Factors Affecting Nurses’ Clinical Judgments Regarding Earthquake Response in a Referral Hospital, Nepal
Main Article Content
Abstract
The chaos during disaster may lead nurses to make poor and inappropriate clinical judgments and decisions. Limited evidence is found which has identified the interaction between variables affecting a nurse’s clinical judgment in dealing with earthquake disasters, especially in Nepal. The aim of this study is to identify the predictive factors of Nepalese nurses’ clinical judgments regarding earthquake response. Eighty-two nurses were purposively selected from different wards of a central referral hospital located in eastern Nepal. Data was collected using a Demographic Data Questionnaire (DDQ), a Nurses’ Knowledge regarding Earthquake Disasters Questionnaire (NK-EDQ) and a Nurses’ Judgment regarding Earthquake Disasters Questionnaire (NJ-EDQ). Multiple regression analysis was performed using statistical software. The results revealed that a combination of six independent variables explained a total of 42.3% of variance in clinical judgment regarding earthquake response. The nurses’ knowledge concerning earthquake response and educational level had positive direct effects on nurses’ judgment regarding earthquake response (p <.001). It was revealed that nurses’ knowledge is important, and improvement is needed in judgment and decision-making skills. It is recommended that training should be more focused on decision-making skills based on scenarios for appropriate disaster management to enhance and facilitate appropriate judgment and decision-making skills among Nepalese nurses.
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Research Articles
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References
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Tachibana, A., Kitamura, H., Shindo, M., Honma, H., & Someya, T. (2014). Psychological distress in an earthquake-devastated area with pre-existing high rate of suicide. Psychiatry Resourses, 219(2), 336-340. doi:10.1016/j.psychres.2014.01.028
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Vargo, D. (2009). Factors Influencing Registered Nurses' Judgments and Decisions in Medication Management. University of Akron. Retrieved from http://rave.ohiolink.edu/etdc/view?acc_num=akron1258131145
Wee, F. C. (2011). (P2-56) Nurses' knowledge, skills and perception towards disaster response and emergency preparedness. Prehospital Disaster Medicine, 26(SupplementS 1), s154-s154. doi:10.1017/S1049023X11005000
Yang, Y. N., Xiao, L. D., Cheng, H. Y., Zhu, J. C., & Arbon, P. (2010). Chinese nurses' experience in the Wenchuan earthquake relief. International Nursing Review, 57(2), 217-223. doi:10.1111/j.1466-7657.2009.00795.x
Bakr, M. M., Sherif, N. M., Eid, N. M., & ELshal, S. E. (2013). Factors influencing decision making and its effect on intern students clinical performance. World Applied Programming, 3(2), 75-84.
Bjørk, I. T., & Hamilton, G. A. (2011). Clinical decision making of nurses working in hospital settings. Nursing Research and Practice, 2011, 1-8. doi:10.1155/2011/524918
Chang, M. J., Chang, Y. J., Kuo, S. H., Yang, Y. H., & Chou, F. H. (2011). Relationships between critical thinking ability and nursing competence in clinical nurses. Journal of Clinical Nursing, 20(2122), 3224-3232. doi:10.1111/j.1365-2702.2010.03593.x
Chapman, K., & Arbon, P. (2008). Are nurses ready?: Disaster preparedness in the acute setting. Australasian Emergency Nursing Journal, 11(3), 135-144. doi: 10.1016/j.ienj.2008.04.002
Chen, S. S., Chen, J. C., Ng, C. J., Chen, P. L., Lee, P. H., & Chang, W. Y. (2010). Factors that influence the accuracy of triage nurses' judgement in emergency departments. Emergency Medicine Journal, 27(6), 451-455. doi:10.1136/emj.2008.059311
Considine, J., Botti, M., & Thomas, S. (2007). Do knowledge and experience have specific roles in triage decision-making? Academic Emergency Medicine, 14(8), 722-726. doi:10.1197/j.aem.2007.04.015
Dadashzadeh, A., Abdolahzadeh, F., Rahmani, A., Ghojazadeh, M. (2014). Factors affecting triage decision-making from the viewpoints of emergency department staff in Tabriz hospitals. Iranian Journal of Critical Care Nursing, 6(4), 269-276.
Doocy, S., Daniels, A., Packer, C., Dick, A., & Kirsch, T. (2013). The human impact of earthquakes: A historical review of events 1980-2009 and systematic literature review. PLOS Currents: Disasters. doi:10.1371/currents.dis.67bd14fe457f1db0b5433a8ee20fb833.
Evans, R. J., & Donnelly, G. W. (2006). A model to describe the relationship between knowledge, skill, and judgment in nursing practice. Nursing Forum, 41(4), 150-157. doi:10.1111/j.17446198.2006.00053.x
Good, L. (2008). Ethical decision making in disaster triage. Journal of Emergency Nursing, 34(2), 112-115. doi:10.1016/j.jen.2007.04.014
Guha-Sapir, D., Hoyois, P., & Below, R. (2014). Annual Disaster Statistical Review 2013- The numbers and trends. Retrieved from Brussels, Belgium: http://www.cred.be/sites/defult/files/ASDR-2013.pdf
Gunnarsson, B. M., & Warrén Stomberg, M. (2009). Factors influencing decision making among ambulance nurses in emergency care situations. International Emergency Nursing, 17(2), 8389. doi:http://dx.doi.org/10.1016/j.ienj.2008.10.004
Hammad, K. S., Arbon, P., Gebbie, K., & Hutton, A. (2012). Nursing in the emergency department (ED) during a disaster: a review of the current literature. Australasian Emergency Nursing Journal, 15(4), 235-244. doi:10.1016/j.ienj.2012.10.005
Hermawati, D. (2010). Nurses’ preparedness of knowledge and skills in caring for patients attacked by tsunami in Banda Aceh, Indonesia and its related factors (Master's thesis), Prince of Songkla University, Thailand.
Husna, C. (2010). Perceived clinical skills for tsunami care and its related factors among nurses in Banda Aceh, Indonesia. (Masters thesis), Prince of Songkla University, Thailand.
International Council of Nurses (ICN). (2009). ICN framework of disaster nursing competencies. Retrieved from http://www.icn.ch/images/stories/documents/ networks/DisasterPreparednessNetwork/Disaster_Nursing_Competencies_lite.pdf
Jahanpour, F., Sharif, F., Salsali, M., Kaveh, M. H., & Williams, L. M. (2010). Clinical decision-making in senior nursing students in Iran. International Journal of Nursing Practice, 16(6), 595-602. doi:10.1111/j.1440-172X.2010.01886.x
Kilner, T. (2002). Triage decisions of prehospital emergency health care providers, using a multiple casualty scenario paper exercise. Emergency Medicine Journal, 19(4), 348-353. doi:10.1136/emj.19.4.348
LaMartina, K., & Ward-Smith, P. (2014). Developing critical thinking skills in undergraduate nursing students: The potential for strategic management simulations. Journal of Nursing Education and Practice, 4(9), 155-162. doi:10.5430/jnep.v4n9p155
Lu-Ping, Z., Rodriguez-Llanes, J. M., Qi, W., van den Oever, B., Westman, L., Albela, M., . . . GuhaSapir, D. (2012). Multiple injuries after earthquakes: a retrospective analysis on 1,871 injured patients from the 2008 Wenchuan earthquake. Critical Care, 16(3), R87-R87. doi:10.1186/cc11349
(Per citation advice in journal).Noon, A. J. (2014). The cognitive processes underpinning clinical decision in triage assessment: A theoretical conundrum? International Emergency Nursing, 22(1), 40-46. doi:http://dx.doi.org/10.1016/j.ienj.2013.01.003
Phaneuf, M. (2008). Clinical Judgement – An Essential Tool in the Nursing Profession Retrieved from http://www.infiressources.ca/fer/Depotdocument_anglais/ Clinical_Judgement%E2%80%93An_Essential_Tool_in_the_Nursing_Profession.pdf
Polit, D. F., & Beck, C. T. (2012). Nursing Research: Generating and Assessing Evidence for Nursing Practice (9th ed.). Philadelphia: Lippincott Williams & Wilkins.
Sandman, L., & Nordmark, A. (2006). Ethical conflicts in prehospital emergency care. Nursing Ethics, 13(6), 592-607.
Shin, S., Ha, J., Shin, K., & Davis, M. K. (2006). Critical thinking ability of associate, baccalaureate and RN-BSN senior students in Korea. Nursing Outlook, 54(6), 328-333. doi: 10.1016/j.outlook.2006.09.008
Standing, M. (2014). Clinical judgement and decision making for nursing students. (2nd ed.). Retrived from https://uk.sagepub.com/en-gb/asi/clinical-judgement-and-decision-making-for-nursingstudents/book242300#contents
Tachibana, A., Kitamura, H., Shindo, M., Honma, H., & Someya, T. (2014). Psychological distress in an earthquake-devastated area with pre-existing high rate of suicide. Psychiatry Resourses, 219(2), 336-340. doi:10.1016/j.psychres.2014.01.028
United Nation High Commissioner for Refugees (UNHCR). 2015. Nepal: 2015 Earthquakes and Aftershocks, People Killed/Injured by District (as of 26 May 2015). Retrieved from: http://reliefweb.int/map/nepal/nepal-2015-earthquakes-and-aftershocks-people-killedinjured-district-26-may-2015
Van Graan, A. C., Williams, M. J. S., & Koen, M. P. (2016). Clinical judgement within the South African clinical nursing environment: A concept analysis. Health SA Gesondheid, 21(1), 33-45. doi:http://dx.doi.org/10.1016/j.hsag.2015.05.003
Vargo, D. (2009). Factors Influencing Registered Nurses' Judgments and Decisions in Medication Management. University of Akron. Retrieved from http://rave.ohiolink.edu/etdc/view?acc_num=akron1258131145
Wee, F. C. (2011). (P2-56) Nurses' knowledge, skills and perception towards disaster response and emergency preparedness. Prehospital Disaster Medicine, 26(SupplementS 1), s154-s154. doi:10.1017/S1049023X11005000
Yang, Y. N., Xiao, L. D., Cheng, H. Y., Zhu, J. C., & Arbon, P. (2010). Chinese nurses' experience in the Wenchuan earthquake relief. International Nursing Review, 57(2), 217-223. doi:10.1111/j.1466-7657.2009.00795.x