Complex Health Situations Research Articles

Providing compassionate care via eHealth.

eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic. to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals working to contain the COVID-19 pandemic. A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually. Permission to conduct the study was obtained from the Institutional Review Board. Participants stated that "eHealth enabled compassionate care during the pandemic" by ensuring patient care availability and accessibility. They shared experiences of "communicating compassionate care via eHealth" with suggestions of addressing patients' needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended "setting realistic mutual expectations" considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered "low eHealth literacy hinders compassion." Additionally, they recommended the need for "institutional/system-level support to foster compassionate care." Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients.

Fuzzy modelling approach and soft computing mechanism for predicting cognitive impairment in old people

Growing older is a phenomenon that is associated with increasingly complex health situations as a result of the coexistence of several chronic diseases. As a result, there is a downward tendency in both older people and their caretakers’ quality of life, which frequently results in frailty. There are numerous solutions available to treat the issue, which primarily affects older people. The basic and most popular imaging method for predicting cognitive impairment is magnetic resonance imaging. Furthermore, few of the earlier models had a definite level of accuracy when diagnosing the condition. Further, there is a critical need to put in place a stronger, more reliable approach to precise prediction. When compared to other procedures, using magnetic resonance images to predict cognitive decline is the safest and most straightforward. The advanced concept for a better optimized strategy to predict cognitive impairment at an early stage is presented in this research. The hybrid krill herd and grey wolf optimization method is offered as a solution to address the challenges in locating the impacted area. In a short amount of time, a significant number of MRI images are analyzed, and the results show a more precise or higher rate of recognition.

Nursing and end-of-life care at home in a health crisis

The Covid-19 pandemic led healthcare professionals to reconsider their work organization and some of their practices, in order to respond to the health emergency and the importance of care needs. While hospital teams managed the most serious and complex health situations, home care workers also made significant efforts to redeploy their rounds, to take care of and accompany patients at the end oftheir lives and their loved ones while managing hygiene constraints. A nurse looks back on one of these cases and the questions it raised.

Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

BackgroundEvidence of multimorbidity has come mainly from high-income regions, while disparities among racial groups have been less explored. This study examined racial differences in multimorbidity in the multiracial cohort of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto), ELSA-Brasil.MethodsThe study examined baseline (2008–2010) data for 14 099 ELSA-Brasil participants who self-reported being white, mixed-race, or black. A list of 16 morbidities was used to evaluate multimorbidity, operationalised by simple count into ≥ 2, ≥ 3, ≥ 4, ≥ 5 and ≥ 6 morbidities, in addition to evaluating the number of coexisting conditions. Prevalence ratios (PR) were estimated from logistic models and a quantile model was used to examine racial differences graphically in the distribution quantiles for the number of morbidities.ResultsOverall prevalence of multimorbidity (≥ 2 morbidities) was 70% and, after controlling for age and sex, was greater among mixed-race and black participants – by 6% (PR: 1.06; 95% CI: 1.03–1.08) and 9% (PR: 1.09; 95% CI: 1.06–1.12), respectively – than among white participants. As the cutoff value for defining multimorbidity was raised, so the strength of the association increased, especially among blacks: if set at ≥ 6 morbidities, the prevalence was 27% greater for those of mixed-race (PR: 1.27; 95% CI: 1.07–1.50) and 47% greater for blacks (PR: 1.47; 95% CI: 1.22–1.76) than for whites. The disparities were smaller in the lower morbidity distribution quantiles and larger in the upper quantiles, indicating a heavier burden of disease, particularly on blacks.ConclusionsMultimorbidity was common among adults and older adults in a Brazilian cohort, but important racial inequalities were found. Raising the cutoff point for defining multimorbidity revealed stronger associations between race/skin colour and multimorbidity, indicating a higher prevalence of multimorbidity among mixed-race and black individuals than among whites and that the former groups coexisted more often with more complex health situations (with more coexisting morbidities). Interventions to prevent and manage the condition of multimorbidity that consider the social determinants of health and historically discriminated populations in low- and middle-income regions are necessary.

Critical thinking dispositions’ level among neophyte nursing students

Introduction: Critical thinking dispositions (CTD) are valued across the health professions disciplines being essential for decision-making, critical judgment and managing complex health situations. Promoting critical-thinking dispositions in undergraduate nursing students can support the students to utilize critical thinking during challenging patient care and problem-solving situations.
 Objective: This study aimed to assess the level of critical thinking disposition among neophyte nursing students in a private nursing college.
 Methodology: An analytical cross-sectional study design was adopted. Neophyte students (n=98) of the BSN program participated in the study. Critical Thinking Dispositions Scale (CTDS) of 54 items under seven constructs was utilized to assess CTD level. Data was analyzed at descriptive and inferential level using SPSS 23.0 version. 
 Results: Overall, CTD among neophytes nursing students is at 75% a progressive level. Contextual and inquisitiveness construct of CTDs are at positive CTD level while other constructs are at the progressive level. Students have completed their matriculation from public 55(56.1%) while FSc (Faculty of Science) from private sector 57(58.2%). Mothers of most neophytes 73(74.5%) were housewives and fathers were working in private organization 32(32.7%). There was no statistically significant association between CTD’s construct with demographic variables (P-Value, >0.05). FSc marks showed a significant association with overall CTD scores, intellectual and inquisitiveness, while admission entry test scores associate significantly with intellectual construct.
 Conclusion: The CTD level of neophyte is at a progressive level which suggest that different teaching and learning strategies could be implemented to improve this level.

Understanding patient outcomes to develop a multimorbidity adapted patient-reported outcomes measure: a qualitative description of patient and provider perspectives

BackgroundMultimorbidity is a complex health situation that requires interventions tailored to patient needs; the outcomes of such interventions are difficult to evaluate. The purpose of this study was to describe the outcomes of patient-centred interventions for people with multimorbidity from the patients’ and healthcare providers’ perspectives.MethodsThis study followed a qualitative descriptive design. Nine patients with multimorbidity and 18 healthcare professionals (nurses, general practitioners, nutritionists, and physical and respiratory therapists), participating in a multimorbidity-adapted intervention in primary care were recruited. Data were collected using semi-structured interviews with 12 open-ended questions. Triangulation of disciplines among interviewers, research team debriefing, data saturation assessment and iterative data collection and analysis ensured a rigorous research process.ResultsOutcome constructs described by participants covered a wide range of themes and were grouped into seven outcome domains: Health Management, Physical Health, Functional Status, Psychosocial Health, Health-related Behaviours, General Health and Health Services. The description of constructs by stakeholders provides valuable insight on how outcomes are experienced and worded by patients.ConclusionParticipants described a wide range of outcome constructs, which were relevant to and observable by patients and were in line with the clinical reality. The description provides a portrait of multimorbidity-adapted intervention outcomes that are significant for the selection and development of clinical research outcome measures.

Perceptions of intensive care unit nurses of therapeutic futility: A scoping review

Introduction Intensive care units are contexts in which, due to the remarkable existence of particularly technological resources, interventions are promoted to extend the life of people who experience highly complex health situations. This ability can lead to a culture of death denial where the possibility of implementing futile care and treatment cannot be excluded. Objective To describe nurses’ perceptions of adult intensive care units regarding the therapeutic futility of interventions implemented to persons in critical health conditions. Method Review of the literature following the Scoping Review protocol of the Joanna Briggs Institute. The Population, Concept, and Context mnemonic was used to elaborate the research question and the research was performed using the EBSCOHost search engine in the CINAHL Complete databases, MEDLINE Complete, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews to identify studies published between 1990 and 2019. Seven studies were selected. Results Nurses consider that therapeutic futility, a current problem in adult intensive care units, may have a negative impact on persons in critical health conditions and that contributes directly to resource expenditure and moral conflicts and consequently leads to emotional exhaustion. Conclusion Due to the complexity of this concept, knowing and understanding people’s and families’ perceptions is crucial to the decision-making process, for which reason nurses can play a key role in managing these situations.

Sense making in complex health situations

PurposeUsing a sense making approach, the purpose of this paper is to examine the role that virtual health communities play as a source of informational and social support for pregnant diabetic women. The paper helps to understand how women suffering from a critical medical condition (i.e. diabetes during pregnancy and birth) manage a complex health situation.Design/methodology/approachThe data sample consisted of 507 posts collected from a virtual health community for diabetic pregnant women. Data were analysed deductively looking for different expressions of normality and different types of health information about diabetes.FindingsContent analysis revealed four themes that reflect the process that diabetic women go through from their attempts to conceive through pregnancy and birth. The findings show that for women dealing with a chronic illness such as diabetes, the breakdown of normal was the beginning of the pregnancy that prompted a new range of informational and emotional needs. The members of the community negotiated a socially constructed sense of normality and tried to empower other members with a new sense of normal by sharing information about their births. The findings also showed that members of the community disclosed personal health information to elicit medical information, advice and social support from other members.Originality/valueThe study highlighted the significance of sense-making processes in managing complex health situations and the value of virtual communities as sources of information and social support as to resolve discontinuities in the management of their illnesses.

Couples Adjusting to Multimorbidity: A Dyadic Study on Disclosure and Adjustment Disorder Symptoms.

BackgroundMultimorbidity is challenging not only for the patient but also for the romantic partner. Strategies for interpersonal emotion regulation like disclosing to the partner are supposed to play a major role in the psychosocial adjustment to multimorbidity. Research has often focused on disease-related disclosure, even though disclosing thoughts and feelings related to mundane, everyday life occurrences might also play a role in coadjustment. The current dyadic study aimed at investigating the association between these two types of interpersonal regulation strategies and adjustment disorder symptoms, following the new ICD 11 criteria in multimorbid patients and their partners.MethodsShortly after being hospitalized due to an acute health crisis, N = 28 multimorbid patients (average age 70 years) and their partners filled in questionnaires on disclosure in the couple, adjustment disorder criteria of the ICD 11 (“preoccupation,” “failure to adapt”), and sleep problems.ResultsBoth patients and their partners did show similarly high levels of preoccupation and failure to adapt indicating adjustment problems to the complex health situation. The adjustment symptoms of both partners correlated between r = 0.22 and 0.45. Regression based on Actor-Partner Interdependence-Models revealed that own mundane disclosure was related to less adjustment symptoms in the patients. Beyond that, a partner effect was observed, revealing a negative association between partners’ illness-related disclosure and the patients’ level of preoccupation. For the partners, mundane disclosure of the partner was associated with less preoccupation, failure to adapt, and reported sleep problems above and beyond own disclosure reports. Furthermore, there was an actor effect of disease-related disclosure on less sleep problems for the partners.ConclusionThese results support an interpersonal view on adjustment processes to physical disease. Disclosure as a way of regulating the relationship and emotional responses might play a relevant role here, which seems to be different for patients and their partners. Further research is needed to shed more light on the differential role of disease-related and mundane everyday disclosure for psychosocial adjustment in couples confronted with health challenges.

Nursing care and outcome in surgical patients - why do we have to care?

Nurses have an important role in patient care. They continuously work in very close contact with patients and foster the realization of activities of daily living as well as ensure quality medical treatment. For both, a high educational level is needed. A large proportion of patients with complex health situations involving chronic illnesses and multimorbidities are treated in hospitals with shortened hospital lengths of stay, changing the caring needs and the demands on nursing. Nurses must handle complex nursing tasks for which a higher educational level is indispensable, including the ability to implement evidence-based practice. In addition, studies show a correlation between the educational level of nursing staff and the health outcomes of patients. If there are too few highly educated nurses, there is an increase in patient mortality as well as the risk of patient complications, such as falls. Also, a low number of nursing staff and a high proportion of admissions decrease the quality of nursing and result in unfavorable patient outcomes. Both developments call for the necessity of a changing nursing practice and the possibilities to transform interprofessional work.

Giving permission to care for people with dementia in residential homes: learning from a realist synthesis of hearing-related communication

BackgroundManaging hearing communication for residents living with hearing loss and dementia in long-term care settings is challenging. This paper explores how care can be effective in optimising hearing communication for residents living with dementia. We argue that the underlying notion of permission or authorisation allows care staff to do what they know will be effective in providing person-centred care that enhances hearing communication. The paper also indicates that this notion of permission can usefully be applied to other areas of care home practice.MethodsTo address hearing-related communication in care homes, we conducted a realist synthesis (RS). As a theory-driven approach to reviewing literature, it also uses expert opinion to understand complex health situations. Using RS, we developed a theory surrounding the management of hearing-related communication in care homes. Applying formal processes to the literature search and data extraction, the analysis uncovered relevant mechanisms and contexts to help confirm, refute or refine our understanding of how hearing communication could be improved.ResultsForty-three papers were selected for the realist synthesis. The documents were analysed to construct five context-mechanism-outcome configurations (CMOCs). The CMOCs represent possible care interventions to optimise hearing-related communication in care homes for person living with dementia and hearing loss (PLWDHL). They include leadership promoting positive regard and empathy through person-centred care, communication training for staff, ‘knowing the person’ and relationship building for responsive awareness of residents’ hearing needs, maintaining and monitoring hearing communication through care planning, and managing noise in the care home environment.ConclusionsLeadership that provides appropriate training and resources is likely to enhance knowledge and skills, leading to staff feeling able and equipped to respond to the hearing-related communication needs of PLWDHL. Collaboration with local hearing services is likely to raise awareness of hearing loss among care home staff. Importantly, care staff require a sense of permission from leadership, to work with knowledge and autonomy in the interest of residents living with dementia and hearing loss.

Critical Thinking Disposition in Asian and Non-Asian Countries: A Review

Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools.

Health and social care planning in collaboration in older persons' homes: the perspectives of older persons, family members and professionals.

Providing health and social care to older persons is challenging, since older persons often have multiple diseases and a complex health situation. Hence many professions and organisations are involved. Lack of interprofessional and interorganisational collaboration leads to fragmented care. Care planning meetings before hospital discharge have long been used to overcome this fragmentation, but meetings conducted at the hospital have limitations in identifying long-term needs at home. A new model for health and social care planning in collaboration (HSCPC) in older persons' homes was introduced in two Swedish municipalities. The aim of this study was to gain a deeper understanding of the HSCPC-meeting from the perspectives of older persons, family members, and professionals. Ten care planning meetings from two municipalities were consecutively included. Interviews in retrospect with ten older persons, eight family members, and ten groups of professionals who had attended the HSCPC-meeting at home were analysed with a hermeneutic approach. Four themes emerged: unspoken agendas and unpreparedness, security and enhanced understanding, asymmetric relationships, and ambiguity about the mission and need for follow-up. The comprehensive interpretation is that the professionals handled the HSCPC-meeting mainly as a routine task, while the older persons and family members viewed it as part of their life course. Older persons are in an inferior institutional, cognitive and existential position. However, meeting together in the home partly reduced their inferior position. Findings from this study provide some general suggestions for how HSCPC-meetings should be designed and developed: attention of power relations, the importance of meeting skills and follow-up.

Integrated Care in practice: Improving population health across the care continuum at home

Introduction: The Carmel Health Center serves a population around 20000 inhabitants and it’s located in a suburban deprived area of Barcelona city. The increase in the overaging index (22%), in addition to the topography of the neighbourhood and the number of architectural barriers, contributes to the difficulty in access to Primary Healthcare Centre (PHC). These circumstances prompted the creation, in 2014, of a specific team to take care of the people in need of health homecareDescription of practice change implemented: The aim of the home-visit team (ATDOM) is to provide a qualified and integrated care to people that are not able to move from home, based on their needs and doing network with other sanitary and social resources and using specifics tools for itThe target population (247 people) are all patients of assigned area that are not able to reach de PHC for health reasons, physical condition or their social or environment situation, either temporarily or permanently. The patient must agree to be treated at home. The activity is focused on the patient and his family and the goal is to provide quality care through a multidisciplinary team that ensures social and sanitary continuum care.The home-visit team, formed by one family doctor and two nurses, represents an added value because are permanent references for patients and ensures a continuum of care and a systematic follow-up. The team is completed partial time with a case-manager nurse and a social worker, it has also administrative support and punctual collaboration of medical residents.The home-visits are done in different situations:- By demand of the patient or family- After a hospitalization: the team receives via email information about day of discharge and diagnosis- By alert of the Telecare service, the public network of social workers, the 7x24 circuit, or the emergency-room report assistance- When scheduled follow-up by the teamAll visits are done by nurse, doctor or both depending on each case. Some visits can be resolute via telephoneDifferent public programs are used as resources for the homecare team. All these programs facilitate coordination and continuity of care between different healthcare providers:- The 7x24 circuit: it offers the possibility of calling from the Primary Care Emergency Centre (CUAP) to the patient that requires support during weekend.- The Programme for patients in terminal situation (PADES) offers support to address situations of high complexity- The Telecare service of the City of Barcelona- The family workers of the public social services- Protocols for convalescence stays, family breaks, palliative care and rehabilitation or admission to day-hospitals.The main tools used by the ATDOM team are:- Shared Medical Record (HCC 3): electronic record shared by primary care, hospital, CUAP and discharge reports from different reference health providers.- Shared Individualized Intervention Plan (PIIC): gives useful medical and social information such as: main diagnoses, medication and recommendations in the event of medical decompensation.- Advanced Chronicity Care Model: To identify patients with chronic complex health situations (PCC) or advanced chronic diseases (MACA) in order to offer them a more accurate follow-up. That includes the application of different scales and the Planning Living Wills (PDA) to know the values, preferences and expectations of the patients, and their relatives, in MACA situationKey findings: The number of patients assigned to the service is 247 up today, that represents the 1,26% of the population assigned to PHC, and the 6,1% of the peopled over 65.The assistential burden for medical doctor is 920 and 474 for nursesThere are no data yet to assess the effectiveness of the program. We are planning to assess the accomplishment of the standard set of scales that ATDOM team uses for each patient when is included to the programme and 3 month laterHighlights: The home care with this specialized team assures more continuum care than the previous situation when the patient was attended by doctor on duty. The relationship created is similar when the patients were coming autonomously to the PHC.Contingencies: In the event that the doctor is not in service, the others doctors of the PHC assumes acute situations and the scheduled programme is assumed by the nurses of the team.Conclusions: During 2015 the ATDOM professionals have consolidated as a team. It's a cohesive team and work on specialized care of patients in their own environment and offers a health and social continuum care.

Trajectories of multimorbidity: exploring patterns of multimorbidity in patients with more than ten chronic health problems in life course.

BackgroundPhysicians are frequently confronted with complex health situations of patients, but knowledge of intensive forms of multimorbidity and their development during life is lacking.This study explores patterns and trajectories of chronic health problems of patients with multimorbidity particularly those with more than ten conditions and type and variety of organ systems involved in these patterns during life.MethodLife time prevalence patterns of chronic health problems were determined in patients with illness trajectories accumulating more than ten chronic health problems during life as registered by general practitioners in the South of the Netherlands in the Registration Network Family Practices (RNH).ResultsOverall 4,560 subjects (5%) were registered with more than ten chronic health problems during their life (MM11+), accounting for 61,653 (20%) of the 302,808 registered health problems in the population (N = 87,837 subjects). More than 30% accumulates 4 or more chronic health conditions (MM4-5: 4–5 conditions (N = 14,199; 16.2%); MM6-10: 6–10 conditions (N = 14,365; 16.4%).Gastro-intestinal, cardiovascular, locomotor, respiratory and metabolic conditions occur more frequently in the MM11+ patients than in the other patients, while the nature and variety of body systems involved in lifetime accumulation of chronic health problem clusters is both generic and specific. Regarding chronic conditions afflicting multiple sites throughout the body, the number of neoplasms seems low (N = 3,592; 5.8%), but 2,461 (49%) of the 4,560 subjects have registered at least one neoplasm condition during life. A similar pattern is noted for inflammation (N = 3,537, 78%), infection (N = 2,451, 54%) and injury (N = 3,401, 75%).ConclusionThere are many challenges facing multimorbidity research, including the implementation of a longitudinal, life-time approach from a family practice perspective. The present study, although exploratory by nature, shows that both general and specific mechanisms characterize the development of multimorbidity trajectories. A small proportion of patients has a high number of chronic health problems (MM11+) and keeps adding health problems during life. However, GP’s need to realise that more than one third of their patients accumulate four or more chronic health problems (MM4-5 and MM6-10) during life.

The Influence of Asthma Exacerbations on Health-Related Quality of Life.

The purpose of this study was to determine the influence of asthma on the quality of life (QoL) of patients hospitalized for an exacerbation of the disease and those with controlled asthma receiving outpatient treatment, and to establish the patients' somatic status and the level of health care utilization. This study involved 239 adults with asthma (123 hospitalized patients and 116 outpatients of family physicians). The authors used: WHOQOL-BREF questionnaire and a questionnaire measuring health care utilization. There were no differences in QoL levels between the patients with severe and controlled asthma. The psychological domain was assessed higher by hospitalized patients (p = 0.02). QoL levels correlated negatively with age, place of residence, and marital status, and positively with education. The general QoL level was most strongly influenced by gender, age, education, the number of home visits and interventions of a district nurse, and the somatic index (p < 0.05). Somatic symptoms were more severe in hospitalized patients. The QoL assessment of asthma patients in relation to somatic symptoms, health care services and socio-demographic variables allows better understanding of the complex health situation of patients at various stages of the disease, and tailoring the therapy to individual needs. Patients receiving outpatient treatment require professional psychotherapeutic support.

Loneliness and health care consumption among older people.

Few studies have investigated loneliness in relation to health care consumption among frail older people. The aim of this study was to examine loneliness, health-related quality of life (HRQoL), and health complaints in relation to health care consumption of in- and outpatient care among frail older people living at home. The study, with a cross-sectional design, comprised a sample of 153 respondents aged from 65 years (mean age 81.5 years) or older, who lived at home and were frail. Data was collected utilising structured interviews in the respondent's home assessing demographic data, loneliness, HRQoL and health complaints. Patient administrative registers were used to collect data on health care consumption. Loneliness was the dependent variable in the majority of the analyses and dichotomised. For group comparisons Student's t-test, Mann-Whitney U-test and Chi-square test were used. The results showed that 60% of the respondents had experienced loneliness during the previous year, at least occasionally. The study identified that lonely respondents had a lower HRQoL (p = 0.022), with a higher total number of reported health complaints (p = 0.001), and used more outpatient services including more acute visits at the emergency department, compared to not lonely respondents (p = 0.026). Multiple linear regression analysis showed that a depressed mood was independently associated to total use of outpatient care (B = 7.4, p < 0.001). Therefore, it might not be loneliness, per se, that is the reason for seeking health care. However, reasons for using health care services are difficult to determine due to the complex situation for the frail older person. To avoid emergency department visits and to benefit the well-being of the frail older person, interventions targeting the complex health situation, including loneliness, are suggested.

Critical Thinking Dispositions of Nursing Students in Asian and Non-Asian Countries: A Literature Review

Critical thinking disposition represents an inclination of a person to use possessed skills in relation to critical thinking. The trend of critical thinking has been described as inner motivation to solve problems and make decisions by thinking. In nursing as a practical profession, the concept of critical thinking dispositions is important component in helping to manage complex health situations and to deal with patient issues effectively. Willingness to think critically is a prerequisite for safe and subtly performance. The results of studies show critical thinking dispositions of nursing students in Asian countries are different from non-Asian countries. Aim of this literature review was to compare critical thinking dispositions of nursing students in Asian and non-Asian countries. Literature review was done in English and Persian databases. The results showed of the 795 articles published in English and Persian language that studied critical thinking, 73 ones studied critical thinking skills and dispositions in nursing education, and relationship between teaching methods and critical thinking skills and dispositions in nursing education of different countries. Fifteen of seventy three articles assessed critical thinking dispositions in nursing students. Limited studies showed that the Asian nursing students had mostly undermining score of the critical thinking dispositions, while non-Asian countries tend to positive scores. The reasons for these differences could be due to issues such as environmental, educational methods and cultural differences. However, future studies should measure critical thinking disposition by discipline-based tools.

Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand

This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation.

Improving Health Outcomes in Diverse Populations: Competency in Cross-cultural Research with Indigenous Pacific Islander Populations

Objective. There is a large disparity in health status between the indigenous peoples of the US Associated Pacific compared to any population in the USA. The research process that has been supported by US academic institutions and federal agencies has been limited in its ability to address the disparate health issues and may be part of the problem. We define culturally competent research and review approaches to developing competency in cross-cultural research with indigenous Pacific Islander populations. Design. This is a descriptive review of the investigators' experience in the Hawaii MEDTEP Center experience and of the experience of others conducting research with the indigenous people of the Pacific Islands. Results. Culturally competent cross-cultural research with the indigenous peoples of the Pacific requires an understanding and application of indigenous peoples' paradigms of health knowledge science and research. It is not sufficient to train more indigenous Pacific Islanders to do more Western-style research. Unraveling the complex health situation and determining the changes that need to be made is dependent on the dominant culture engaging the indigenous Pacific populations in a way that bridges cultural paradigms. Conclusion. Positively affecting the disparity of health in the indigenous populations of the Pacific is in part dependent on employing an indigenous-peoples-centered model of research. The model can have application to the study of indigenous peoples in other parts of the world.