[Nursing students' views on problems in clinical education in the pediatric ward in Bushehr university of medical sciences]

Introduction: Clinical education is the most important part of nursing education and is expected to provide the students with necessary clinical skills. Nursing students face with many clinical education problems in pediatric ward. This study aimed to investigate the clinical education problems in pediatric ward

Method: This cross-sectional study was performed on forth year students and graduate nurses affiliated to Bushehr University of medical sciences. Methods of sampling were census. Data gathering tool was a questionnaire consist of two parts: 1 - Demographic characteristics 2 - Inventory problems of clinical education in pediatric ward. Reliability and validity of the questionnaire were measured. Data analyzed using SPSS version 18

Results: The most important difficulties in clinical education from the students' viewpoint were deficiency of facilities, lack of access to the Internet, lack of pediatric scientific journals in the hospital library, unsuitable hospital library location, and lack of students' evaluation based on training objectives by clinical educators, unclear curriculum and training objectives by clinical educators

Conclusion: It is recommended that nursing education administrators and planners improve students' learning and motivation by application of the results of this research

[Clinical decision making process in last year nursing students: a qualitative study]

Although improving clinical decision making skills is declared as one of the main aims of nursing education, evidences show that it is not presented effectively within nursing education programmes. The present study aimed at exploring clinical decision making process among last year nursing student. Using qualitative method [Grounded theory], six focus groups and 12 sessions of participants' observation were conducted with a purposeful sample of 32 last year nursing students. The data were analyzed through constant comparative analysis. Participants believed competent clinical instructor, applicable knowledge, clinical experience; appropriate setting for clinical education and professional self confidence are the main influential factors on students' clinical decision making. Acquiring professional self confidence is the most important factor in experiencing and learning clinical decision making. The study revealed nursing student believe that not acquiring applicable knowledge and appropriate clinical experiences have impact on low professional self confidence required for clinical decisions. Therefore they are not satisfied with their gained competencies in clinical decision making. The result of this study showed that nursing students were not satisfied with the competency in clinical decision making. They experience low professional self-confidence as a result of feeling incompetent due to lack of applicable knowledge, suitable clinical experiences and conductive clinical learning climate

Comparison of axillary, tympanic and rectal body temperatures using a covariate-adjusted receiver operating characteristic approach

Accurate temperature measurement is crucial in pediatric population. Before diagnostic tests are implemented in practice, it is suggested that their accuracy or ability to discriminate to be studied. The accuracy of a diagnostic test can be summarized in a Receiver Operating Characteristic [ROC] curve. This study was carried out to compare the accuracy of tympanic and axillary methods with rectal measurement in children less than 6 years old. A total of 220 pair of ears, axillaries, and rectal sites were used to determine the body temperature in patients aged between 3 months and 6 years, who referred to Emergency Department of Ali Asghar Hospital affiliated to Bushehr University of Medical Sciences. Rectal temperature [RT] was considered as gold standard. Fever was defined as RT >/= 38°C. RT, axillary, right and left tympanic temperature were measured. Measure agreement was assessed by covariate-adjusted ROC regression. By comparing the area under the curves in Hanely method and the results from ROC regression analysis, we found out a significant agreement among the three measuring techniques and none of them was more accurate than the others. None of these techniques [axillary, right and left tympanic] was more accurate than the others and it is better to use a technique that is more convenient, painless, and safer than rectal temperature. We also propose using a modified parametric distribution-free ROC estimator which is conceptually easy and is simple to implement with the existing softwares for comparing the accuracy of medical tests

comparative study on temperature accuracy between tympanic, rectal, and axillary sites

A new method recently used for measuring the temperature is using tympanic thermometer. The aim of this study was to compare the accuracy of this method with rectal and axillary measurement in children less than 6 years old. A total of 220 pair ears, axillaries, and rectal sites were used to determine the body temperature in patients aged between 3 months to 6 years who referred to Emergency Department of Fateme Zahra Hospital affiliated to Bushehr University of Medical Sciences. Rectal temperature [RT] was considered as gold standard. Fever was defined as RT???38oC, axillary temperature [AT] ????37.2oC and tympanic temperature [TT] ????38oC. Correlation between rectal and tympanic temperature was statistically significant. The mean difference between RT and TT was 0.3oC and between RT and AT was 0.1oC. When cutoff point was considered 38oC for TT, the sensitivity was 46%, specificity was 97% and positive predictive value [PPV] and negative predictive value [NPV] were 92% and 72% respectively. ROC curve showed the best cutoff point for TT as 37oC, which increased the sensitivity to 92% and PPV to 0.98 but decreased the specificity to 90% and NPV to 0.57. Kappa test showed a good agreement rate between RT and TT. Age had significant effects on the TT/RT relationship. If the cut off point for TT is set at 38oC the sensitivity and NPV will be unacceptably low and a number of children with fever may be missed by screening with a tympanic thermometer. If the cutoff point is 37oC, the sensitivity and NPV will improve and TT can be used as a safe, easy, rapid, and accurate method in pediatrics