Challenges In Care Of Patients Research Articles

Surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia.

Noma, an overlooked infectious disease, inflicts severe facial tissue damage, posing substantial challenges in patient care. This study delves into surgical complications and subsequent revision surgeries among noma cases treated in Ethiopia. The research employed a cross-sectional retrospective review of medical records treated between 2007 and 2019 retrieved from the Facing Africa database. The review encompasses 235 noma cases. Twenty-four cases (19 females and 5 males) experienced various complications, predominately major complications leading to subsequent revision surgeries. The identified complications included flap necrosis, abscess formation, tenderness, graft site infection, flap bulking, dental misalignment, corner of the mouth dehiscence, infected bone and plate, flap malpositioning, restricted mouth opening with ankylosis, neuropathic pain, recurrent flap infection, and offensive odor. Revision surgeries included wound cleansing, abscess drainage, skin graft removal, exploratory surgery, wound care, debulking, scar removal, debridement, trismus release, commisuroplasty, and flap repositioning. These findings illuminate the intricacies of noma surgery in Ethiopia, emphasizing the importance of understanding the nature and frequency of complications for optimizing treatment outcomes. Insights from this study can guide healthcare providers, especially novice surgeons, and policymakers, in refining surgical interventions and enhancing outcomes for noma patients. Improved knowledge in this realm is crucial for advancing patient care and developing targeted interventions. 5.

The Neglected Healers: Urgent Need for Physicians Self-care in Healthcare

In the heart of healthcare, where doctors tirelessly tend to their patients, a crisis quietly brews – the disregard for their own well-being. The phenomenon of physician burnout is rampant, fuelled by relentless work demands, unyielding stress, and a culture that prizes patient care above self-care. In Pakistan, where the health system is still developing, clinicians have to go beyond their capacity for the provision of standard care to the patients. Physician burnout, a shadow that looms over the medical profession, is reaching alarming proportions. Studies reveal shocking rates of emotional exhaustion, detachment, and a sense of diminished accomplishment among doctors.1 This epidemic not only threatens the mental health of physicians but also compromises patient care and safety.2 Yet, burnout is just the tip of the iceberg. Mental health struggles, like anxiety and depression, affect doctors at disproportionately high rates.3 Stress-induced ailments, from hypertension to musculoskeletal disorders, plague the healers who sacrifice their own well-being in the name of their patients. The solution lies in a radical shift – a culture of wellness and self-care within the medical community. Institutions must step up to provide the support systems necessary for doctors to thrive. Mental health resources, wellness initiatives, and flexible work arrangements are not luxuries but necessities in combating burnout and promoting resilience.4 Doctors must carve out time amidst their demanding schedules for rest, rejuvenation, and reflection. Regular exercise, mindfulness practices, and hobbies are essential tools for preserving physical and emotional well-being.5 Education on stress management and self-care should be woven into the fabric of medical training, right from the medical college, empowering future generations of physicians to prioritize their own health. Peer support networks and mentorship programs offer a great support in the face of adversity.2 As there are regular campaigns and awareness sessions for the patients and general public, there is an immense need to talk about well-being of the health professionals. In conclusion, the plight of physicians neglecting their own health demands urgent attention. By championing self-care and wellness, we can create a more resilient medical workforce, better equipped to navigate the challenges of patient care with compassion and efficacy.

Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians' Views on Access, Expectations, and Communication.

Internet hospitals in China are an emerging medical service model similar to other telehealth models used worldwide. Internet hospitals are currently in a stage of rapid development, giving rise to a series of new opportunities and challenges for patient care. Little research has examined the views of chronic disease physicians regarding internet hospitals in China. We aimed to explore the experience and views of chronic disease physicians at 3 tertiary hospitals in Changsha, China, regarding opportunities and challenges in internet hospital care. We conducted semistructured qualitative interviews with physicians (n=26) who had experience working in internet hospitals affiliated with chronic disease departments in 3 tertiary hospitals in Changsha, Hunan province, south central China. Interviews were transcribed verbatim and analyzed by content analysis using NVivo software (version 11; Lumivero). Physicians emphasized that internet hospitals expand opportunities to conduct follow-up care and health education for patients with chronic illnesses. However, physicians described disparities in access for particular groups of patients, such as patients who are older, patients with lower education levels, patients with limited internet or technology access, and rural patients. Physicians also perceived a gap between patients' expectations and the reality of limitations regarding both physicians' availability and the scope of services offered by internet hospitals, which raised challenges for doctor-patient boundaries and trust. Physicians noted challenges in doctor-patient communication related to comprehension and informed consent in internet hospital care. This study explored the experience and views of physicians in 3 tertiary hospitals in Changsha, China, regarding access to care, patients' expectations versus the reality of services, and doctor-patient communication in internet hospital care. Findings from this study highlight the need for physician training in telehealth communication skills, legislation regulating informed consent in telehealth care, public education clarifying the scope of internet hospital services, and design of internet hospitals that is informed by the needs of patient groups with barriers to access, such as older adults.

Exploration of a noninvasive radiomics classifier for breast cancer tumor microenvironment categorization and prognostic outcome prediction

Rationale and Objectives: Breast cancer progression and treatment response are significantly influenced by the tumor microenvironment (TME). Traditional methods for assessing TME are invasive, posing a challenge for patient care. This study introduces a non-invasive approach to TME classification by integrating radiomics and machine learning, aiming to predict the TME status using imaging data, thereby aiding in prognostic outcome prediction. Materials and MethodsUtilizing multi-omics data from The Cancer Genome Atlas (TCGA) and The Cancer Imaging Archive (TCIA), this study employed CIBERSORT and MCP-counter algorithms analyze immune infiltration in breast cancer. A radiomics classifier was developed using a random forest algorithm, leveraging quantitative features extracted from intratumoral and peritumoral regions of Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) scans. The classifer’s ability to predict diverse TME states were and their prognostic implications were evaluated using Kaplan-Meier survival curves. ResultsThree distinct TME states were identified using RNA-Seq data, each displaying unique prognostic and biological characteristics. Notably, patients with increased immune cell infiltration showed significantly improved prognoses (P < 0.05). The classifier, comprising 24 radiomic features, demonstrated high predictive accuracy (AUC of training set = 0.960, 95 % CI: 0.922, 0.997; AUC of testing set = 0.853, 95 % CI: 0.687, 1.000) in differentiating these TME states. Predictions from the classifier also correlated significantly with overall patient survival (P < 0.05). ConclusionThis study offers a detailed analysis of the complex TME states in breast cancer and presents a reliable, noninvasive radiomics classifier for TME assessment. The classifer’s accurate prediction of TME status and its correlation with prognosis highlight its potential as a tool in personalized breast cancer treatment, paving the way for more individualized and less invasive therapeutic strategies.

Ventilatory Effect of Proprioceptive Neuromuscular Facilitation Patterns in Critically Ill Patients: A Brief Review

Background: The Intensive Care Unit (ICU) plays a crucial role in managing patients with life-threatening conditions, and the mortality rate of mechanically ventilated patients in developed countries is on the rise. Chest complications during ICU stays, such as respiratory failure and pneumonia, pose significant challenges in patient care, requiring continuous and vigilant medical and physiotherapy intervention. Objective: This narrative review explores the role of Proprioceptive Neuromuscular Facilitation (PNF) techniques in chest physiotherapy for mechanically ventilated patients, aiming to assess their impact on respiratory parameters and overall patient outcomes. Method: A comprehensive analysis of relevant literature was conducted, focusing on studies investigating the ventilatory effects of PNF in different patient populations, including neurological injuries, organophosphorus poisoning, and chronic obstructive pulmonary disease (COPD). Results: The reviewed studies demonstrated that incorporating PNF techniques, such as intercostal stretch and anterior basal lift, alongside conventional chest physiotherapy, positively influenced respiratory rates, oxygen saturation, and pulmonary compliance. These findings suggest that PNF can be an effective adjunct in preventing pulmonary complications and improving outcomes in mechanically ventilated patients. Conclusion: The evidence presented in this narrative review supports the integration of PNF techniques into chest physiotherapy for mechanically ventilated patients. The positive outcomes reported in the literature suggest that PNF can be a valuable adjunct to conventional care, contributing to better respiratory function and potentially reducing complications associated with immobility. Keywords: Intensive Care Unit (ICU), Mechanical ventilation, Physiotherapy intervention, Chest complications, Chest physiotherapy techniques, PNF techniques

The Skills Olympics: Using Competition to Illustrate Patient Care Challenges and Promote the Transfer of Nursing Knowledge.

The fundamental skills lab provides students with a safe place to learn new skills and develop knowledge and attitudes necessary for professional nursing. However, learning skills without situational challenges like those encountered in the clinical setting does not adequately prepare students for future challenges. The Skills Olympics, a competitive team event, can be used to foster teamwork, communication, and problem-solving abilities, thereby introducing students to the realities of patient care challenges and promoting transfer of learning.

Extensive analysis of risk factors associated with surgical site infections post-cardiothoracic open surgery.

Surgical site infections (SSIs) post-cardiothoracic surgery represent a significant challenge in patient care. Understanding the risk factors contributing to SSIs is essential for improving surgical outcomes and patient safety. A comprehensive retrospective analysis was conducted at our institution from January 2021 to December 2022. This study included 30 patients with SSIs and 60 without, following cardiothoracic open surgery. Data were collected on various variables, including hypertension, anaemia, operation time, hospital stay, alcohol consumption, smoking habits, Body Mass Index, age, and drainage tube placement. Univariate and multivariate logistic regression analyses were employed using SPSS software to identify significant predictors of SSIs. Univariate analysis indicated a strong correlation between SSIs and factors like smoking, diabetes mellitus, drainage tube placement, anaemia, and significant intraoperative blood loss (≥800 mL). These factors were statistically significant with p-values < 0.05. Multivariate logistic regression further confirmed the impact of these factors, with high odds ratios indicating a substantial increase in SSI risk associated with these conditions. This study highlights intraoperative blood loss, anaemia, drainage tube placement, smoking, and diabetes mellitus as key risk factors for SSIs post-cardiothoracic surgery. Recognising and addressing these factors through targeted preventive measures is crucial in clinical practice to reduce the incidence of SSIs and improve postoperative care in cardiothoracic surgery.

Assessment of the Challenges in Care of Patients with Substance Use Disorder among Caregivers at Parirenyatwa Hospital Psychiatric Unit, Zimbabwe

This paper assesses the challenges in care of patient with substance use among care givers at Parirenyatwa Group of Hospitals psychiatric Unit, Zimbabwe. This paper seeks to further explore the experiences of care givers supporting family members with substance use disorder and their engagement in self-care. Exploratory Qualitative research design was employed to facilitate the exploration of family experiences affected by Substance Use Disorder and to identify the necessary assistance they may require. A Sampling size of 21 participants was used to avoid biased information and participants were recruited using purposive sampling technique, by selecting individuals with members affected, by Substance Use Disorder. The findings from the study strongly indicated that family members were significantly affected by the responsibility of caring for individuals with substance use disorder. This article extensively explores the intricate and multifaceted challenges faced by the caregivers supporting individuals grappling with substance use disorder. Researchers recommended that it is crucial for health care system, to acknowledge the indispensable role played by caregivers and extend the necessary support system.

Implementation of evidence-based practice and its correlates among nurses working in southern Ethiopia

BackgroundEvidence-based utilization is crucial for improving overall patient care quality, nursing practice, and building trust in decision-making with patient preferences to solve clinical challenges in patient care, but its practice is relatively low. ObjectiveTo assess the implementation of evidence-based practice (IEBP) and its correlates among nurses working in west Arsi zone public hospitals, Ethiopia. MethodAn institutional-based cross-sectional study design was employed using structured, interviewer-administered, pretested data from June 1 to July 30, 2022 and entered into epidata version 4.4.1 statistical software and exported to SPSS version 25 for further analysis. ResultsA total of 385 nurses responded the questionnaire, with 100 % response rate. Majority of participants 194 (50.4 %) were females with mean age of 32.02 (SD ± 6.8) years. The overall mean implementation of EBP among nurses was found to be 11.4 ± 8.53. Attitude, self-efficacy, working in referral hospital, being diploma in the level of education (β: −3.925; 95 % CI:(-6.399- (-1.451), knowledge of nurses toward EBP (β: 1.213; 95 % CI: 0.989–1.438) and availability of job rotation (β: 3.475; 95 % CI: 1.20–3.750) were significantly associated with the mean score of EBP utilization at a p-value ≤ 0.001. ConclusionA significant proportion of nurses use evidence-based practice infrequently. Knowledge, Attitude, self-efficacy, hospital level, level of education, and availability of job rotation, were the variables that contributed to the low utilization of evidence-based practice. It is recommended that integrating EBP training into nursing education curricula, establishing EBP training workshops, and research mentorship programs at the workplace are needed.

Dual Management: Diabetes and Sickle Cell Anemia in Patient Care

The coexistence of diabetes mellitus (DM) and sickle cell anemia (SCA) presents a complex medical challenge, necessitating an integrated approach to patient care. This review explores the interplay between diabetes and sickle cell anemia, addressing the epidemiology, pathophysiological intricacies, and the compounded complications associated with these comorbidities. Emphasizing the need for an interdisciplinary care model, the review discusses the challenges in patient care, encompassing both physiological and psychosocial dimensions. Furthermore, it outlines innovative treatment strategies, including medication management and lifestyle interventions, aiming to optimize outcomes for individuals navigating the dual management of diabetes and sickle cell anemia. By synthesizing current research findings and highlighting areas for future investigation, this review provides valuable insights into the complexities of dual management and offers a foundation for enhancing the quality of care for this unique patient population

Implementing integrated care in ophthalmology: a community case study.

In 2017, in a context of financial and patient care challenges, Moorfields Eye Hospital in the borough of Croydon launched the first Ophthalmology Integrated Care Contract in the United Kingdom. A realistic, systematic approach is presented for an efficient implementation of an integrated care ophthalmology contract under a lead provider. The main elements of the new contract are portrayed. A new healthcare contract that would lead to system-wide transformation requires significant time commitment, vision, shared narrative, leadership, multi-functional working culture, shared accountability of all participating parties and education and support of all parties involved. Key levers to elevate the quality of care are collaborative relationships between health professionals, investing in information and technology and facilitating bottom-up innovation. System-wide changes such, as integrated care contracts are possible, although the interplay between context, design and implementation is more complex than expected.

Anti-inflammatory and Antioxidative Potential of Herbs and Fruits in the Management of Inflammatory Bowel Disease Beyond Medications

Inflammatory Bowel Disease (IBD), a chronic inflammatory condition of the gastrointestinal tract, primarily encompasses ulcerative colitis and Crohn's disease. Characterized by recurring inflammation, IBD is marked by its unpredictability and complexity. Crohn's disease may impact any part of the digestive system, causing significant ulcerations, whereas ulcerative colitis is mainly restricted to the colon, leading to persistent damage and ulcers. The intermittent nature of IBD, alternating between remission and active flare-ups, presents continuous challenges in patient care and treatment. Its etiology is multifaceted, involving a combination of genetic susceptibility, environmental triggers, and immune system malfunctions. Symptomatically diverse, IBD can manifest as abdominal discomfort, diarrhea, weight loss, and fatigue, complicating the establishment of uniform treatment protocols. Traditional pharmacological treatments often offer limited relief and may introduce side effects, necessitating frequent adjustments in therapy. This disease profoundly impacts not only the physical well-being of individuals but also their overall quality of life, calling for a comprehensive and individualized management approach. This review delves into the potential of herbs and fruits in IBD management, examining their proximate composition and the roles their anti-inflammatory and antioxidant properties play in enhancing gut health.

Primary care needs to rise to the challenge of caring for patients during climate disasters

Primary care needs to rise to the challenge of caring for patients during climate disasters

Socio-economic and environmental factors associated with community-acquired pressure injuries: A mixed method study

AimsTo: (1) report on the prevalence of community-acquired pressure injuries (CAPIs) in patients admitted into the acute care setting; (2) examine the socio-economic and home environment associated with CAPIs; and (3) understand the challenges of caring for patients with CAPIs at home. MethodsThis mixed-method study recruited patients admitted with CAPIs in the acute care hospital between March 2021 to June 2022. The hospital's pressure injury (PI) database was used to screen patients admitted with CAPIs. A purposive sample of CAPI patients and their caregivers participated in this study. A cross-sectional survey study was first performed to examine the prevalence of CAPIs and the socio-economic and home environment factors. Semi-structured interviews were conducted to understand the caregivers' challenges in caring for patients with CAPIs at home. ResultsThe CAPI prevalence was reported at 1.1 % during the study period (1039 had CAPIs out of 97 912 patients admitted to the hospital). A total of 70 caregivers and patients consented to participate in the study. The mean age of patients was 84.2 (SD = 10.4) years old; 68.6 % (n = 48) were females. Majority presented with a deep tissue injury (DTI) (37.1 %; n = 26) or unstageable PI (31.4 %; n = 22). More than half of the patients had alternating air mattresses at home (54.3 %; n = 38), and only 10 % (n = 7) had positioning wedges and used a sliding sheet for turning. The mean age of the caregivers was 43.4 years old (SD = 13.1), and 84.3 % (n = 59) were female. Continuous data were summarised using means and standard deviations, and categorical data were summarised using frequencies and percentages. Logistic regression found no significant socio-demographic and clinical predictors of patients having PI stages 2, 3, and 4 compared to patients with DTI and unstageable PI. Challenges to caring for PI at home included high financial burden, physical limitations, and personal challenges in CAPIs management. ConclusionCAPIs are prevalent among older patients admitted to the acute care setting. Understanding the influence of socio-economic factors is crucial for developing comprehensive strategies to mitigate the occurrence and impact of PIs. Ongoing support and education to the caregivers in the community is essential to address the reported challenges in PI care.

Determinants of Bone-Modifying Agent Prescribing for Metastatic Castration-Resistant Prostate Cancer in a National Health Care Delivery System.

Despite guidelines recommending bone-modifying agents (BMAs) to decrease skeletal-related events (SREs) in men with metastatic castration-resistant prostate cancer (mCRPC), BMAs are underutilized. In this retrospective cohort study, we report the factors associated with BMA use in a national health care delivery system. We used the Veterans Affairs Corporate Data Warehouse to identify men with mCRPC between 2010 and 2017. BMA prescribing frequency was evaluated, and the association between patient- and disease-specific factors with BMA use was assessed using multivariable logistic regression. Among 3,980 men identified with mCRPC (mean age 73.5 years, 29% Black), 47% received a BMA; median time to BMA from start of mCRPC treatment was 102 days. Factors associated with BMA use included previous BMA use (adjusted odds ratio [aOR], 7.81 [95% CI, 6.48 to 9.47]), diagnosis code for bone metastases (aOR, 1.26 [95% CI, 1.08 to 1.46]), and concomitant corticosteroid use (aOR, 1.53 [95% CI, 1.29 to 1.82]). Decreased BMA use was associated with advancing age (aOR, 0.85 per 10 years [95% CI, 0.78 to 0.92]), Charlson comorbidity index ≥2 (aOR, 0.76 [95% CI, 0.63 to 0.93]), Black race (aOR, 0.83 [95% CI, 0.70 to 0.98]), and decreased estimated glomerular filtration rate (eGFR; aOR, 0.19 [95% CI, 0.11 to 0.32] for eGFR 0-29 mL/minutes; aOR, 0.76 [95% CI, 0.64 to 0.91] for 30-59 mL/minutes). Patients who are older, Black, or have more comorbidities are less likely to receive guideline concordant care to prevent SREs. These observations highlight the unique challenges of caring for patients with mCRPC and the need for future studies to increase BMA use in these populations.

Making in the Midst of a Pandemic

The COVID-19 pandemic posed unprecedented challenges in patient care, prompting frontline clinicians globally to devise novel solutions. This article highlights the creativity of clinicians who adapted to meet the evolving standards of care. The researchers explored the scale of clinician awareness of the novel devices and protocols that were being made. A thematic analysis revealed rapid team coordination, supportive management, acknowledgment of practice-based medicine, and just-in-time fabrication as drivers behind the design, fabrication, and scaling of clinician-made solutions throughout the hospital. Results show that the presence of the Makerspace significantly contributed to the hospital’s nimble and proactive response to the pandemic, emphasizing the need for transformative approaches that embrace innovation, collaboration, knowledge-sharing, and recognition of clinician-led innovations to advance patient care.

PERIODONTITIS AND CARDIOVASCULAR DISEASE AS A SHARED CLINICAL CHALLENGE IN PATIENT CARE

Cardiovascular disease (CVD) remains the leading cause of death, accounting for approximately one-third of all deaths worldwide. The primary aim of the study is to find the link between periodontitis and cardiovascular disease as a shared clinical challenge in patient care. This retrospective observational cohort study was conducted in Jinnah Medical and Dental College Karachi from May 2023 to August 2023. The study included a total of 230 patients from a diverse patient population. Patient data were collected meticulously through a comprehensive dental and medical records review. A total of 230 patients were included in this retrospective observational cohort study. Patient demographics, including age and gender, were documented to provide an overview of the study population. The study included 230 patients with a mean age of 45. 55% of the participants were male, and 45% were female. Based on clinical measurements, 35% of patients showed mild periodontitis, 45% moderate periodontitis, and 20% severe periodontitis. Radiographic evidence of bone loss was observed in 60% of the patients. 40% of the patients had a documented history of cardiovascular diseases, including coronary artery disease, myocardial infarction, stroke, or hypertension.It is concluded that a significant association between periodontitis and cardiovascular diseases has been found. While the precise mechanisms remain fully understood, these findings underscore the importance of comprehensive healthcare that considers both oral and cardiovascular health.

Prediction of stress-related gastrointestinal bleeding in patients with aneurysmal subarachnoid hemorrhage using caudate Hounsfield unit value in ASPECT score.

Stress-related gastrointestinal bleeding (SRGB) is one of the major complications after aneurysmal subarachnoid hemorrhage (aSAH), and it can present challenges in patient care and treatment. The aim of this study was to explore the clinical significance of the caudate Hounsfield unit (HU) value in the Alberta Stroke Program Early CT (ASPECT) score for predicting SRGB in patients with aSAH. We retrospectively analyzed the data of 531 aSAH patients admitted to our institution between 2019 and 2022. Potential predictors of SRGB were identified using multivariate Cox regression analysis. We used a restricted cubic spline (RCS) to evaluate whether there is a nonlinear relationship between the right caudate HU value and SRGB. MaxStat analysis (titled as maximally selected rank statistics) was performed to identify the optimal cutoff point for the right caudate HU value. Another Kaplan-Meier method with the log-rank test was used to analyze the right caudate HU value in predicting the occurrence of SRGB. The incidence rate of SRGB was 17.9%. In the multivariate Cox regression analysis, the right caudate HU value was an independent predictor of SRGB [Hazard ratio (HR) = 0.913; 95% confidence interval (CI): 0.847-0.983, and p = 0.016]. The RCS indicated that the incidence of developing SRGB reduces with increasing right caudate HU values (nonlinear p = 0.78). The optimal cut-off value of the right caudate HU was 25.1. Among aSAH patients, lower right caudate HU values indicated a higher risk of developing SRGB. Our findings provide further evidence for the relationship between the gastrointestinal system and the brain.

Facilitating and Preventing Factors of Tracheostomy Patient Care by Home Caregivers: A Qualitative Study

Background: The unstable condition of tracheostomy patients and the lack of support resources for patients and their families during discharge is the biggest challenge, especially for their home and non-professional caregivers. The present study aimed to identify the factors affecting the care of tracheostomy patients provided by home caregivers. Materials and Methods: This qualitative research was conducted from September 2018 to December 2019 using the content analysis method and interviews with nine home caregivers and one professional caregiver in Lorestan Province, Iran. The required data were collected by holding in-depth semi-structured interviews and continued until reaching data saturation. Simultaneously, the gathered data were analyzed using the 5-step approach of Graneheim and Lundman (2004). Results: The results led to the extraction of 2 themes of preventing and facilitating care factors, 7 categories, and 21 subcategories. The categories related to the theme (preventing factors) of patient care challenges included neglecting the caring role of informal caregivers by the healthcare system, interaction challenges, the high pressure of caregiving, and lack of trust. The categories related to the facilitating factors theme were the experience of the care facilitating over time, the intensification of care with the aim of prevention, and hope and inner satisfaction underlying the care. Conclusion: The challenges of the family's lack of readiness to accept the new role, the exhausting nature of caregiving, and the caregivers’ lack of skills, and as a result, the imposition of a burden of caregiving, and the emergence of harmful consequences for them in various dimensions, the existence of non-governmental organizations that aim to continue to care for these patients and support their families seems necessary. With support systems and gaining experience over time, the care transition process is facilitated.

Revising Reflection Assignments to Align With Clinical Judgment Measurement Model Language: Maximizing Critical Thinking, Feedback, and Measurement in Simulation.

Student reflection stimulates self-awareness, deep learning, insight into patient care challenges, and professional role development. As such, reflection assignments are an ideal target for revision using language associated with the steps of the clinical judgment measurement model (CJMM) to maximize critical thinking. Tanner's clinical judgment model aligns with the CJMM and underpins the curriculum in many nursing programs. Faculty used the model to update a simulation reflection assignment template, incorporating CJMM language and facilitating improved measurement of clinical judgment. Substantially improved student responses resulted during an initial quality improvement pilot study.