Is Clinical Decision Making Skills are Developed through Academic Nurturing? A Review Based on Available Literature

Introduction: Today’s nurses are having challenges, demanding their ability to the profession. Nursing education should concentrate on educating competent health care providers to handle complex health care technology with fundamental implications for latest generation of patients. This paper aims to identify the various strategies used to enhance the clinical decision making ability among nurses. Methods: A comprehensive systematic review of published literature and journal articles from PubMed and Cinhal databases was done. Search strategy specific to each database was used. During initial search 6808 titles were retrieved and after screening 12 articles were selected for full text screening. Finally 12 research articles were selected based on the inclusion criteria. Results: Out of 12 articles, 7 research studies supported that clinical decision making can be developed using different types of simulation (such as human patient simulators, simulated clinical experiences, simulation to create rubric assessment). Two of those studies propose clinical reasoning abilities can be acquired through Outcome-Present state Test (OPT) model. Individual studies used strategies like concept mapping, educational interventions, analogy guided learning experiences, structured reflection in education and workshops can develop clinical decision making. Computer based and multimedia computer simulation program did not showing any clear outcome. Conclusion: Clinical decision making is an abstract skill which can be developed by using different strategies in different specialities and different situations.  Since situational factors and time constraints are evident in practice, findings were supportive for clinical decision making(CDM) skill. The ideal setting for students to learn CDM skills is real clinical practice environment, especially when facilitated by opportunities for immediate feedback and reflection. CDM is necessary for providing quality patient care and favouring patient satisfaction. Keywords: Decision making, Nurses, Judgement, Clinical Competenc

Buku Ajar Ilmu Bedah Ilustrasi Berwarna Edisi 3 Jilid 1

528 hlm.; 28.5 x 22 c

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640 hlm.; 28.5 x 22 c

Evaluation of effect of entropy monitoring on isoflurane consumption and recovery from anesthesia

Background and Aims: Entropy monitoring entails measurement of the effect of anesthetic on its target organ rather than merely the concentration of anesthetic in the brain (indicated by alveolar concentration based on which minimum alveolar concentration [MAC] is displayed). We proposed this prospective randomised study to evaluate the effect of entropy monitoring on isoflurane consumption and anesthesia recovery period. Material and Methods: Sixty patients undergoing total abdominal hysterectomy under general anesthesia using an endotracheal tube were enrolled in either clinical practice (CP) or entropy (E) group. In group CP, isoflurane was titrated as per clinical parameters and MAC values, while in Group E, it was titrated to entropy values between 40 and 60. Data including demographics, vital parameters, alveolar isoflurane concentration, MAC values, entropy values, and recovery profile were recorded in both groups. Results: Demographic data and duration of surgery were comparable. Time to eye opening on command and time to extubation (mean ± standard deviation) were significantly shorter, in Group E (6.6 ± 3.66 and 7.27 ± 4.059 min) as compared to Group CP (9.77 ± 5.88 and 11.63 ± 6.90 min), respectively. Mean isoflurane consumption (ml/h) was 10.81 ± 2.08 in Group E and 11.45 ± 2.24 in Group CP and was not significantly different between the groups. Time to readiness to recovery room discharge and postanesthesia recovery scores were also same in both groups. Conclusion: Use of entropy monitoring does not change the amount of isoflurane consumed during maintenance of anesthesia or result in clinically significant faster recovery