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YM12 Nursing

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YM12 Nursing

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Course Code: YM12
University: International Islamic University Malaysia

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Country: Malaysia

Question:
Choose ONE of the following clinical scenarios to base your essay on:
 
a) There has been an increase in the number of complaints about the timing of Doctors Rounds. Design a small study to investigate this.
 
OR
 
b) A new dressing for surgical wounds has been introduced to your ward. The manufacture claims that it is superior to others on the market. Design a small study to investigate this. 
Answer:

Introduction
In the hospital setting, the ward round is central to the major activities of the hospital. The ward round mainly involves the doctors in white coats appearing at the bedside of the patient in an unannounced manner. The doctor then speaks to the patients, listens to the current condition of the patient and then the doctor murmurs certain jargons in a swift manner which passes on too quickly. Patients’ cooperation is fundamental to their prosperity and feeling of rationality, and in addition to their comprehension of and adherence to recommended medicines (AlMutar, AlTourah, HussainSadeq& Marwan, 2013). Ward rounds fill in as a gathering for sharing data among patient and parental figure. The motivation behind the ward round is to get data and plan medicinal and nursing care through staff– quiet correspondence.However there is very little evidence available as to the perspective of the patient and the professional regarding the ward rounds (Hale &McNab, 2015). This paper therefore aims to highlight the present dwelling condition which involves the complaints of the patient regarding the ineffective timing of the doctors for rounds. This paper will elucidate the condition through a study which through which it can be pondered upon the dwelling condition in the hospital setting.
Hierarchy of evidence
The concept of hierarchy of evidence refers to one of the core principles of the evidence based practise (EBP) (Bossen& Jensen, 2014). The hierarchy is useful in ways that it allows the researcher to undertake a top-down approach for the purpose of location of the evidence that is best in contrast to the practise where first the search is conducted for locating a well conducted systematic review. However in case this is not available, the hierarchy enables to move down to the next level of evidence in order to answer the concerned question (Cohn, 2013). This hierarchy of evidence allows the ranking of the types of the study in terms of the rigour of the study and their methods of research. Different hierarchies are followed for the different types of the questions.
Search terms used to find literature

 

Search terms used

Explanation

a)

Ward rounds

This is one of the key search terms since the research question is based on this. The crisis lies in relation to the ward rounds therefore this should be used as the key search terms.

b)

Doctors

The situation lies in relation to the doctors itself who are believed to be ineffective in the timings of the ward rounds therefore this has been used as one of the keywords.

c)

Patients’ rooms

The main setting of the situation being investigated is the patients’ room in the hospital, since it is the patients who have complains.  Hence this is used as one of the key search terms.

d)

Communication

The ward rounds that are taken by the doctors are mainly conducted in order to communicate to the patient to understand the present condition of the patient. Therefore this has been used as one of the key search terms for the study.

 Justification of the search engines used

 

Search engines/ databases used

Explanation

a)

CINAHL

The Cumulative Index to Nursing and Allied Health (CINAHL) database is involved in providing the authoritative coverage of the literature that is related to nursing and the allied health.

b)

Cochrane library

The Cochrane Library represents a collection of databases which contains evidences that are independent in nature. The clinical treatment decisions are based on this..

c)

EMBASE: ExcerptaMedica Database

EMBASE is an abstract and indexing database related to the field of biomedicine. However it also excels in its coverage of the research related to the pharmaceutical field. It is known to currently contain more than 15 million records from ExcerptaMedica Database (1974 to present) along with the selected Medline records (1966-present). However the current library does not own the archives of Embase from 1947 to 1973.

d)

MEDLINE through Ovid

The National Library of Medicine’s premier bibliographic database is involved in covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences. However this is limited to 30 simultaneous users only.

Research design
Pilot study design
Research question
The current situation that dwells is that there has been an increase in the amount of complaints regarding the timings of the ward rounds of the doctors. Therefore in order to conduct a pilot study to investigate this situation the research questions raised is as follows:  Can the ward rounds be effectively organised in order to reduce complains of the patients regarding the infective timings of the doctors for ward rounds.
Research approach
The research approach that will be implemented for this study is the qualitative study using a focus group. The ward rounds that are taken by the doctors or the medical specialists were observed for the conduction of the study. For this four hospitals were taken into account between the periods of six months. There were approximately 90 wards which were taken into account.
Study design
The study design that was undertaken for the given situation were the investigation using semi-structured questions. The questions consisted of themes like how the ward rounds were structured, how these routines were employed and finally the contributions were made by the doctors and the patient respectively during the condition of the rounds. There were also some follow-up questions in case there were clarifications required for the understanding of the situation. There were observational notes prepared on the basis of the ward rounds which were in turn categorized in accordance to their structures. The semi-structured questions were provided in the form of a questionnaire. This questionnaire helped the collection of the data from a wide group of participants. The application of the focus group and the questionnaire acted as complementary with respect to the study undertaken. A combination of open ended and closed ended questions were included in the questionnaire.  
Setting
The study setting was the hospital wards that is the ninety wards which were involved in the study from the four different hospitals.
Sample
The sample for the study undertaken was approximately 30 doctors who conducted the rounds. The rounds that were taken by the doctors were of four types which was also taken into account. These are as follows: the ward rounds only which were used for teaching and business purpose only. The second is the pre-ward round meeting that was followed by the ward round, followed by the ward round follow-up along with a post-ward round meeting. The last one is the pre-ward round meeting, in addition to the ward round that was followed-up with a post-ward round meeting. The patients were also included in the study, which consisted of 10 males and 10 female patients belonging to the concerned wards.
Inclusion/exclusion criteria
The inclusion criteria was that the doctors who were asked to participate should have an experience of rounds for more than 10 months and for the patients, they should have at least experienced two ward rounds while there stay in the hospital. Those patients who were not able to speak in English were not included in the study.
Recruitment process
The recruitment process included the recruitment of those participants rather the doctors who had at least completed 10 weeks of ration on the medical ward rounds including all the types of the rounds that have been mentioned above. The patients were also included in the study which consisted of 10 men and 10 women belonging to the undertaken wards.
Informed consent process
An informed consent was obtained from each of the participants after the objectives of the study were explained to them. Each of the participants were assured of the confidentiality of the information that is required to be collected. It was also mentioned that the participants were allowed to participate in the study.
Ethics
In terms of the ethical approval, the study was approved by the research ethics committee of the respective university and IRBS in Singapore.
Data collection
The data was collected using the semi-structured questions during a period of six months which contained a combination of open ended and close ended questions. The respective questionnaires were sent to the doctors in charge of the respective wards for the collection of the data. The patients were also included in the study for which semi-structured interviews were conducted were they were asked to describe any one positive and a negative experience that is associated with the rounds.
Data analysis
For the analysis of the data, the interviews and the answers were analysed using the qualitative content analysis methodology. The written words were used as the foundation of the analysis in case of the qualitative content analysis. For the interview which were audio-taped, the transcript was read and re-read by the authors so that the understanding can be gained and familiarity can be attained with the present text. From the obtained text, the units, words and the phrases can be identified which corresponded to the aim of the study and were finally coded by the authors individually. For better data analysis, there was categorising of the codes which were interpreted. In the last step of the analysis, a theme was developed which was then brought together with the content of the condensed meaning units along with the codes, the categories in addition to the subthemes on a level that is interpretative.  In order to increase the credibility and the dependability of the study, the researchers were required to discuss each and every step in order to reach an agreement.
Sharing of the findings
The investigation uncovered one subject and three subthemes identified with patients’ encounters of ward rounds. The principle subject was treatment of data from the everyday ward round while sitting tight for private interview. The subthemes were making the best of the brief timeframe spent on ward rounds; experiencing customary jobs and breathing easy because of staff competency; and having the capacity to pick how much one takes an interest in the decision?making procedure.
Barriers faced while sharing the research

a)

The first barrier can be the legal issues that related to the privacy of the patient- there were considerations required for the patient privacy and also for the regulations because of the barriers to data sharing. In spite of the desire to see the innovations associated with the progress of the biomedical research, there is a concern regarding the potential loss of privacy to the public.  Although till now the exact nature of the concerns is not well understood (Hull, Birnbach, Arora, Fitzpatrick &Sevdalis, 2014).

b)

Cultural barriers- In terms of the cultural barrier there is a fear regarding the misuse of the shared data. This is because often less priority is given to the method of data collection and analysis or to the nature of the population of the patient. There might be some misinterpretations that can be published outside the peer-reviewed literature so that standard quality controls do not apply(Launer, 2013).

c)

Technical challenges- One of the difficult tasks is that to unearth the data after the paper describing those data has been published. There are several issues like the coding, cleaning, and logical queries take some time to resolve, but their difficulty is probably overrated.Some fields have been seen to adopt quite strong principles for the cause of data sharing. This can be seen in one of the best examples that is in the field of human genomics. It has principles on the process of how to share information among all the investigators who are working in the same area. Additionally in some of the cases, data is required to be shared with other investigators and also the public(Liu, Manias &Gerdtz, 2013). 

Dissemination and implementation
The ward round, which is a settled and sacred element of the doctor’s facility day, has endured a continuous and critical decrease. Regardless of being considered important, there is a feeling that the ward adjustments must now must be fitted into a calendar of contending errands in outpatient facilities and operating theatres (Pucher, Aggarwal &Darzi, 2014). The examination of the investigation uncovers that pros that with double accreditation of the doctors, it can enhance the inpatient care with positive effect on a few areas of the ward round. All survey respondents and participants at the center gathering was able to reveal full satisfaction with the new working model. Enhanced time went through with every patient, enhanced cooperation and junior specialist and attendant educating, and in addition expanded quantities of releases are among a portion of the points of interest (Soliman, Riyaz, Said, Hale, Mills &Kapur, 2013). Besides, commitment of the staff in the process uncovered an enthusiasm to improve the situation for the patients. For instance, one of the results toward the finish of the center gathering was to build up a 30-min multidisciplinary group (MDT) board round twice week by week, when all supporting wellbeing experts (physiotherapist, word related advisor, dietitian, drug specialist) take care of talk about troublesome cases (Ward, Ghali, Graham &Lemaire, 2014).. Occupation fulfillment is an essential factor in keeping up a solid harmony among work and life. Any future procedure to enhance inpatient care ought to assess the accompanying models specifically: broadening geriatrician numbers and administrations, expanding intense doctors’ job and the improvement of US-style hospitalists, contrasted and enhancing the present circumstance as recommended by the creators’ undertaking. Both the hospitalists and the intense doctors risk wearing out and of long haul vocation disappointment. Our investigation has a few constraints, in any case; it depends on the experience of one ward in one region healing facility. This probably won’t matter to instructing healing facilities or tertiary referral focuses. These outcomes should be repeated in other general healing facilities. No formal patient fulfillment polls were done as a feature of this investigation. The investigation uncovered one subject and three subthemes identified with patients’ encounters of ward rounds. The primary subject was taking care of data from the everyday ward round while sitting tight for private discussion (Swenne&Skytt, 2014). The subthemes were making the best of the brief span spent on ward rounds; experiencing conventional jobs and breathing easy in light of staff competency; and having the capacity to pick how much one takes an interest in the basic leadership process. Patients felt assuming a functioning job in the ward rounds was troublesome in light of the fact that the rounds were too short; this finding was bolstered in a past report (Tobiano, Marshall, Bucknall&Chaboyer, 2015). The patients endeavored to get a thorough image of their medicinal circumstance by keeping an eye on and organizing data given at the ward rounds, which additionally has been appeared in past investigations, however the expert group, did not generally incorporate them. The patients likewise talked about the significance of day by day reports on test outcomes, treatment and care arranging. In the event that they are to take an interest in their own consideration, patients require connection and exchange with parental figures. Investment is subject to the association of the two patients and parental figures. Inclusion does not just require being available and partaking (Hale &McNab, 2015). The patient should likewise be incorporated into the procedure, and the patient’s view must be acknowledged as a feature of the procedure. It is in this way fundamental that the environment welcomes patients to take an interest in the expert group. The conventional ward round might be too short for inquiries and excessively centredon restorative issues and basic leadership (Pryss, Mundbrod, Langer & Reichert, 2015). In the present investigation, patients thought about that the short adjusts negatively affected doctors’ capacity to reach patients. The ward round members could be numerous in number, which was both invigorating and startling; this excessively has been accounted for beforehand. The patients felt it was ‘alright’ for different patients to catch the discussion amid the ward rounds, as long as they didn’t feel uncovered, however they needed data about wellbeing status and visualization to be given in private (Bossen& Jensen, 2014). The present investigation recommends that there must be an adjustment in the ward round daily schedule to permit more opportunity for a two-route procedure of data trade between the doctor and the patient with the end goal to satisfy the National Board of Health and Welfare aims for two-path procedure of data among parental figures and patient (Launer, 2013). There is a need of redesign of the ward round to address the patients’ issues. It ought to be noticed that quiet cooperation may depend not just on the demeanors of those associated with the ward round, yet additionally on the handy plan of the round. Specialized improvements in present day human services may make doctors center more around detectable signs, while the significance of accounts and indications announced by patients has diminished (AlMutar, AlTourah, HussainSadeq& Marwan, 2013). Announced side effects should be painstakingly assessed, not just on the grounds that side effect easing is critical for treatment, yet in addition to direct doctors when making guesses concerning unending infection. Patients ought to be welcome to share their lived involvement of the illness with doctors and to address their own correspondence objectives. The doctors ought to recognize patients’ entitlement to take part and welcome their interest during the time spent data trade. It was discovered that the patients’ depictions of patient support concentrated on ‘having information instead of being educated and on associating with wellbeing experts, as opposed to only sharing in basic leadership’ (Krautter et al., 2014). The patients in this investigation expressed that their capacity to communicate as the need should arise differed. They thought that it was simpler to reach medical attendants than with doctors and considerably more hard to begin a discussion with a senior doctor. This ought to be considered, as patients’ esteem the data given by senior doctors, yet think that it is less demanding to comprehend the data given by medical attendants.
Conclusion
In order to conclude it can be stated that the routines of the ward rounds are not efficient enough and does not live up to the National Board of Health and Welfare intention especially in terms of the timings of the ward rounds. The investigation conducted was able to suggest that several aspects of the traditional round routines of the ward, however it was difficult to improve this. However the ward rounds can also be re-established as a core element of the daily hospital routine. By placing a high priority on the ward rounds and through the alteration of the pattern of work of the specialist who are dually accredited, there can be a possible positive impact on the care of the inpatients. This in turn might help in the provision of a high-quality, efficient, safe and multidisciplinary ward rounds. A few parts of conventional ward round schedules could be enhanced concerning the two?way data trade process among parental figures and patient. Patients’ and parental figures’ capacity to impart their objectives and the earth in which the correspondence happens are of incredible significance. The data given by medical caretakers is simpler to comprehend than that given by doctors. The climate must be open; the patient ought to be treated with compassion by staff; and patients’ entitlement to partake must be recognized by all social insurance experts included.
References

AlMutar, S., AlTourah, L., HussainSadeq, J. K., & Marwan, Y. (2013). Medical and surgical ward rounds in teaching hospitals of Kuwait University: students’ perceptions. Advances in medical education and practice, 4, 189.doi:  [10.2147/AMEP.S52096]
Bossen, C., & Jensen, L. G. (2014, February). How physicians’ achieve overview’: a case-based study in a hospital ward. In Proceedings of the 17th ACM conference on Computer supported cooperative work & social computing(pp. 257-268). ACM.Retrieved from:
Cohn, A. (2013). Restore the prominence of the medical ward round. Bmj, 347, f6451.
Krautter, M., Koehl-Hackert, N., Nagelmann, L., Jünger, J., Norcini, J., Tekian, A., &Nikendei, C. (2014). Improving ward round skills. Medical teacher, 36(9), 783-788. Retrieved from: https://doi.org/10.3109/0142159X.2014.909585
Soliman, A., Riyaz, S., Said, E., Hale, M., Mills, A., &Kapur, K. (2013). Improving the quality of care for medical inpatients by placing a higher priority on ward rounds. Clinical Medicine, 13(6), 534-538. Retrieved from: https://www.clinmed.rcpjournal.org/content/13/6/534.short
Swenne, C. L., &Skytt, B. (2014). The ward round–patient experiences and barriers to participation. Scandinavian Journal of Caring Sciences, 28(2), 297-304. Retrieved from:https://doi.org/10.1111/scs.12059
Tobiano, G., Marshall, A., Bucknall, T., &Chaboyer, W. (2015). Patient participation in nursing care on medical wards: an integrative review. International Journal of Nursing Studies, 52(6), 1107-1120. Retrieved from: https://doi.org/10.1016/j.ijnurstu.2015.02.010
Ward, D. R., Ghali, W. A., Graham, A., &Lemaire, J. B. (2014). A real-time locating system observes physician time-motion patterns during walk-rounds: a pilot study. BMC medical education, 14(1), 37. Retrieved from: https://doi.org/10.1186/1472-6920-14-37

AlMutar, S., AlTourah, L., HussainSadeq, J. K., & Marwan, Y. (2013). Medical and surgical ward rounds in teaching hospitals of Kuwait University: students’ perceptions. Advances in medical education and practice, 4, 189.doi:  [10.2147/AMEP.S52096]
Bossen, C., & Jensen, L. G. (2014, February). How physicians’ achieve overview’: a case-based study in a hospital ward. In Proceedings of the 17th ACM conference on Computer supported cooperative work & social computing(pp. 257-268). ACM.Retrieved from:
Cohn, A. (2013). Restore the prominence of the medical ward round. Bmj, 347, f6451.
Foster, K., & Laurent, R. (2013). How we make good doctors into good teachers: a short course to support busy clinicians to improve their teaching skills. Medical teacher, 35(1), 4-7. Retrieved from: https://doi.org/10.3109/0142159X.2012.731098
Hale, G., &McNab, D. (2015). Developing a ward round checklist to improve patient safety. BMJ Open Quality, 4(1), u204775-w2440. Retrieved from: https://bmjopenquality.bmj.com/content/4/1/u204775.w2440.short
Hull, L., Birnbach, D., Arora, S., Fitzpatrick, M., &Sevdalis, N. (2014). Improving surgical ward care: development and psychometric properties of a global assessment toolkit. Annals of surgery, 259(5), 904-909. Retrieved from: doi: 10.1097/SLA.0000000000000451
Krautter, M., Koehl-Hackert, N., Nagelmann, L., Jünger, J., Norcini, J., Tekian, A., &Nikendei, C. (2014). Improving ward round skills. Medical teacher, 36(9), 783-788. Retrieved from: https://doi.org/10.3109/0142159X.2014.909585
Launer, J. (2013). What’s wrong with ward rounds?. Postgraduate medical journal, 89(1058), 733-734. Retrieved from: https://dx.doi.org/10.1136/postgradmedj-2013-132472
Liu, W., Manias, E., &Gerdtz, M. (2013). Medication communication during ward rounds on medical wards: Power relations and spatial practices. Health:, 17(2), 113-134. Retrieved from: https://doi.org/10.1177/1363459312447257
Pryss, R., Mundbrod, N., Langer, D., & Reichert, M. (2015). Supporting medical ward rounds through mobile task and process management. Information Systems and e-Business Management, 13(1), 107-146. Retrieved from: https://link.springer.com/article/10.1007/s10257-014-0244-5
Pucher, P. H., Aggarwal, R., &Darzi, A. (2014). Surgical ward round quality and impact on variable patient outcomes. Annals of surgery, 259(2), 222-226. Retrieved from: doi: 10.1097/SLA.0000000000000376
Soliman, A., Riyaz, S., Said, E., Hale, M., Mills, A., &Kapur, K. (2013). Improving the quality of care for medical inpatients by placing a higher priority on ward rounds. Clinical Medicine, 13(6), 534-538. Retrieved from: https://www.clinmed.rcpjournal.org/content/13/6/534.short
Swenne, C. L., &Skytt, B. (2014). The ward round–patient experiences and barriers to participation. Scandinavian Journal of Caring Sciences, 28(2), 297-304. Retrieved from: https://doi.org/10.1111/scs.12059
Tobiano, G., Marshall, A., Bucknall, T., &Chaboyer, W. (2015). Patient participation in nursing care on medical wards: an integrative review. International Journal of Nursing Studies, 52(6), 1107-1120. Retrieved from: https://doi.org/10.1016/j.ijnurstu.2015.02.010
Ward, D. R., Ghali, W. A., Graham, A., &Lemaire, J. B. (2014). A real-time locating system observes physician time-motion patterns during walk-rounds: a pilot study. BMC medical education, 14(1), 37. Retrieved from: https://doi.org/10.1186/1472-6920-14-37

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