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Annals of Nursing and Practice

Factors Affecting Clinical DecisionMaking Practice among Nurses Working in Jimma University Medical Center; Jimma Southwest Ethiopia

Research Article | Open Access | Volume 5 | Issue 2

  • 1. 1 School of Nursing and Midwifery, Jimma University, Ethiopia
  • 2. Department of Nursing, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  • 3. Department of Nursing, Jimma University Medical Center, Ethiopia
  • 4. School of Nursing and Midwifery, Jimma University, Ethiopia
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Corresponding Authors
Admasu Belay Gizaw, School of Nursing and Midwifery, Jimma University, Ethiopia, P.O. Box: 378, Ethiopia, Tel: 251925270512
Absract

Background: Clinical decision-making is a process of making judgments regarding patient care and management. Nurses should be able to use decisionmaking 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 analyse quantitative data. Statistical significance was declared at a p-value less than 0.05. Qualitative data was analysed 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.

Keywords

Clinical decision making, Clinical decision-making practice, Nurses and Jimma

Citation

Gizaw AB, Kidane BB, Negese DT, Negassa EH (2018) Factors Affecting Clinical Decision-Making Practice among Nurses Working in Jimma University Medical Center; Jimma Southwest Ethiopia. Ann Nurs Pract 5(2): 1094.

INTRODUCTION

Almost every country and health care system has witnessed a growing demand for health care services over the last few decades [1]; while health systems are facing an increasing number of challenges due to limited financial resources, environmental change, increasing health care cost, health care demand and public expectations [2]. Nurses are the largest group of professionals who serve health service organizations and community, practice should take place in a context of ongoing advances in research and technology, which in turn changes the complexity of nursing care requirements [3]. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients’ nursing care needs [4,5].

In the recent years, the public and the government in developing country have censured nurses because of decreased quality of nursing care. Due to this many studies have started to focus on nurses’ clinical decision-making practice and clinical skills [6-7]. So, identification of facilitators and inhibitors of clinical decision-making practice will be the first step in strengthening and empowering nurses to make better clinical decisions [8].

Judgments and decisions made by nurses may help healthcare systems, promote healthand prevent harm. Evidence from healthcare systems throughout the world suggested judgments and decisions made by clinicians could be improved: around half of all adverse events have some kind of errors [9,10]

Understanding the concept of decision-making practice in the health care environment gave us insight about clinical decisionmaking practice and chance of choosing alternatives or options from series of judgments, problem-solving skills, best plan ability formulation of hypotheses and selection and determination of nursing interventions [11-17]. Clinical educators are currently challenged with knowing how to best support nurses in developing their clinical decision-making capacity [18,19] Worldwide, 19 million nurses will exercise clinical judgment before making choices for their patients. These patients trust nurses to make decisions that do more good than harm [20].

Eleven percent of the patients in the UK experience some form of adverse event resulting in drug induced harm. Of the 34% of these events that are serious, 6% lead to permanent injury and 8% of patients die. Half of these deaths are preventable. In absolute terms, this represents 850,000 injuries per year and an avoidable healthcare spend of £1 billion year. Similarly, in Canada, with 7.5% of patients experience adverse events in hospital, 36.9% of these judged as preventable and 20.8% leading to premature death. The judgment and decision-making of health care professionals including nurses is an important component in the etiology behind these statistics [20].

South African Nursing Council’s reports an increase in the number of disciplinary cases among nurses and these disciplinary cases reflect situations within which the nurse had made decisions to maintain, restore or promote the health of the patient. However, from these observations the researcher concluded that nurses’ clinical decision-making is ineffective, as it does not adhere to the framework of clinical, ethical and legal correctness for any nursing action including clinical decisionmaking. A possible solution to the problem might be practice standards for quality care and effective clinical decision-making practice in nursing will be highly required. However, there are no such practice standards in the South African context, against which one can evaluate and assess nurse s’ quality of clinical decision-making [21].

Study conducted in Iran stated that clinical decision-making practice is a vital element in nurses’ professional performance and it makes professional nurses distinct from non-professional personnel in medical care unit. The result of the study also identified there is a significant association among nurses’ clinical decision-making with age, gender, working background [22]

Another study done in Egypt showed that clinical experience, competence, education regarding decision-making, situation/ work environment relationship, and self-confidence are identified as factors influencing clinical decision-making [23]. Several factors play a role in determining factors that affect and facilitate clinical decision-making, these factors may be inter-related and may contribute to factors that facilitating and inhibiting clinical decision-making [24-31].

The Ethiopian Health sector transformation plan (HSTP) annual report revealed that there is a deteriorating quality of nursing care in local hospitals across the country and noted that nurses’ motivation has been deteriorated in the past several years [32-34]. Quality nursing can be affected by clinical-decision making knowledge and practice. Meanwhile, factors that can facilitate or inhibit clinical decision-making practice were not investigated across the health care institutions as well to the study area Jimma zone. So, the main objective of this study was to identify factors affecting (facilitating and inhibiting) clinical decision-making practice among nurses.

MATERIALS AND METHODS

Study area and period

The study was conducted at Jimma University Medical center which is one of the oldest public hospitals serving 15 million people in southwestern part of Ethiopia. It provides services for about 20,000 inpatients, 200,000 outpatient attendances, 5000 delivery and 15000 emergency services yearly. Currently the hospital has 23 service delivery units, 562 Staff nurses, and different working units like: medical, surgical, gynecology, maternity, pediatrics, neonatology, Intensive care unit (ICU), psychiatry and ophthalmology. The study was conducted from March 10 to April 10 2017.

Study design Institution based cross-sectional study involving both quantitative and qualitative methods of data collection were employed. This design was selected to enrich and support quantitative data.

Sample size determination

The sample size is 251 nurses which were determined by using formula for estimating a single population proportion.

Sampling technique & procedure

For quantitative: Working units in the hospital were categorized in to inpatient and outpatient departments. Then six and five working units were selected from inpatient and outpatient departments respectively. Finally, the required sample size was proportionally allocated for each selected inpatient and outpatient working units and participants were selected by simple random sampling techniques (Figure 1).

Figure showing Sampling technique and procedure on the  study of Factors affecting clinical Decision- Making Practice among  nurses working in jimma University Medical centre, Jimma South  West Ethipia.

Figure 1 Figure showing Sampling technique and procedure on the study of Factors affecting clinical Decision- Making Practice among nurses working in jimma University Medical centre, Jimma South West Ethipia.

For qualitative study: Five Key informants were selected purposely from surgical, medical, gynecology and obstetrics, outpatient working units and nursing director office by purposive expert sampling technique. These key informants were purposively selected based on their responsibility of monitoring and evaluating nursing care practice at the study institution (Jimma University Medical center).

Data collection instruments &Data collection procedure

Data collection instruments were adapted from Lethbridge Alberta December 1991. This instrument has four parts; sociodemographic information, factors influencing clinical-decision making practice, factors facilitating clinical decision-making practice. For the qualitative data, interview guide were used. Quantitative data was collected by 5 BSc nurses and two MSc nurse supervisors by using self-administered questionnaires.

Qualitative data was collected by principal investigator (Biskut Bezabih). Topic guided semi-structured, in-depth interviews were used to enable a detailed exploration of factors facilitating and inhibiting clinical decision-making practice among nurses. Interviews were audio-recorded at separate office, with participant permission, and lasted between 30-45 minutes. The data collection guide included the following stimuli to provoke nurse’s views and experiences: (1) what do you say about clinical decision-making practice among nurses in your institution, (2) What are factors that facilitate clinical decisionmaking practice (3) What are factors that influence clinical decision-making practice among nurses in your institutions. Ideas raised by participants were audio recorded and notes were taken by principal investigator and one assistant.

Data quality control Data quality was controlled by pretest among 10 % of the sample nurses working in Shenen Gibe hospital. Two days training was given for data collectors and facilitators to ensure the quality of the data, the supervisor was checking all questionnaires on daily bases.

Data analysis

Data was checked for consistency, completeness, missing values and then coded entered in to Epidata version 3.1 and exported to SPSS version 20 for analysis. Descriptive statistics, binary and multi-variable logistic regression analysis was computed to describe, select candidate and identify predictors of clinical decision- making practice. A p-value less than 0.25 were used to select candidate on Binary regression and p-value of less than or equal to 0.05 were considered to declare statistical significance.

Qualitative data was analyzed based on thematic frameworks to support the quantitative results after transcription of audio recorded data and data from note book. Deductive analysis was employed manually based on priory prepared interview guide. Different text highlight color was used to select similar concepts from the text data and to generate initial codes. Quotes were extracted from the text data and stored separately. After conceptualizing of related coded datum, searching of categories among codes was made. Then initial category was made. After reviewing the initial categories, categorizing of the categories into predetermined theme was done. Finally, interview result was written by compiling memos and quotes.

Ethical consideration

Ethical clearance and approval to conduct the study was obtained from Jimma University Ethical Review Board (JU IRB) and permission letter was secured in order to get support for the study from administrative body. The purpose of study was explained to the participants and they are told as participation was voluntarily, confidential and anonymity will be ensured throughout the execution. Finally, verbal and written consent was assured from the study subjects.

RESULTS AND DISCUSSIONS

Socio-demographic characteristics

A total of 251 questionnaires were distributed to study participants from which 249 were returned, yielding to 99.2% response rate. Majority 171 (68.7) of the study participants found in the age group of 20-29 years. More than half 134(54.2%) of the study participants were male (54.2%). 128 (51.4%) are degree holders 152 (60.6%) single, 219 (87.2%) have work experience of less than 10 years. Almost half 115 (45.9%) of the study participants get 3579-4446 Ethiopian birr monthly salary (Table 1).

Table 1: Socio-demographic characteristics of nurses working in Jimma university medical center. Jimma, south west Ethiopia, 2017 (n=249).

variables Category F (%)
Age 20-29 171 68.7
  30-39 69 27.7
  40-49 7 2.8
  >= 50 2 .8
Sex Male 134 54.2
  Female 115 45.8
Ethnicity Amhara 59 23.6
  Oromo 142 57.2
  Gurage 24 9.6
  Tigre 8 3.2
Educational status Diploma 121 48.6
  Degree 128 51.4
Working experience <10years 219 87.2
  11-20years 27 11.6
  21-30years 3 1.2
Religion Orthodox 124 49.4
  Protestant 62 25.1
  Muslin 57 23.1
Marital status Single 152 60.6
  Married 96 39.0
  Divorced 1 .4
Salary in Ethiopian Birr <3579 41 16.3
  3579-4446 115 45.9
  4447-5583 34 13.5
  >5583 59 24.3

Factors affecting clinical decision-making practice From questions about facilitating factors of clinical decisionmaking practice among nurses, knowledge achieved in basic professional education, continuous review of literature, good collaboration among health care workers, continuing education and supported ranked as 1st, 2nd ,3rd, 4th and 5th ranks respectively (Table 2).

Table 2: List of factors that might facilitate nurse’s clinical decision-making practice at Jimma university medical center, South west Ethiopia 2017(n=249).

Variable Response category
  1st (N (%)) 2nd (N (%)) 3rd N (%) Least N (%)
Knowledge achieved in basic professional education 124(67.0) 48(25.9) 7(3.8) 6(3.2)
Continuous review of literature 7(5.8) 43(35.5) 32(26.4) 39 (32.2)
Knowledge about guiding principles of nursing practice 17(13.4) 25(18.7) 40(29.9) 51 (37.2)
Regular continuing education 9(6.2) 19(15.9) 34(30.1) 54 (48.8)
Knowledge about rules regulations of your health care institution 3(5.8) 2(3.8) 12(23.1) 35 (67.3)
Good collaboration among health care workers 5(11.0) 20(19.2) 36(34.6) 47 (45.2)
Good knowledge about patients personal characteristics 6(11.5) 10(19.2) 12(23.1) 24 (46.2)
Knowledge about your own values that guide your work 7((21.2) 5(15.2) 2(6.1 19 (57.3)
Knowledge about patient's previous experiences in health care   3(18.8) 1(6.2) 12 (75)
Medical diagnoses 45(33.5) 38(29.3) 19(14.3) 30 (22.5)
Feeling as you are competent 7(9.2 12(22.2 12(22.2) 65 (66.3)
Being supported by your supervisor/s 7(9.9) 4(5.6) 8(11.3) 52 (73.3)
1st (N (%))= First Important number and percent
2nd (N (%))= Second Important number and percent
3rd (N(%))=Third Important number and percent
4th (N (%)) = Fourth Important number and percent
Last N (%) = Last Important number and percent

Results from qualitative study also point out factors that facilitate clinical decision-making practice among nurse. Among these, Participant two said “I have to have ongoing supervision and feedback for my activities from my first and next immediate supervisors in order to accomplish my duties meticulously and as expected; So that I want to be identified from those nurses not doing their duty and want to be categorized to the best achievers’’.

The fourth participant also Said “If I was committed and well trained I feel patients problem as my own, they come to me for help, I can do everything that are expected from me, I carry out in my duty time effectively, then I see my decision outcome and satisfied. This can facilitate my clinical decision-making. If you are not committed and cannot do your professional obligation this can influence your clinical decision-making

Concerning hindering factors, 184 (73.8%), 171 (68.7%), 66 (26.6%), 58 (23.1%), 72 (28.7%), 62(24.7%), 17 (6.8%), and 45 (17.9%) of the study participants think as their previous nursing experience, working unit characteristics, Hospital policy, attitude of staffs, outcome of their own decision of care, level of confidence, observation of other staff members and time constraints to work influence clinical decision-making practice among the study participants respectively (Table 3).

Table 3: List of factors that might inhibit nurse’s clinical decision making practice at Jimma university medical center, South west Ethiopia 2017(n=249).

Variables Frequency
My previous nursing experience
No 65 (26.2)
Yes 184 (73.8)
The environment on the unit
No 78 (31.3)
Yes 171 (68.7)
Hospital policy
No 183 (73.4)
Yes 66 (26.6)
Attitude of staff
No 191(76.9)
Yes 58(23.1)
Outcome of my decision
No 177(71.3)
Yes 72(28.7)
My level of self confidence
No 187(75.3)
Yes 62(24.7)
My observation of other staff members  
No 232(93.2
Yes 17(6.8)
Time constraints to work  
No 204(82.1)
Yes 45(17.9)

On the other hand results of in-depth interview showed working environment, low level of professional commitment and absence of freedom and authority for decision, poor management of resource for care; high nursebed ratio can hinder effective clinical decision making practice among study participants. For further confirmation, Participant one said “independent regular patient care can’t be performed even if standard formats are available. Nurses are expected to do nursing care as per nursing standard. For these low level of commitment to our professional responsibility and the environment in which we work with, way of management including resource, nurse to bed ratio can inhibit nurses’ clinical decision-making practice”.

The other two participants (participant one & four) said “authority and autonomy” as a prerequisite in clinical decisionmaking and also as a critical factor in providing timely and quality care

The third participant mentioned that “Starting from few things like water, patient monitoring machines, transportation beds, space for admission and nurse to bed ratio can be considered as negatively influenced nurse’s clinical decision’’. In this situation nurses are restricted to provide full care to the patient which was influenced clinical decision-making’’. In other way even if resource related limitation, close follow up in above mentioned managerial problems for e.g. maintenance of non -functional machines, available instruments for service provision site, patient care is team work; evaluation of each team is week so close follow up and feedback for each team is enabling nurse in there clinical decisions”.

The fifth participant considered structure and culture of the health care system was another important factor affecting nurse’s clinical decision-making practice as facilitating factor. ‘Said I cannot see over other’s health professionals or my boss until their instruction to do something, I know why I was being here and both suffering from different cases are looking to you. So I do everything what expected from me on time’. Also, management of working environment, equipping and creating good communication and on time supervision is related to organizational structure and organizational structure affect clinical decision-making practice among nurses.

The results of regression analysis showed that those selfconfident nurses perform clinical decision-making practice 3.482 times more likely than those of non- self- 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) (Table 4,5).

Table 4: Multivariate analyses of association with clinical decision making practice among nurses working in Jimma university medical center, South west Ethiopia 2017(n=249).

Cariables Frequency(n) p-value AOR 95% CI for AOR
Being self confidence       lower upper
No 187(75.3) 0.001 1    
Yes 62(24.7)   3.482 1.655 7.327
Being supported          
No 191(76.9) 0.004 1    
Yes 58(23.1)   2.878 1.388 5.967
Regular continuous education          
No 138(55.0) <0.001 1 0.116 0.395
Yes 113(45.0)   0.214    

Supplementary Data
Table 5: Categories of main theme, subthemes and quotes of data from in-depth interview on the study factors affecting clinical decision-making   practice among nurses working at JUMC.

Main theme Subthemes Quotes
Factors affecting clinical 
decision-making practice
What factors facilitate 
clinical decision making 
practice?
1. Continuous supervision 
and feedback from 
immediate supervisors. 
2. Maintenance and 
replacement nonfunctional equipments
3. Team work and 
collaboration
4. Continuous professional 
development
5. Commitment
Participant two said “I have to have ongoing supervision and feedback for my activities 
from my first and next immediate supervisors in order to accomplish my duties 
meticulously and as expected; So that I want to be identified from those nurses not 
doing their duty and want to be categorized to the best achievers’’.
The fourth participant Said “If I was committed and well trained I feel patients 
problem as my own, they come to me for help, I can do everything that are expected 
from me, I carry out in my duty time effectively, then I see my decision outcome and 
satisfied. This can facilitate my clinical decision-making. If you are not committed and 
cannot do your professional obligation this can influence your clinical decision-making
What factors inhibit 
clinical decision making 
practice?
6. Working environment
7. Professional freedom.
8. Authority for decision.
9. Management of 
resource for care
10. Nurse-bed ratio
Participant one said “independent regular patient care can’t be performed even if 
standard formats are available. Nurses are expected to do nursing care as per nursing 
standard. For these low level of commitment to our professional responsibility and the 
environment in which we work with, way of management including resource, nurse to 
bed ratio can inhibit nurses’ clinical decision-making practice”.
The other two participants (participant one & four) said “authority and autonomy” 
as a prerequisite in clinical decision-making and also as a critical factor in providing 
timely and quality care. 
The third participant mentioned that “Starting from few things like water, patient 
monitoring machines, transportation beds, space for admission and nurse to bed ratio 
can be considered as negatively influenced nurse’s clinical decision’’. In this situation 
nurses are restricted to provide full care to the patient which was influenced clinical 
decision-making’’. In other way even if resource related limitation, close follow up 
in above mentioned managerial problems for e.g. maintenance of non -functional 
machines, available instruments for service provision site, patient care is team work; 
evaluation of each team is week so close follow up and feed-back for each team is 
enabling nurse in there clinical decisions”.
The fifth participant considered structure and culture of the health care system 
was another important factor affecting nurse’s clinical decision-making practice as 
facilitating factor. ‘Said I cannot see over other's health professionals or my boss until 
their instruction to do something, I know why I was being here, and both suffering 
from different cases are looking to you. So I do everything what expected from me 
on time'. Also, management of working environment, equipping and creating good 
communication and on time supervision is related to organizational structure and 
organizational structure affect clinical decision-making practice among nurses.

The above findings are consistent with study in Egypt in which continuous education as facilitating factors with clinical decisionmaking practice [23], study in Norway Oslo where the absence of continuous formal and informal professional development may have resulted to differences in awareness, decreased cognition, and skill and attitude level among nurses [25] and study in Iran in which the mode, type and levels of participation of nurses in the clinical decisions might be determined by educational experiences, level of education and overall cognitive, affective and psycho motor abilities [1,24].

In this study 24.7 % of the respondents had confirmed as self -confidence can influence clinical decision-making practice. The finding is relatively similar with study done in Egypt [24] and Iran [26] in which both studies identified self- confidence as influencing factors for clinical decision-making practice among nurses. Self-confidence is considered a vital factor in effective clinical decision-making since it was believed that those nurses self- confident may have better control over their work, make effective and efficient decisions and intervene independently..

A Confident nurse will be more assertive in their decisionmaking and this allows them to take control of situations. By contrast, a nurse who is not confident will have self-doubt in their decisions, feel powerless, and be unsure of their choices [26]

CONCLUSION

The findings of this study helped to reach a better understanding of the factors facilitating and inhibiting clinical decision-making practice among nurses. Accordingly, continuous educational development, support from immediate supervisors, level of self- confidence, professional commitment, personal commitment to help or care others, resource and its management, patient-nurse ratios are identified factors influencing clinical decision-making practice among nurses.

Commitments to once professional responsibility, ongoing supervision and feedback, authority and autonomy, creating good communication were identified as facilitating clinical decision-making practice. On the other hand ways of resource management, Patient-nurse ratio, resource and supply (water, patient monitoring machines, transportation beds, space for admission), structure and culture of the health care system, absence of continuous formal and informal professional development, lack of self -confidence and level of knowledge on basics of nursing profession are identified as factors inhibiting clinical decision-making practice among nurses.

Nurse Managers have to search for solutions on how to decrease and if possible completely avoid factors that affect clinical decision-making practice and encouraging implementation and utilization of facilitating factors. Providing continuous in-service training to increase nurses’ knowledge base, and ongoing supervision and feedback.

ACKNOWLEDGEMENTS

First our thanks go to Jimma University Medical Center, staffs and administration for their support and help in providing important and pertinent information for the study. Then, we would like to acknowledge Jimma University for covering the survey cost and providing internet access. Finally, we would like to acknowledge data collectors, our family members and friends of all authors

Authors’ Contribution

Biskut Bezabih, Admasu Belay and Endalew Hailu conceived and designed the protocol. Additionally, Biskut Bezabih and Desalegn Tamiru performed the data collection and contributed equally. Admasu Belay and Biskut Bezabih contributed on data analysis, and wrote the draft. Admasu Belaypreparedmanuscript. Endalew Hailu approved it. All authors read and approved the final paper.

 

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Gizaw AB, Kidane BB, Negese DT, Negassa EH (2018) Factors Affecting Clinical Decision-Making Practice among Nurses Working in Jimma University Medical Center; Jimma Southwest Ethiopia. Ann Nurs Pract 5(2): 1094.

Received : 23 Apr 2018
Accepted : 12 Jun 2018
Published : 14 Jun 2018
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ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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