total of 97 nursing students in their first year of the programme were enrolled in the study. In the pre-intervention phase all students were assessed for their level of self-directed learning and ways of knowing, using two instruments, named- SDLRS (Self Directed Learning Readiness Scale) and WOKAT (Ways of Knowing Assessment Tool). The students were allocated to experimental and controlled groups based on their score on WOKAT. Those in the experimental group were taught to develop concept-maps. In the post-intervention phase, all students were reassessed on SDLRD, WOKAT, and GPA and their scores were compared between the groups. Findings of the study showed significant difference between the controlled and experimental groups in terms of students GPA but no substantial change was noted in their scores on SDLRS and WOKAT

Levels and predictors of self-care among patients with hypertension in Pakistan

Background: Globally, hypertension is the leading non-communicable disease and strongest predictor of cardiovascular diseases. To mitigate and prevent hypertension-related complications, self-care behavior adaptation has proven to be vital. In this study, we examined the six clinically prescribed levels of self-care as prescribed by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and its predictors among a select sample of hypertensive individuals in Karachi, Pakistan.Methods: This study reports the cross-sectional survey of a sequential mixed method study which assessed the levels of self-care of hypertensive individuals residing in an urban cosmopolitan setting within Karachi Pakistan. Four hundred and two patients were screened using the H-SCALE questionnaire, while socio-demographic predictors of self-care and level of knowledge of hypertension were identified using a study-specific checklist. Self-care was assessed against six clinical domains including medication adherence, diet, weight management, physical activity, and abstinence from alcohol.Results: Participants were recruited from the two largest tertiary care hospitals in Karachi. Good knowledge about hypertension, including its causes, management, and complications was reported by 4.47% of the participants. Highest levels of self-care adherence were found for abstinence from alcohol (100%), smoking cessation (83.33%), and medication compliance (71.89%), whereas lowest levels were found for diet (27.11%), and physical activity (24.88%). In terms of predictors for self-care, age, male gender, and self-checking of blood pressure at home, followed by the level of education were the most common predictors for each self-care behavior in the given population.Conclusion: Overall knowledge of self-care for hypertension is sub-optimal among hypertensive patients in Pakistan which is reflected in their behaviors. There is a need to introduce healthcare educational programs in Pakistan which can improve self-care behaviors of hypertensive individuals and potentially reduce the prevalence of associated cardiovascular diseases and its complications

The impact of COVID-19 safety interventions on creating a controlled environment on campus

Objectives: During COVID-19 the re-opening of educational institutes was frequently debated, however with the decline in the number of COVID-19 cases, The Aga Khan University (AKU) in Karachi, Pakistan opened its campus for medical and nursing students after more than 6 months of closure. To ensure gradual resumption of activities on-campus, a combination of interventions was diligently deployed to minimize student infection rates. Scarce literature exists on students' perceptions regarding decisions implemented by university leadership. The aim of the study was to determine the efficacy of these interventions. Methods: We conducted a convergent, parallel, mixed-methods observational study targeting medical and nursing students. An online questionnaire was disseminated to elicit students' degree of (dis)agreement on a four-point Likert scale. Focused group discussions (FGDs) were conducted to comprehend reasons for (dis)agreement. Results: Total of 183 students responded to questionnaire (59.0% nursing, 67.8% female), 11 FGDs were conducted with 85 students. Interventions with highest agreement were mandatory face masks policy (94.54%), weekly mandated COVID-testing (92.35%) and students' Academic Bubble (91.26%); highest disagreement was for Sehat Check application (41.53%); and stay strong campaign (40.44%). Four themes emerged from FGDs: Effective safety interventions, Safety interventions with limited effectiveness, Utility of Sehat Check Application and Future recommendations for informing policy. Conclusion: It is paramount to seek student-feedback at forefront of university re-opening strategy. Clear communication channels are as important as an administrative response system's robustness. Bidirectional communication channels are fundamental and requisite during ever-changing policies and regulations. Engaging student representatives in decision making or implementation processes (such as “pilot” before “roll-out”) would allow any potential issues to be managed early on. Gather real-time anonymous feedback and identify key areas that need further promulgation and those that need to be replaced with more effective ones

Concept mapping strategy: An attempt to transform rote-learners into critical thinkers

Critical thinking is an important component of higher education in any discipline. Teaching strategies such as reflections, self-directed learning, questioning, and concept mapping, which ask for active engagement of students in their learning, fosters critical thinking. Contrary to these strategies, didactic teaching and rote learning is still prevalent in most teaching institutions in Pakistan. This paper reports the findings of a quasi-experimental study in which students at Aga Khan University School of Nursing were taught to use concept mapping strategy. A total of 97 first year nursing students were enrolled in the study. In the pre-intervention phase all students were assessed for their level of self-directed learning and ways of knowing, using two instruments, named SDLRS (Self-Directed Learning Readiness Scale) and WOKAT (Ways of Knowing Assessment Tool). Students were allocated to experimental and control groups based on their WOKAT score. The experimental group students were taught concept-maps development.. In the post-intervention phase, all students were reassessed on SDLRS, WOKAT, and GPA, and their scores were compared. Findings revealed significant difference between the GPA scores of control and experimental groups but no substantial changes were noted in their SDLRS and WOKAT scores

Initiation and Implementation of an E-assessment: An experience

Online assessment is considered one of the reliable and efficient assessment strategies, especially for a large class. This article reports, a feasibility study that was done to explore the readiness of institution, teachers as well as students to initiate online assessment within a blended learning course (health assessment) of baccalaureate Programme in a private nursing school at Karachi Pakistan. Eighty three undergraduate students and six faculty members participated in this project. Participants were educated about the change in strategy for quizzes through on-going presentations, written guidelines, module and hands on experience. Students and faculty found the online quiz assessment as a user friendly, time and cost effective strategy. The benefits of online assessment (MCQ test) were observed to be automated marking, immediate results, students’ review of their performance and item analysis. Students’ readiness for online learning may help educators to engage and assess these students easily and prepare them for the upcoming online world of future

Developing teaching and learning resources using technology

Overview The workshop will be aimed at course directors, academic leaders, course coordinators, faculty members and anyone who is engaged in or interested to teach and develop courses using technology. The workshop will offer the participants an opportunity to identify teaching and learning resources available and develop their own using technology according to the needs of the course / session in Health Profession’s Education (HPE). Hands on practice of developing teaching learning resources will be embedded within theoretical models of teaching and learning with technology. Objectives By the end of the workshop, the participants will be able to: Appreciate the various types and advantages of electronic and web-based teaching and learning resources in HPE Identify appropriate and effective e-learning resources based on the teaching and learning needs of the course / session Develop effective teaching and learning resources using technology according to the good practice guidelines Appreciate importance of evaluating the use of various teaching and learning resources in HP

Nurse-led culturally relevant smoking reduction intervention among cardiovascular and respiratory patients in Pakistan

Introduction: Socioeconomically deprived populations are at greater risk for smoking-induced diseases and death, such as cancers, and cardiovascular and respiratory illnesses. The initiation of a nurse-led smoking cessation program in clinical practice is an effective method to enhance smoking cessation among cardiovascular and respiratory patients in Pakistan. This study aimed to evaluate the effectiveness of nurse-led smoking reduction intervention performed at out-patient clinics in Karachi, Pakistan.Methods: A single group pre-and post-test study was conducted on eligible patients (n = 83) with a typical profile of cardiovascular and respiratory diseases in a tertiary care hospital from December 2020 to July 2021.Intervention: The multi-modal nurse-led intervention consisted of two face-to-face motivational counseling (30-min) and free nicotine replacement therapy with telephonic counseling and follow-ups offered to all eligible patients for 2 months.Results: The nurse-led intervention resulted in a significant decrease in daily cigarette consumption in most of the patients (75.9%) by 50% and 16.9% of the patients reported smoking abstinence (quitter) at 1-week follow-up (p \u3c .001), verified by a CO breath test.Conclusion: A nurse-managed smoking reduction intervention for even a short duration (2 months) in clinics is an effective approach in enhancing smoking abstinence and reduction among cardiovascular and respiratory patients

Faculty practice in a private teaching institution in a developing country: embracing the possibilities.

Aim: This paper discusses a case study on implementing faculty practice in a private teaching institution in a developing country where direct \u27hands-on\u27 care is undervalued by nurses. Background: In Pakistan, faculty practice is not well known and related to indirect care. In the institution studied, faculty practice has been a major consideration to strengthen relationships between clinical and academic sectors. Data Source: MEDLINE and CINHAL were searched (1979 to July 2009). A consultative process was used by the faculty practice committee members and involved open discussions with academic and clinical service faculty in the institution studied. Discussion: There is no empirical evidence to identify effective models for implementing faculty practice. A formalized faculty practice plan was identified as an important organization factor to promote faculty practice. Implications For Nursing: Identifying a definition of faculty practice and scholarship was an important step to ensure conceptual clarity. Consistent with the literature, workload, remuneration and performance appraisal were identified as perceived threats. The hierarchy in nursing is a unique organizational factor that will need to be addressed. Given the lack of research on the effectiveness of faculty practice and its models, evaluation is imperative. Conclusion: Dissonance is an overall theme of the literature and stems from the perceived threats/risks of faculty practice. Faculty practice may fulfil institutional, personal and professional needs of individual faculty members. Faculty practice offers an opportunity to change attitudes, beliefs and values related to direct care in the institution studied and influence other institutions in Pakistan