Nurses’ Clinical Judgment Development: A Qualitative Research in Iran

Abstract

Background:Clinical judgment development is necessary because it leads to appropriate nursing diagnoses, clinical decision-making and health promotion.Objectives:In this study we explored the process of Iranian nurses’ development in clinical judgment.Patients and Methods:This qualitative study was conducted in 2013 at hospitals of Kurdistan University of Medical Sciences, located in the Sanandaj city of Iran. The data were collected based on semi-structured interviews and the study included 24 participants. Data analysis was carried out concurrently with data collection using the grounded theory method.Results:The study participants’ main concern was ‘being non-professional in clinical judgment’. In response to this concern, they were struggling for gaining professional autonomy, striving for integrating clinical judgment skills, scrambling to make effective educational interventions and striving for professional and inter professional collaboration in clinical judgment. The core category was ‘struggling for becoming professional in clinical judgment development’. When nurses were supported professionally, they were able to develop their professional clinical judgment.Conclusions:The findings of this study provided critical information about nurses’ professionalization in clinical judgment. Accordingly, the participants adopted different strategies to develop their clinical judgment ability. Integrating these strategies into nursing theory and clinical education can improve nurses’ clinical judgment ability.

Trust in physician, satisfaction with physician and their relationship among diabetic patients in Kerman, Iran

“…North Carolina showed that the greatest dissatisfaction of patients was due to disrespect, failure to meet medical expectations, providing inadequate information to the patient, lack of timely access to the physician, lack of inter-professional communication, lack of information provision and distrust with the physician (All of these categories were among the indicators in the questionnaire in the present study) [31]. It appears that the patient-physician relationship is one of the main factors associated with patient satisfaction [16,20]. In addition to the above, the results of oneway ANOVA showed that patients who had a longer visit to a physician had a higher degree of satisfaction (α=0.05).…”

“…Interpersonal aspects of care, including physician's attitudes and communication are considered the main components of patient satisfaction. Since patient's satisfaction with the treatment process provides the motivation for continuing treatment and timely and correct use of medical prescriptions, which will ultimately lead to the acceleration of recovery and health on the one hand, and the achievement of a positive image of the existing therapeutic process on the other hand [20], it can be concluded that patient satisfaction survey is of particular importance. Diabetes is a chronic disease of a particular concern to the health system for several reasons, including the spread of disease, complications, and the high costs of care and treatment.…”

“…Khadem-Nejad's study showed that patientphysician relationship affects patient satisfaction [19]. The researchers concluded that the degree of satisfaction with the physician was closely related to the interpersonal interactions between the physician and the patient [16,20]. Another study showed that physicians' knowledge of patients' expectations and factors that affect their satisfaction improves patient-physician relationship and quality of healthcare which is the ultimate goal of the health system [21].…”

Raciocínio clínico do enfermeiro: uma abordagem segundo a teoria do processo dual

“…Nesse sentido, estudo iraniano verificou que enfermeiros mais experientes, com maior tempo de trabalho na área assistencial, utilizam, predominantemente, o raciocínio clínico não-analítico para a tomada de decisões, pois confiam em suas habilidades de reconhecer padrões. Atestou, ainda, que os enfermeiros recém-formados, valem-se do raciocínio clínico analítico, devido à insegurança e falta de experiências clínicas suficientes a ponto de permitir o reconhecimento de padrões 17 . Paralelamente, estudo australiano constatou que os profissionais com maior tempo de experiência clínica possuem raciocínio clínico acurado e ágil, enquanto que aqueles que têm pouco tempo de experiência apresentam dificuldades para coletar dados do histórico de saúde e integrá-los aos seus conhecimentos científicos, lentificando o processo de raciocínio clínico 13 .…”

“…Ao decorrer de sua trajetória assistencial, o enfermeiro vivencia e processa muitas informações clínicas semelhantes, as quais, geralmente, levam à determinação de cuidados parecidos 17 . Assim, pode-se inferir que o processamento repetido dessas informações pelo sistema 2 de raciocínio proporciona o reabastecimento dos padrões reconhecidos pelo sistema 1, fazendo com que essas informações sejam rapidamente reconhecidas e processadas pelo sistema não-analítico, nas próximas vezes que forem vivenciadas.…”