Nursing experience and leadership skills among staff nurses and intern nursing students in Saudi Arabia: a mixed methods study

BACKGROUND

Nurse leaders have a crucial impact in healthcare settings. Hospitals require qualified nurses with leadership skills to provide healthy work environments and enhance the outcomes related to staff nurses and patients. This study aimed to investigate the effect of nursing experience on leadership skills among staff nurses and intern nursing students.

METHODS

A mixed methods design was applied (quantitative survey design for quantitative part and open-ended questions for qualitative part). Convenience sampling of staff nurses and intern nursing students in Saudi Arabia was applied. There were148 participants who completed the survey of the quantitative part, and 50 of them completed the qualitative part. Participants completed the Leadership Practice Inventory Questionnaire. SPSS v26 was used to analyze quantitative part, and thematic analysis was used to analyze qualitative part.

RESULTS

This study found a significance difference among participating groups regarding to the years of experience (F = 5.05, p = 0.00). Three themes were found for the qualitative part which were strategies to enhance leadership skills, factors affecting leadership skills, and obstacles facing participants related to leadership skills. The qualitative data also revealed that participants found that clinical supervision and education ways to enhance the leadership skills, while work pressure, work environment and communication were obstacles of developing their leadership skills.

CONCLUSION

Leadership skills are considered as a significant component of the function of qualified nurses and should be viewed as central to intern nursing students' learning development. Moreover, leadership skills are essential for the patient and organization outcomes. Nursing colleges and educators play an important role in enhancing to leadership skills as well as experience. Nurse leaders can create healthy care environments that have high quality and safety for patients. Management systems in healthcare organizations must motivate and support clinical leaders who can recognize both individual and clinical requirements and address current issues in their field.

Utilization of direct oral anticoagulants in a Saudi tertiary hospital: a retrospective cohort study

OBJECTIVE

This study aimed to assess the appropriateness of direct oral anticoagulants (DOACs) utilization in a Saudi tertiary hospital.

PATIENTS AND METHODS

Adult inpatients and outpatients diagnosed with atrial fibrillation, deep vein thrombosis, or pulmonary embolism were included in a retrospective cohort study. Patients received at least one month of apixaban, rivaroxaban, or dabigatran. The duration of the study at the Armed Forces Hospital Southern Region in Khamis Mushait, Saudi Arabia, was from January 1, 2019, to December 31, 2021. The study assessed the appropriateness of DOACs dosing, initial and follow-up monitoring, the presence of clinically significant interactions, and treatment duration adherence.

RESULTS

778 patients were included in the analysis (mean age 71.34 ± 15.98 years, equal male and female representation). Rivaroxaban was administered to 40.8% of the patients, while apixaban and dabigatran were administered to 31.02% and 28.18% of the patients, respectively. The most prevalent indication for DOACs was atrial fibrillation (72.84%), followed by deep vein thrombosis and pulmonary embolism (27.16%). The most prevalent category of medication errors was inappropriate maintenance dose (41.7%), followed by inappropriate initial dose (37.97%) and lack of laboratory parameter monitoring (36.42%). 31.5 percent of the study sample lacked baseline renal functions, while 24.5% of patients lacked baseline liver functions. 115 patients (14.8%) had potential clinically significant interactions. Regarding treatment duration, 232 patients (29.8%) were improperly prescribed DOACs based on their indications.

CONCLUSIONS

In a significant proportion of DOAC patients, the prescribed rational DOAC utilization parameters were not implemented. The results of the study provide specific improvement areas and objectives for Anticoagulation stewardship programs.

Surgical management of medial and lateral elbow instability secondary to acute atypical complex elbow dislocation: Case report and literature review

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The patient presented with an atypical complex elbow dislocation with fracture.

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The patient underwent lateral collateral ligament repair.

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The patient also underwent medial collateral ligament reconstruction.

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Elbow stability improved and the patient experienced improved functionality.

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Care is needed to identify and manage the underlying injury in this type of case.

Introduction and importance

Elbow dislocation is common in adults, and complex elbow dislocations are generally associated with bone fractures. Anteromedial coronoid fracture, in association with lateral collateral ligament (LCL) disruption, often results from varus posteromedial forces. “Terrible triad” injuries are more likely to result from valgus posterolateral forces. However, our case presentation has combined medial and lateral elbow instability in addition to “terrible triad” injury of the elbow with no radial head injury.

Case presentation

The patient was a 38-year-old man with an atypical complex elbow dislocation. He was successfully treated by stabilizing the medial epicondyle and coronoid anterolateral facet fractures, in addition to LCL repair and medial collateral ligament (MCL) reconstruction. A radial head fracture was unnoted. The procedure yielded satisfactory functional outcome, with a stable and painless full elbow range of motion.

Clinical discussion

Multi-ligament injuries with coronoid fractures result in highly unstable elbow joints, forming a variant of the “terrible triad” injury. Surgical options vary according to the surgeon’s experience and equipment availability. In this case, direct LCL repair and MCL reconstruction were performed and were well tolerated. Elbow stability improved and the patient experienced improved functionality with minimal pain. However, it may be premature to report a definite outcome in this case because of short follow-up time postoperatively.

Conclusion

The injury described in this case has a unique presentation as a multi-ligamentous injury will make the elbow very unstable. Thus, careful clinical judgment, knowledge, and experience are needed to identify the underlying injury and for optimal management.

Conditional risk of diverticulitis after non-operative management

BACKGROUND

The objective of this study was to describe conditional recurrence-free survival (RFS) of patients after an index episode of diverticulitis managed without surgery, and to estimate the difference in conditional RFS for diverticulitis according to specific risk factors.

METHODS

This was a multicentre retrospective cohort study including all patients managed without surgery for acute sigmoid diverticulitis at two university-affiliated hospitals in Montreal, Quebec, Canada. Conditional RFS for diverticulitis was estimated over 10 years of follow-up. A Cox proportional hazards model was performed at the index episode and again 2 years later.

RESULTS

In total, 991 patients were included for analysis. The 1, 2- and 3-year actuarial diverticulitis RFS rates were 81·1, 71·5 and 67·5 per cent respectively. Compared with the 1-year actuarial RFS rate of 81·1 per cent, the 1-year conditional RFS increased with each additional year survived recurrence-free, reaching 96·0 per cent after surviving the first 4 years recurrence-free. A similar phenomenon was observed for 2-year diverticulitis conditional RFS. Lower age (hazard ratio (HR) 0·98, 95 per cent c.i. 0·98 to 0·99), Charlson Co-morbidity Index score of 2 or above (HR 1·78, 1·32 to 2·39) and immunosuppression (HR 1·85, 1·38 to 2·48) were independently associated with recurrence of diverticulitis from the index episode. At 2 years from the index episode, immunosuppression was no longer associated with diverticulitis recurrence (HR 1·02, 0·50 to 2·09).

CONCLUSION

The conditional RFS of patients with diverticulitis improved with each year that was survived recurrence-free. Although several factors at index presentation may be associated with early recurrence, the conditional probability of recurrence according to many of these risk factors converged with time.

Assessment of the efficacy of SERI osteotomy for hallux valgus correction

BACKGROUND

SERI (Simple, Effective, Rapid, and Inexpensive) osteotomy is an accepted minimally invasive distal first metatarsal osteotomy performed to correct hallux valgus (HV). In the absence of reports of efficacy of the SERI technique in the Middle East, we studied 1-year outcomes of SERI osteotomy performed at our hospital in Saudi Arabia.

METHODS

We reviewed the medical charts of patients aged 20 to 60 years who underwent SERI osteotomy for HV between August 2013 and September 2016 and identified 29 patients, 2 (6.9%) men and 27 (93.1%) women, who met the criteria for inclusion in the study. Patients' clinical and operative characteristics were examined, their pre- and postoperative (1-year) radiographic measurements were compared, and the occurrence of any postoperative complication/event was noted.

RESULT

Patients' mean age was 34.9 ± 13.6 years. Six patients (20.7%) were treated for severe HV. Mean operation time was 11.1 ± 2.3 min. Four patients (13.8%) reported postoperative pain. No revision surgery was done. Congruency of the hallux metatarsophalangeal joint increased significantly, documented in only 4 patients (13.8%) preoperatively but in 17 (58.6%) at 1 year. The mean hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) were significantly decreased at 1 year. The HVA normalized in 20 patients (69.0%), the IMA normalized in 25 patients (86.2%), but the DMAA normalized in only 4 patients (13.8%). The number of patients with sesamoid subluxation decreased from 29 (100%) to 13 (44.8%).

CONCLUSION

Our study data indicate that SERI osteotomy reliably reduces a wide spectrum of HV deformities and it is a safe procedure with very minimal complications.

TRIAL REGISTRATION

This study is registered in ClinicalTrials.gov under the following reference number: NCT03669900 .

Bizarre calcaneal spur: A case report

INTRODUCTION

A calcaneal spur, also known as enthesophyte, is an abnormal bone outgrowth at the inferior part of the calcaneus, which is the most common site of bony spur occurrence. Although there is consensus that a calcaneal spur is a common cause of heel pain, approximately 20% of calcaneal spurs are asymptomatic and its pathology remains not fully understood.

PRESENTATION OF CASE

In this report, we present a rare case of a very large and bizarre calcaneal spur in a young adult man. The calcaneal spur was painful, which affected his foot function and was associated with plantar fasciitis. The spur length was measured in the radiograph and exhibited the longest calcaneal spur reported in the literature. The patient was treated conservatively, and he fully recovered his foot function.

DISCUSSION

This case was unique because although the patient presented with an extremely large unilateral calcaneal spur, he was young and did not have any chronic disease; hence, he was treated conservatively. The pain subsided and he regained full function of his foot. This case questions the association between calcaneal spur length and plantar fasciitis symptoms.

CONCLUSION

This case confirms that the length of calcaneal spurs, even extremely long ones, is not associated with the pathology of plantar fasciitis and that surgical treatment is not necessary.

Fracture healing in osteoporotic fractures: is it really different? A basic science perspective

Osteoporosis is a major health problem characterized by compromised bone strength that predisposes patients to an increased risk of fracture. Osteoporotic patients differ from normal subjects in bone mineral composition, bone mineral content, and crystallinity. Poor bone quality in patients with osteoporosis presents the surgeon with difficult treatment decisions. Much effort has been expended on improving therapies that are expected to preserve bone mass and thus decrease fracture risk. Manipulation of both the local fracture environment in terms of application of growth factors, scaffolds and mesenchymal cells, and systemic administration of agents promoting bone formation and bone strength has been considered as a treatment option from which promising results have recently been reported. Surprisingly, less importance has been given to investigating fracture healing in osteoporosis. Fracture healing is a complex process of bone regeneration, involving a well-orchestrated series of biological events that follow a definable temporal and spatial sequence that may be affected by both biological factors, such as age and osteoporosis, and mechanical factors such as stability of the osteosynthesis. Current studies mainly focus on preventing osteoporotic fractures. In recent years, the literature has provided evidence of altered fracture healing in osteoporotic bone, which may have important implications in evaluating the effects of new osteoporosis treatments on fracture healing. However, the mechanics of this influence of osteoporosis on fracture healing have not yet been clarified and clinical evidence is still lacking.