Clinical Decision-making Ability Research Articles

Registered Nurses (RNs)’ knowledge sharing and decision‐making: the mediating role of organizational trust

This study study aimed to investigate the effects of explicit and tacit knowledge sharing on clinical decision-making abilities and the mediating role of trust among registered nurses at Korean hospitals. Decision-making abilities comprise a key area of nursing practice and link nurses' perceptions with behaviours. Tacit knowledge is embedded within an individual and cannot be expressed or transmitted to other people in a specific form. Over time, new nurses gradually gain experience and tacit knowledge and become experts. Trust, an organizational characteristic, may serve as a potential mediator in the association between knowledge sharing and decision-making abilities among nurses. However, few studies have investigated the mediatory role of trust in this association. The data were collected from 210 nurses selected via random sampling. The research instrument in the model included Knowledge-Sharing Behavior, Trust, and Clinical Decision-Making in Nursing Scale. Structural equation modelling was used to analyse the collected data. The study findings showed that explicit knowledge sharing directly affects decision-making abilities, whereas tacit knowledge sharing is only associated with decision-making abilities when trust plays a mediating role. A higher level of organizational trust can improve clinical decision-making abilities via tacit knowledge sharing. This study demonstrated that unlike explicit knowledge, which is shared more easily, tacit knowledge sharing does not directly lead to clinical decision-making abilities. A higher level of organizational trust leads to a stronger beneficial effect of tacit knowledge sharing on clinical decision-making abilities. These findings concerning the mediatory role of trust on the association between knowledge sharing and clinical decision-making abilities provide new knowledge that will allow nurses, managers, and researchers to support the clinical decision-making abilities of nurses.

Structural Equation Modeling on Clinical Decision Making Ability of Nurses

The purpose of this study was to construct and test a hypothetical model of clinical decision-making ability of nurses based on the Decision Making Process model and the Cognitive Continuum theory. The data were collected from nurses working at 11 hospitals in Busan, Daejeon, and South Gyeongsang Province from June 30 to August 1, 2017. Finally, the data from 323 nurses were analyzed. The goodness-of-fit of the final model was at a good level (χ²/df=2.46, GFI=.87, AGFI=.84, IFI=.90, CFI=.90, SRMR=.07, RMSEA=.07) and 6 out of 10 paths of the model were supported. The clinical decision-making ability was both directly and indirectly affected by task complexity and indirectly affected by experiences, autonomy, and work environment. Specifically, it was strongly directly affected by analytical competency but was insignificantly affected by intuitive competency. These variables accounted for 66.0% of clinical decision-making ability. The nurses' clinical decision-making ability can be improved by improving their analytical competency. Therefore, it is necessary to organize nursing work, create a supportive work environment, and develop and implement various education programs.

The importance of preliminary evaluation in developing ambulance staff training curriculum for developing countries: A survey in Uzbekistan.

The Tashkent city, the capital of the republic of Uzbekistan, started joint project with Korean emergency physicians to improve the quality of their ambulance services in 2016. Ambulance service in Tashkent city has been facing challenges in processing a large number of calls, and low competency of their staff in providing advanced prehospital emergency care. To design an appropriate capacity building training program for ambulance staff, we analyzed the current ambulance service in Tashkent concerning resources and competency of the staff. In this study, ambulance staff participated in the constructed survey and pre-validated written test. Statistics and other information were provided by the Ministry of Health of Uzbekistan. Ninety-eight ambulance staff were participated in this study, and more than half (53.1%) of the participants were physicians. The average years of service in the ambulance were 8.71±6.9 years. In the ambulance, drugs were stocked in enough quantity include injections for critical care, except large volume fluids for resuscitation. Only 19 to 52 percent of the ambulances were equipped with essential monitoring devices. Competency for the basic procedure was surveyed higher than 60%, but critical care skills, such as defibrillation, were as low as 18%. The written test resulted in only 41.1% correct answer rate, though it was higher than 60% in the validation test for Korean ambulance staff. Conventional prehospital knowledge and skillset deemed to be essential for ambulance staff were found to be marginal in the test. The ambulance staff in Tashkent, Uzbekistan found to have insufficient medical knowledge and clinical decision-making abilities. Training program for ambulance staff in Tashkent should be developed on the basis of the findings in this study.

Development and application of dynamic scoring information system for critically ill patients

Objective To develop and preliminarily apply a dynamic scoring information system for critically ill patients to optimize the management system for critically ill patients. Methods Totally 55 risk factors of three groups were selected based on Acute Physiology and Chronic Health Evaluation Scoring System, Tiss-28 Scoring System 2, critical value and expert consensus and included in the information platform, which was connected to the hospital's information and data system. A dynamic scoring system was designed and developed independently. The system consisted of two modules: alarm and clinical decision-making. An operation protocol was made by the Department of Nursing and included into the nursing management system to ensure that the system could run effectively. Data of inpatients in Tenth People's Hospital of Tongji University from October 2015 to October 2017 was selected. The disease recognition of the dynamic scoring system and the existing MEWS alarm and scoring system and the success rate of treatment in critically ill patients before and after the dynamic scoring system was introduced were compared. Results The area under receiver operating characteristic curves (AUC-ROC) of the dynamic scoring system was 0.947 (95%CI 0.930-0.964) , which showed higher recognition of critical illness compared with the MEWS alarm and scoring system (P<0.05) . After the dynamic information system was introduced, the success rate of treatment in critically ill patients was 68.61%, which was higher than that before it was applied (χ2=10.046; P=0.002) . Conclusions The dynamic scoring system can accurately evaluate patients' disease and provide digital data and a list of clinical decisions for nurses, thus improving the success rate of treatment in critically ill patients and enhancing nurses' clinical decision-making ability. Key words: Critical illness; Scoring system; Informatization; Clinical decision-making; Alarm

Cultural adaptation and validation of the Lasater Clinical Judgment Rubric in nursing students in Spain

BackgroundThe clinical judgment and decision-making abilities of nurses can influence many health outcomes, hence the importance of addressing these qualities in university studies. In this respect, clinical simulation is a commonly employed teaching method. The evaluation of simulation activities requires standardised instruments, such as the Lasater Clinical Judgment Rubric, which is widely used for this purpose, although a culturally adapted and validated version in Spain is not available. AimsTo obtain a Spanish culturally adapted and validated version of the rubric for undergraduate students of nursing. Design, Participants and SettingCultural adaptation and psychometric validation study carried out with undergraduate nursing students in the simulation laboratories at the University of Málaga (Spain). MethodsA process of translation/back-translation and cultural adaptation was carried out in accordance with international standards. The rubric was empirically evaluated in standardised scenarios with high and medium-fidelity simulators. Each student took part in two different simulation sessions, led by two instructors. In each simulation, the data were collected by two independent observers. Results152 observations were obtained from 76 students. The interobserver reliability was high, with an intraclass correlation coefficient of 0.93 (95% CI 0.92–0.95) (p = 0.0001) and Cronbach's alpha of 0.93. According to the confirmatory factor analysis, the fit of the model was satisfactory in all indices, with a χ2/df value of 1.08, GFI 0.96, TLI 0.99, NFI 0.97 and RMSEA 0.24 (90% CI 0.000–0.066). ConclusionsThe rubric obtained is culturally adapted to the Spanish educational context, and is valid and reliable for nursing students. Further prospective studies should be undertaken to evaluate the responsiveness, potential for transfer to clinical practice and cost-benefit ratios of different simulation designs.

Exploring student perceptions of ward simulation as an exercise to improve decision-making skills in the clinical context.

This article was migrated. The article was marked as recommended. Introduction: At the point of graduation, medical students are expected to demonstrate competence making a range of decisions in the clinical environment. However, research continues to highlight that both students and graduates lack effective methods for dealing with complex decisions, with students emphasising having little, if any, experience of making many clinical decisions during their undergraduate training. To combat this, an Acute Medical Unit ward simulation exercise (AMUWSE) has been recently incorporated into the 4 th year curriculum at Dundee Medical School to aid the development of these skills. Methodology: This study aimed to explore how students perceive their decision-making ability is influenced by an AMUWSE and how this teaching exercise could be improved. An action research approach was adopted to investigate medical students' perceptions of how participation in this exercise influences clinical decision-making skills. An initial online questionnaire was circulated before four group interviews were conducted. Results: It was found that the majority of students perceived the AMUWSE to have been of significant benefit in developing clinical decision-making. A number of learning points from the exercise were identified, incorporated into six overarching themes: making clinical decisions, prioritising, handing over information, asking for help, dealing with time constraints and preparation for clinical practice. Within many of these themes, students expressed deficiencies in teaching during the "basic science" years of medical school. Conclusions: This study highlighted the effectiveness of an AMUWSE to improve the clinical decision-making ability of medical students, while offering invaluable insights into the nature of clinical practice. Despite this, areas for improvement have been identified to make this simulation exercise a more effective means of improving clinical decision-making. Furthermore, there remains a need for consideration of how these skills can be developed during the early years of medical school. While a complex process, certain teaching interventions, such as an AMUWSE, have shown potential in aiding this development; helping to create more competent, well-equipped junior doctors.

A pilot study exploring the relationship between the use of mobile technologies, walking distance, and clinical decision making among rural hospital nurses.

Providing evidence-based information at the point of care for time-poor nurses may lead to better clinical care and patient outcomes. Smartphone applications (apps) have the advantage of providing immediate access to information potentially increasing time spent with patients. This small-scale pre-post survey study explored the impact a smartphone app had on the distance nurses walked and their perceived clinical decision-making ability. A total of 20 nurses working in a rural hospital medical/surgical unit participated. The findings suggest that the use of the smartphone app did not decrease nurses' walking distance. Nor did using the app enhances nurses' perception of their clinical decision-making ability. However, there was a statistically significant increase in confidence in the app over time (F(1,16) = 5.416, p = 0.033, partial η2 = 0.253), suggesting that providing training opportunities including time to learn how to use smartphone applications has the potential to enhance nurses work.

Mobile emergency simulation training for rural health providers.

Mobile emergency simulation offers innovative continuing medical educational support to regions that may lack access to such opportunities. Furthermore, satisfaction is a critical element for active learning. Together, the authors evaluated Canadian rural healthcare providers' satisfaction from high fidelity emergency simulation training using a modified motorhome as a mobile education unit (MEU). Over a 5-month period, data was collected during 14 educational sessions in nine different southern Manitoban communities. Groups of up to five rural healthcare providers managed emergency simulation cases including polytrauma, severe sepsis, and inferior myocardial infarction with right ventricular involvement, followed by a debrief. Participants anonymously completed a feedback form that contained 11 questions on a five-point Likert scale and six short-answer questions. Data from 131 respondents were analyzed, for a response rate of 75.6%. Respondents included nurses (27.5%), medical residents (26.7%), medical first responders (16.0%), and physicians (12.2%). The median response was 5 for overall quality of learning, development of clinical reasoning skills and decision-making ability, recognition of patient deterioration, and self-reflection. The post-simulation debrief median response was also 5 for summarizing important issues, constructive criticism, and feedback to learn. Respondents also reported that the MEU provided a believable working environment (87.0%, n=114), they had limited or no previous access to high fidelity mannequins (82.7%, n=107), and they had no specific training in crisis resource management or were unfamiliar with the term (92%, n=118). A high level of satisfaction was reported in rural health providers with mobile emergency simulation. Access to and experience with high fidelity mannequins was limited, suggesting areas for potential educational growth.

Discussion on clinical practice teaching of patient-oriented critical care medicine

Considering the fact that the critical medical education was relatively backward, and the basic medical education was out of touch with clinical practice, this study, combined with the complexity, uncertainty and comprehensiveness of critical care medicine, puts forward the concept of critical care holistic medicine in clinical practice. We try a patient-oriented approach in clinical practice, focusing on the whole, focusing on the interaction relationship among patient and disease and its pathologi-cal and physiology processes, development, complication and prognosis of disease, instead of paying atten-tion only to disease or single organ itself. The purpose of patient-based learning is trying to train medical students and junior residents to form good clinical thinking ability and decision-making ability. Key words: Intensive medicine; Clinical practice; Patient-based learning; Teaching method

Medical Student Perception of the Impact of Early Ultrasonography Education on Experiences during Clinical Rotations

Teaching medical students ultrasonography has a positive impact on their confidence in its use. The study institution has integrated ultrasonography education into the first 2 years of its 4-year curriculum. The first-year ultrasonography course taught students how to use ultrasound equipment and identify a number of structures in the neck, abdomen, pelvis, chest, and extremities. A pass/fail elective course during second year provided more opportunities to practice ultrasonography skills and use ultrasonography training models for guided procedures. The objective of this study was to investigate student perception of early ultrasonography education as related to their experience during clinical rotations. After completing third-year rotations, students were surveyed on their perception of how ultrasonography training impacted their clinical decision-making abilities, how often they engaged in ultrasonography activities, the obstacles that prevented them from using ultrasonography, and the specialties in which they used ultrasonography most. Eighty-five students from the class of 2015 and 162 students from the class of 2016 participated. Students agreed ultrasonography training aided their clinical decision-making abilities (P<.001) and their ultrasonography skills were used during third-year rotations (P<.001). Many students experienced at least 1 obstacle, most commonly lack of permission. Ultrasonography was used most during obstetrics and gynecology rotations. Despite obstacles, ultrasonography was used in a variety of specialties. These results support the inclusion of ultrasonography in the medical school curriculum to improve clinical decision-making skills and promote the development of ultrasonography skills.

Are nurse-led chemotherapy clinics really nurse-led? An ethnographic study

BackgroundThe number of patients requiring ambulatory chemotherapy is increasing year on year, creating problems with capacity in outpatient clinics and chemotherapy units. Although nurse-led chemotherapy clinics have been set up to address this, there is a lack of evaluation of their effectiveness. Despite a rapid expansion in the development of nursing roles and responsibilities in oncology, there is little understanding of the operational aspects of nurses’ roles in nurse-led clinics. ObjectivesTo explore nurses’ roles within nurse-led chemotherapy clinics. DesignA focused ethnographic study of nurses’ roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses. SettingsFour chemotherapy units/cancer centres in the UK ParticipantsPurposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations. MethodsNon-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation. Results61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses’ autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses’ autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses’ roles. ConclusionsFour different levels of nurse-led chemotherapy clinics were identified, illustrating disparities in nurses’ roles. Although clinics are run by nurses they are often controlled by medical consultants, which can reduce nurses’ autonomy and negatively impact on patient care.

Research on clinical decision-making ability of junior nurses and its influencing factors

Objective To investigate the influencing factors for clinical decision-making ability of junior nurses, and provide theoretical basis for the cultivation of clinical decision-making ability of junior nurses. Methods A total of 633 junior nurses were investigated by using the general information questionnaire and the clinical decision-making ability questionnaire. Results The gross score in clinical decision-making ability of junior nurses was (143.55 ± 14.01) points, they scored lowest on the dimension of finding the solution to the problem, the score was (30.98±4.80) points, and they scored highest on the dimension of evaluating implementation effect, the score was (37.31±4.53) points. The unilabiate analysis revealed that the influence on the clinical decision-making ability of hospital level, job purpose, academic activity, relationship between nurses and patients, whether competent in nursing work were statistically significant (F=3.089-21.694, P<0.05 or 0.01). The multivariate analysis revealed that the factors impacting the nursing clinical decision-making ability were work experience, marital status, academic activity, relationship between nurses and patients, whether competent in nursing work. Conclusions The clinical decision-making ability of junior nurses remains to be improved, and the nursing administrators and educators should pay more attention to the different features of the unmarried nurse or the one lacking in work experience, intervene the controllable factors, make up the training gap, and teach the communication technique between nurses and patients to improve the clinical decision-making ability and the quality of nursing service. Key words: Nursing care; Junior nurses; Clinical decision-making ability; Influencing factors

An exploration of the correlates of nurse practitioners' clinical decision-making abilities.

This study investigated nurse practitioners' clinical decision-making abilities and the factors that affect these abilities. Nurse practitioners play an important role in clinical care decision-making; however, studies exploring the factors that affect their decision-making abilities are lacking. A cross-sectional descriptive survey was employed. A purposive sample of 197 nurse practitioners was recruited from a medical centre in central Taiwan. Structured questionnaires consisting of the Knowledge Readiness Scale, the Critical Thinking Disposition Inventory and the Clinical Decision-Making Model Inventory were used to collect data. The intuitive-analytical type was the most commonly used decision-making model, and the intuitive type was the least frequently used model. The decision-making model used was significantly related to the nurse practitioners' work unit. Significant differences were noted between the nurse practitioners' clinical decision-making models and their critical thinking dispositions (openness and empathy). The nurse practitioners' years of work experience, work unit, professional knowledge and critical thinking disposition (openness and empathy as well as holistic and reflective dispositions) predicted the nurse practitioners' analytical decision-making scores. Age, years of nurse practitioner work experience, work unit and critical thinking disposition (holistic and reflective) predicted the nurse practitioners' intuitive decision-making scores. This study contributes to the topic of clinical decision-making by describing various types of nurse practitioner decision-making. The factors associated with analytic and intuitive decision-making scores were identified. These findings might be beneficial when planning continuing education programmes to enhance the clinical decision-making abilities of nurse practitioners. The study results showed that nurse practitioners demonstrated various clinical decision-making types across different work units. Consideration of nurse practitioners' knowledge readiness and their specific needs while planning on-duty education programmes is necessary.

Measure of Clinical Decision-Making Abilities of Nurse Practitioner Students.

This study reports the validity and reliability of using unfolding case studies to measure the clinical decision-making abilities of nurse practitioner students. Two unfolding case studies were developed to assess students' ability to collect, interpret, and evaluate data. Content validity was assessed through percent agreement from three expert clinicians. Reliability was measured using Cronbach's alpha, test-retest, and interrater reliability. Fifty-two participants, primarily from family, acute care, and adult nurse practitioner programs, completed both unfolding cases. Content validation was nearly 100% for most items; other items were revised or deleted. A significant correlation was found between total mean scores at initial testing and at 1 month after both cases. High inter-rater reliability of the scored tool was noted, as measured with intraclass correlation coefficient. The use of case studies is a learner-centric method to measure the development and transition of clinical decision making.

Impact of Nursing Professional Self-Concept, Clinical Decision Making Ability, Critical Thinking Disposition, Professional Autonomy of Clinical Nurse’s

Purpose: This study is a descriptive study that aimed to examine relationship among such factors as self-concept, clinical decision-making ability, critical thinking disposition, and professional autonomy of nursing professionals and to present basic data necessary for mapping out strategies vital for improving autonomy of nursing professionals. Methods: For this study, a survey was conducted of 213 professional nurses working at Region A and Region D, respectively, who were selected based on convenience sampling. The collected data analyzed through t-test, ANOVA, Pearsons correlation coefficients and Stepwise multiple regression analysis. Results: The results of this study showed that the mean score on professional autonomy was 158.3 which corresponded to an intermediate level of autonomy. The factors influencing professional autonomy the most were found to be in the order of self-concept, clinical decision-making ability, and critical thinking disposition, and the explainability was 46.0%. Conclusion: Thus, it is considered urgent to map out strategies conducive to increasing self-concept, clinical decision-making ability, and critical thinking disposition of professionals as prerequisite for improving autonomy of nurses.

Relationships Between Clinical Decision-Making Patterns and Self-Efficacy and Nursing Professionalism in Korean Pediatric Nurses

As pediatric nurses must make decisions on a regular basis when caring for hospitalized children, clinical decision-making abilities are necessary in this profession. In the present study, we explored clinical decision-making patterns and their association with self-efficacy and nursing professionalism in pediatric nurses. We surveyed 173 pediatric nurses and analyzed the relationships between their clinical decision-making patterns and self-efficacy and nursing professionalism. Factor analysis identified 5 clinical decision-making patterns: patient-family-nurse collaborative (PNC), individual patient-oriented (IP), nurse model-oriented (NM), pattern-oriented intuitive (PI), and nursing knowledge-oriented (NK). The most frequently observed clinical decision-making pattern was the PNC. The self-efficacy and nursing professionalism were found to be higher in pediatric nurses using the IP and NM, and were lower for those using the PNC. Thus, the present results suggest that pediatric nurses' clinical decision-making patterns are influenced by nursing professionalism and self-efficacy. Therefore, intervention programs focusing on these variables might improve clinical decision-making in pediatric nurses.

Concurrent validity of physical therapist performed musculo-skeletal (MSK) diagnostic ultrasound imaging (DUI) vs MRI in detecting shoulder RTC tears

satisfaction, physiotherapists’ knowledge of and adherence to the CPG-LBP, as well as to compare the results of the two cycles. Methods: All physiotherapists (n= 9) in the Medical Cente participated. The Focus-PDCA (Plan-Do-Check-Act) cycle was selected as a tool for multi-faceted and continuous quality improvement. Physiotherapists were educated focusing on guideline recommendations and patient education, and receivedmonthly reminders. A competency test was conducted to test the therapists’ knowledge and ability in clinical decision-making. Patient files were audited to evaluate physiotherapists’ adherence to guideline recommendations based on thirteen quality indicators. Outcome of care in the second cycle was measured by assessing patients’ health status with the Quebec Back Pain Disability Scale (QBPDS) and Numeric Rating Scale for Pain (NRS-P). Adherence was calculated using descriptive statistics. Results of the second cycle and differences between the two cycles were analyzed with Chi-square statistics and Fisher’s exact test (p value = 0.05). Results: The competency test in the second cycle resulted in an average score of 73% in correct definitions and 60% in clinical decision–making. Adherence to guideline recommendations was derived from 44 patient files. For the diagnostic process, the overall percentages of adherencewere high (90% and 93% in first and second cycle respectively). Overall percentage of adherence in the treatment process improved significantly in the second cycle (42% and 64% for first and second cycle respectively). Health status of patients after treatment during the second cycle was improved significantly for the QBPDS and NRS-P. In the second cycle patients reported 85% agreement with the therapists’ education, 72% satisfaction with the outcome of care, and 70% in overall satisfaction with their recovery. Conclusion(s): A multi-faceted implementation strategy based on identifying barriers to change and continuous evaluation was effective in improving therapists’ adherence to CPG-LBP and patient satisfaction with care. Checking the feasibility of such an implementation strategy nationally is needed. Implications: To the knowledge of the authors this is the first study reporting compared results from two consecutive implementation cycles. Checking the feasibility of such an implementation strategy nationally is needed. Countries like Lebanon, where resources are scarce, can benefit from adopting foreign guidelines to stimulate evidence-based practice.

The influence of situational teaching on the learning ability and operation ability of nursing students

Objective To analyze and explore the influence of situational teaching the learning ability and operation ability of nursing students. Methods A total of 50 nursing undergraduate students who were internships in our hospital were averagely divided into the experimental group and control group, the students of control group were treated by routine method for nursing teaching training, the students of experimental group were on the basis of routine teaching training given scene teaching measures, the nursing comprehensive ability, communicative anxiety score and satisfaction degree of students of two groups were compared and analyzed. Results The nursing undergraduate students' practical ability of experimental group, clinical decision-making ability and communication skills were significantly higher than those of nursing undergraduate students of control group, and the interaction anxiety scores of nursing undergraduate students of experimental group were(27.5±9.2) significantly lower than those of control group(51.2±14.3)score, the satisfaction degree of nursing undergraduate students of experimental group was(96.00%) obviously higher than that of control group(56.00%), the difference had statistical significance(P< 0.05) Conclusions Situational teaching for nursing students learning ability and operation ability can improve the nursing comprehensive ability, reduce the communication anxiety situation, it can be widely used. Key words: Situational teaching; Nursing students; Learning ability; Operation ability

Dimensional psychopharmacology in somatising patients.

Despite the recent DSM-5 review of somatoform disorders, which are now called somatic symptom and related disorders, the categorical definitions of these syndromes have inherent limitations because their causal mechanism or presumed aetiologies are still unknown. These limitations may affect everyday clinical practice and decision-making abilities. As a result, physicians have limited information at their disposal to treat these patients. Furthermore, the clinical presentations of somatic disorders may vary a lot. The purpose of this chapter is to illustrate a psychopathological dimensional approach to the somatising patient. This approach is constantly unconsciously applied in clinical practice using continuous variables, such as rating scales. Moreover, treatment strategies might be improved by adding a dimensional approach, simply recognising the prominent components of the presenting psychopathology of a given patient and addressing them with drugs according to their different mechanisms, targeting circuits and neurotransmitters. Some authors have proposed a shift from the nosological to functional application of psychotropic drugs, in which functional psychopharmacology will be dysfunction oriented and therefore inevitably geared towards utilising drug combinations. Here, we present a summary of the advantages of functional/dimensional psychopharmacology for the treatment of somatic symptoms and related disorders.

Concept Mapping in a Critical Care Orientation Program: A Pilot Study to Develop Critical Thinking and Decision-Making Skills in Novice Nurses

Newly graduated registered nurses who were hired into a critical care intensive care unit showed a lack of critical thinking skills to inform their clinical decision-making abilities. This study evaluated the effectiveness of concept mapping as a teaching tool to improve critical thinking and clinical decision-making skills in novice nurses. A self-evaluation tool was administered before and after the learning intervention. The 25-item tool measured five key indicators of the development of critical thinking skills: problem recognition, clinical decision-making, prioritization, clinical implementation, and reflection. Statistically significant improvements were seen in 10 items encompassing all five indicators. Concept maps are an effective tool for educators to use in assisting novice nurses to develop their critical thinking and clinical decision-making skills.