Effects of Online Unfolding Case Studies on Clinical Reasoning and Academic Performance of Undergraduate Nursing Students.

ABSTRACT: A single-episode online case study increases cognitive load in contrast to an unfolding online case study, which decreases cognitive load, improves academic performance, and enhances clinical reasoning. However, online utilization of unfolding case studies is limited. A one-group pretest posttest experimental design was employed with 45 nursing students in a pathophysiology course. Data were collected using Lasater's clinical reasoning scale and quiz scores to assess academic performance. The academic performance and clinical reasoning of nursing students were significantly higher with online unfolding case studies (p < .001), providing support for the use of the online unfolding case study method.

Development and Psychometric Evaluation of Bilingual English-Urdu Pakistani Critical Thinking Disposition Scale.

Objective: To develop and test the psychometric properties of the Pakistani Critical Thinking Dispositions Scale. Methods: In the item generation phase, constructs of the scale were identified through an in-depth literature review and items were written to measure the constructs. Following this, input of the experts was obtained for content validity index. In the item reduction phase, psychometric properties were measured. Initially, the scale was administered to 580 study participants during May 2018-2020 after approval from the institutional review board. Data was analyzed through SPSS v21, AMOS v21 and Omega extension. Results: First phase identified 54-items for seven constructs including contextual perspective, perseverance, reflection, intellectual integrity, creativity, open-mindedness, and inquisitiveness. Second phase determined KMO test value of 0.974 and Bartlett's test (P-Value < 0.001). The second-order confirmatory factor analysis showed a good fit model explaining 73.37% total variance. Parsimony and baseline comparison indices were favorable. Alpha and Omega value of 42-items was 0.869. Conclusion: Pakistani Critical Thinking Dispositions scale owning seven constructs and 42-items is valid, reliable, and feasible to use in undergraduate nursing education. However, its utilization in other healthcare disciplines can be tested.

Cognitive biases regarding utilization of emergency severity index among emergency nurses.

AIM: The study aimed to measure emergency nurses' prevalence of cognitive biases when utilizing Emergency Severity Index (ESI). Moreover, the study aimed to measure the differences between cognitive biases and demographic variables. BACKGROUND: Nurses use Emergency Severity Index (ESI) to prioritize the patients. Cognitive biases could compromise the clinical decisions of nurses in triage. Consequently, this hinders the delivery of safe and quality patient care. METHODS: A cross-sectional analytical approach invited 208 emergency nurses from four tertiary care hospitals. Institutional review board approval and permission from institutional heads were obtained. Informed consent was attained before data collection. Data was collected through a structured scenario-based questionnaire to measure cognitive biases at five levels of ESI. Descriptive and inferential statistics were obtained through v25.0 of SPSS. RESULTS: Among the 86.6% response rate, 56.2% of nurses were male. 62.90% had nursing diplomas. Cognitive biases were present at all ESI levels one to five, in order 51%, 45%, 90%, 89%, and 91% among nurses. Premature closure 22%, tolerance to risk 12%, satisfying bias 25%, framing effect 22%, and blind obedience 34% from level one to five consecutively. Demographic variables, including males, experience between 2 and 5 years, general nursing as qualification, and without emergency severity index certification, were identified to encounter more cognitive biases when making triage decisions. CONCLUSION: Numerous cognitive biases are considerably existing among emergency nurses when prioritizing patients. Cognitive de-biasing measures can improve triage decisions among nurses that could enhance quality care and patient safety.

Efficacy and safety of surfactant administration by MIST and INSURE techniques in Neonates with Respiratory Distress Syndrome: A randomized controlled trial.

Objective: To measure the efficacy and safety of surfactant administered by MIST and INSURE to neonates with respiratory distress syndrome. Methods: A randomized controlled trial was conducted from June 2021 to August 2022 at the NICU of the University of Child Health Sciences, Lahore. Neonates meeting inclusion criteria i.e with RDS who worsened on nasal Continuous positive airway pressure (nCPAP) (fiO2 30%, pressure 6cmH2O) were enrolled in the study in both interventional arms (MIST, n=36 and INSURE, n=36) using simple random sampling. Data was analysed using SPSS 25. Results: The mean age of neonates in MIST was 1.27±0.40 days and 1.23±0.48 days in INSURE cohort. Neonates with MIST (n=8) required statistically significant reduced need for IMV than INSURE (n=17) technique (P-Value 0.047). This study could not achieve significant difference in duration of mechanical ventilation (1±1.67; 1.52±1.40 days, P=0.152) and duration of nCPAP (3.27±1.65;3.67±1.64 hrs, P=0.312) in MIST versus INSURE. The second dose of surfactant was administered in fewer cases in MIST (n=2) than INSURE (n=7) (P=0.075). Risk estimation, although not significant, determined less likelihood for the pulmonary haemorrhage (0.908 than 1.095), intraventricular hemorrhage (0.657 than 1.353), administration of the second dose of surfactant (0.412 than 1.690) and greater likelihood of discharge (1.082 than 0.270) at 95% confidence interval with MIST technique. Conclusion: Surfactant therapy through MIST is effective and there is significantly reduced need of IMV than in INSURE. Safety profile though could not achieve statistical significance yet determines less risk of complications associated with MIST than INSURE.RCT Registration Number: TCTR20210627001.

Blood Lactate Levels And Lactate Clearance As Predictors Of Mortality In Neonatal Sepsis.

BACKGROUND: Sepsis is life-threatening organ dysfunction caused by dysregulated host response to infection. Aim of the study is Neonatal sepsis refers to infection involving the blood stream in neonates. It is major health problem causing neonatal mortality and morbidity in developing countries. Our study aimed to assess the correlation between lactate clearance and blood lactate levels with outcome of neonatal sepsis. METHODS: Seventy-three eligible neonates recruited with convenience sampling technique. Study was conducted at the Neonatology department, The Children's Hospital & the Institute of Child Health, Lahore. After approval from institutional review board, and informed consent of parents/guardians, neonates with sepsis were selected through a present inclusion and exclusion criteria. Data was collected with the predetermined demographics, inflammatory markers and lactate levels. RESULTS: This research revealed 37% (n=27) mortality rate among septic neonates who were having higher blood lactate levels and low lactate clearance at 6 hours of admission in nursery. Hence higher serum lactate levels and low lactate clearance (<10%) at 6 hours were significant predictors of poor outcome in septic neonates (p-Value, <0.05). The lactate level of neonates who could not survive was 5.68±1.22 as compared to who were discharged 4.11±1.14 (p-Value, <0.05). CONCLUSIONS: Higher blood lactate levels and lactate clearance of less than 10% at 6 hours of admission in nursery are significant predictors of mortality in neonatal sepsis. Early lactate stabilization and sepsis management can improve the clinical outcomes.

Knowledge attitudes and readiness of nursing students in assessing peoples' sexual health problems.

BACKGROUND: Sexual health is an important part of human physical health. Sexual wellbeing is a condition of physical, emotional, mental, and social ease concerning sexuality. Therefore, all health care professionals should respect, protect, and fulfil the sexual-health needs of a person. PURPOSE: This research aims to assess the knowledge, attitudes, and readiness of nursing students in assessing people's sexuality. METHODOLOGY: Cross-sectional descriptive research design was used to conduct this research. A stratified random sampling technique was used to recruit 195 nursing students from BSN (semester VI & VIII), Post RN (semester II & IV). Three self-administered tools Sexually Transmitted Diseases Knowledge Questionnaire (STD-KQ), Self-Addressing Sexual-Health (SA-SH), and Self-Addressing Sexual-Health History Taking was used to collect data from the participants. Data analysis was conducted on SPSS V-23. RESULT: Majority (111, 56.9%) of participants belong to the public sector as compared to the private. The majority of the students were female (n = 117, 60%). Most (153, 78.5%) of the participants were interested in people's sexual-health history taking; they had positive attitudes toward people's sexuality. Most (139, 71.3%) of the study participants were comfortable and ready to some extent to deal with sexual health issues. Religion, culture, and people's opposite-gender were identified barriers in assessing people's sexuality. CONCLUSION: This study identified that nursing students had insufficient knowledge regarding STDs, but they had positive attitudes toward addressing peoples' sexual-health concerns. Students are comfortable and ready to some extent to deal with sexual problems.

Bachelor of Science in Nursing Students' Perceptions Regarding Educator Feedback.

BACKGROUND: Feedback is imperative for academic success, learning, and professional growth. Faculty competence to provide constructive feedback is a cornerstone in the educational process, environment, and outcomes. METHODS: This cross-sectional study evaluated the quantity, quality, timing, and utilization of feedback among 38 Bachelor of Science in Nursing students. An assessment experience questionnaire was used to collected data. RESULTS: The majority of students (n = 27 [71%]) expressed that the timing of feedback is critical; 21 (55%) students reported feedback threatened their self-esteem, 19 (50%) students perceived feedback did not help in completing assignments, and 24 (63%) students reported feedback did not help in understanding assignments. Students reported the negative impact of feedback resulted in feeling discouraged regarding reflection (n = 20 [53%]) and self-regulation (n = 21 [55%]). CONCLUSION: Although feedback is imperative for academic success and professional development, the quantity and quality affects students' utilization of feedback. [J Nurs Educ. 2021;60(10):577-581.].

Academic experiences of undergraduate post-registered BS nursing students in Islamabad, Pakistan.

OBJECTIVE: To assess the academic experiences of undergraduate post-registered BS (Bachelor of Science) nursing students in Islamabad. METHODS: This multisite cross-sectional study was conducted from February to May 2018. It included undergraduate nursing students from one public and three private-sector institutes of Islamabad. A pre-validated Undergraduate Nursing Students' Academic Satisfaction Scale (UNSASS) was used to collect data. Descriptive and Inferential statistics were calculated using SPSS 21, p< 0.05 was considered as significant. RESULTS: Out of 220 nursing students, 198 responded. Nursing students from public-sector were significantly more satisfied than those in private. This satisfaction was significant for classroom teaching and clinical teaching. The students from private institutes reported significantly greater satisfaction towards institutional support and resources. Female students from private colleges were significantly more satisfied with the clinical education (p<0.042) and programme design and delivery (p<0.018) than their male counterparts. First year students from public-sector were significantly more satisfied from classroom teaching (p<0.003), support and resources (p<0.036), while those in private from clinical teaching (p<0.002). Students aged 31 years and above were generally more satisfied. CONCLUSIONS: Post-registered BS nursing students are satisfied from their academic experiences during undergraduate training. Students in public-sector institutes are comparatively more satisfied.

Impact of intermittent kangaroo mother care on weight gain of neonate in nicu: Randomized control trial.

OBJECTIVE: To measure the impact of intermittent kangaroo mother care on weight-gain of neonates in a neonatal intensive care unit. METHODS: The randomised controlled trial was conducted at the Department of Neonatology, the Children Hospital and the Institute of Child Health, Lahore, Pakistan, from March to October, 2018, and recruited newborns admitted to the neonatal intensive care unit. The subjects were randomised into case and control groups. Intermittent kangaroo mother care was given in the case group for seven days. Data was collected and analysed using SPSS 23. RESULTS: Of the 153 neonates, 140(91.5%) were included; 70(50%) in each group. The most common reason for admission was bronchopneumonia 49(35%). In the case group, average weight gain was 10.22±1.65 grams/kg/day compared to 7.87±1.71 in the control group (p=0.0001). The average length of stay in the case group was significantly low compared to the control group (p=0.003). Multivariate analysis determined the effect of kangaroo mother care therapy as effective (p<0.0001). CONCLUSIONS: Intermittent kangaroo mother care was found to be effective for improving weight-gain in neonates in addition to the conventional treatment.

Quality of Antenatal Care Services in a Developing Country: A Cross-Sectional Survey.

The global adult lifetime risk of maternal mortality is 1 in 180; in Pakistan, it is 1 in 170; in developed regions, 1 in 4,900 (Alkema et al., 2016; Filippi, Chou, Ronsmans, Graham, & Say, 2016; World Health Organization [WHO], 2015). The differences in maternal mortality between developed and developing countries are mainly due to the quality of antenatal care (ANC) available in the two groups of countries. The purpose of this study was to assess the structural and procedural quality of ANC services provided and to assess satisfaction levels of women receiving ANC services in two large hospitals in Islamabad, Pakistan. A cross-sectional survey was conducted at the hospitals' outpatient maternal and child health clinics, with a random sample of 138 women. The overall quality of ANC was rated as good (61%), average (17.5%), or poor (17.5%). The findings suggest a need to cultivate quality of care at public health facilities, train health workers in communication skills, and build technical capacity by continuing education and supportive supervision to train health-care providers to follow standard protocols for provision of quality ANC services.

Nursing students' perceptions of their educational environment in the bachelor's programs of the Shifa College of Nursing, Pakistan.

PURPOSE: The objective of this study was to evaluate nursing students' perceptions of their educational environment in a private college. Perceptions were compared between genders and 2 bachelor's programs. METHODS: A total of 219 students participated in this study, drawn from the Generic Bachelor of Science in Nursing (GBSN) and the Post-Registered Nurse Bachelor of Science in Nursing (PRBSN) programs of the Shifa College of Nursing, Islamabad, Pakistan. The Dundee Ready Education Environment Measure was utilized for data collection. Descriptive statistics were used to calculate total scores, as well as means and standard deviations, and the t-test was applied for comparisons according to program and gender. RESULTS: The overall total mean score (119 of 200) is suggestive of more positive than negative perceptions of the educational environment. The mean score of 13 of 28 on the social self-perception subscale suggests that the social environment was felt to be 'not a nice place.' The t-test revealed more positive perceptions among students enrolled in the PRBSN program (P<0.0001) than among those enrolled in the GBSN program and more positive perceptions among female students than among male students (P<0.0001). CONCLUSION: Commonalities and differences were found in the perceptions of the nursing students. Both positive and negative perceptions were reported; the overall sense of a positive environment was present, but the social component requires immediate attention, along with other unsatisfactory components. Establishing a supportive environment conducive to competence-based learning would play an important role in bringing desirable changes to the educational environment.