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  • ISSN: 2379-9501
    Current Issue
    Volume 5 Issue 2
    Research Article
    Admasu Belay Gizaw*, Biscuit Bezabih Kidane, Desalegn Tamiru Negese, and Endalew Hailu
    Background: Clinical decision-making is a process of making judgments regarding patient care and management. Nurses should be able to use decision-making skills to provide safe and effective nursing care. The dynamic nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' health care need.
    Objective: The main aim of this study was to assess factors affecting clinical decision making practice among nurses working in Jimma university medical center.
    Method: Facility based descriptive cross-sectional study was conducted by using quantitative method supplemented by qualitative data among 251 nurses. Structured self-administered questionnaire and in-depth interview guide were used to collect data. Descriptive statistics and multivariable logistic regression analysis were used to analyze quantitative data. Statistical significance was declared at a p-value less than or equal to 0.05. Qualitative data was analyzed based on thematic frameworks to support the quantitative results.
    Results: Nurses who reported greater self-confidence were 3.482 times more likely to perform clinical decisions than less confident nurses (AOR3.482, 95% CI 1.655, 7.327). Those nurses who get support from immediate supervisor/s make clinical decision practice 2.878 times more likely than those not supported (AOR 2.87, 95% CI 8 1.388, 5.967) and nurses who doesn't get chance of continuous educational development make clinical decision practice 79% less likely compared to nurses who already get continuous educational development (AOR 0.214, CI 0.116, 0.395).
    Commitment, ongoing supervision and feedback, authority and autonomy, good communication facilitates clinical decision-making practice whereas poor resource management, patient-nurse ratio, structure and culture of the health care system, absence professional development, low level of self -confidence and level of knowledge inhibits clinical decision-making practice among the study participants.
    Conclusion: Commitment, supervision and feedback, autonomy, good communication were identified as facilitating factors of clinical decision-making practice. On the other hand; poor resource management, patient-nurse ratio, structure and culture of the health care system, absence of continuous professional development, low level confidence and low level of knowledge on basics of nursing profession are identified as factors inhibiting clinical decision-making practice among nurses.
    Michiyo Ando, Hiroko Kukihara, Mayumi Yamamoto, Yasuyoshi Ninosaka, Naoyuki Saito, and Kazuhisa Okamura
    The primary aim of the study was to investigate the feasibility of the narrative approach for terminally ill patients at home hospice. The secondary aim was to examine the efficacy of the narrative approach on spiritual well-being, physical condition, life satisfaction, and hope. Twelve patients agreed to participate in the research, in which patients narrated their thinking or feeling along with some questions in two sessions of approximately 60 minutes each. The patients completed the Functional Assessment Chronic Illness-Spiritual (FACIT-Sp) and the FACT-physical, the Life Satisfaction scale, and the Hope scale. The results showed that 1)10patients completed the narrative approach (feasibility rate 83%), 2) the FACIT-Sp and the Hope score increased, the FACT-physical decreased, and the Life Satisfaction score did not change, although there was no statistical significance. The FACTI-Sp score was at the same level of the standard score and the Life Satisfaction score was higher than the standard score. These facts suggest that the narrative approach for terminally ill patients at home hospice may be feasible, and it may improve spiritual well-being, physical status, and hope.
    Farah Naeem*, Syed NaeemAther Abbas, and Saba Asim
    Public health care facilities and private health care facilities in terms of out of pocket expenditure leads to heavy economic burden on high, middle and low income communities. A study found that individuals in the richest quintile are more likely to use private health care facilities. Even for among poorest quintile, private facilities are used for more than 20% of total outpatient visits in certain countries. The expenditure on health becomes unaffordable for the average citizen. The people still prefer private health care institutions which are costly but they have the essential facilities. The research work presents the comparison of out of pocket expenditure at public and private health care institution and also highlights its association with various income groups. The universe of the research was a public hospital Pakistan institute of medical sciences and a private hospital Shifa International Hospital at Islamabad. A quantitative research with a questionnaire was conducted to collect data from a sample of 220 respondents. The significant findings of the research presents that majority of the respondents have preferred private hospitals because of their proper health services. The reasons for this preference for private hospital have been the facilities, the clean environment and the services of the doctors toward their patients. The health recovery period has been quick at private hospital as majority of the respondents agreed. The research has indicated an increase in out of pocket expenditure on health. It has been a burden because of low income of the people. The various medical tests have also been costly. This research Out of Pocket Expenditure on health (medicine) is burden because of low income, is accepted because the significance level of the data highly supported the hypothesis.
    Case Report
    Nasreen Rafiq*
    Nursing practices are guided by theoretical frameworks which provide functional basis to nursing care. This paper discusses the application of Nightingale’s theory of environment in nursing practices. The theory highlights and explains 13 environmental cannons which include ventilation, cleanliness of walls/rooms, light, noise, personal cleanliness, bed and bedding, and taking food. Florence exquisitely explains the influence of environmental health on patients wellbeing. The application of the theory in nursing practices will help to understand and reflect the direct relation of environment on patients health.
    Review Article
    Mellisa A. Hall*
    Diabetes is a growing epidemic worldwide (CDC, 2017). Type 2 diabetes mellitus (T2DM) affects more than 90% of people with diabetes. Because bedside nurses administer and monitor potential side effects of antidiabetic agents, a review of the numerous categories of antidiabetic agents now on the market to treat T2DM is summarized. This discussion is targeted for bedside nurses who are caring for diabetics in acute and transitional care settings, as well as in patient homes. The underlying pathophysiology of T2DM diabetes is reviewed, along with basic mechanisms of action of each category of antidiabetic agent. Safety considerations and common side effects will be presented for each medication category. Discussion will focus on both oral and injectable antidiabetic categories, including concentrated insulin products new to the market.
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