Oral Care and Positioning to Prevent Ventilator-Associated Pneumonia: A Systematic Review.

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in critical patients. The negative impacts of VAP on patient outcomes emphasize the importance of effective preventive measures such as oral care and patient positioning. The aim of this review was to investigate the impact of oral care and positioning on the prevention of VAP among patients in the intensive care unit. Methods: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed. The methodological quality of included studies was appraised using Joanna Briggs Institute checklists. Results: In total 13 studies were included, all of them were randomized controlled trials. Six out of nine studies about oral care have significant results on VAP incidence. Regarding the position, Patients positioned at a 45-degree were less likely to develop VAP than those positioned at a 30-degree and those in a supine position. Conclusion: Although patients positioned at 45-degree angle were less likely to develop VAP than those at 30-degree, it is necessary to individualize this practice before recommending it, once there are some contraindications, such as neurocritical patients. Regarding oral care to prevent VAP, considering the current guidelines' recommendation not to use oral chlorexidine, further studies evaluating alternatives are needed.

Confounding factors affecting the clinical decision-making of nursing and midwifery students post-pandemic COVID-19: cross-sectional study in Jordan.

BACKGROUND: The ability of a nurse to make effective clinical decisions is the most important factor that can affect the treatment quality. However, several factors can affect the ability of nursing and midwifery students to make effective clinical decisions. OBJECTIVES: This study aims to identify the confounding factors that may affect the clinical decision making of nurses and thus patient outcomes after the COVID-19 pandemic in Jordan. METHODS: A descriptive cross-sectional design was employed in this study. An online self-administered questionnaire was distributed to 269 nursing and midwifery students selected through purposive sampling, 224 of whom completed the questionnaire. The valid and reliable nursing decision-making instrument, which consisted of 24 items, was employed to gather the data, and descriptive statistics and simple linear regression were employed for the data analysis. Data was collected from November to the end of December 2022. RESULTS: Among the respondents, 72.8% were female, and the average age was 20.79 years (SD = 1.44). The vast majority of the respondents (94.6%) was unmarried, and 74.1% were pursuing a nursing degree. The simple linear regression analysis showed that clinical decision making had a negative and significant relationship with social media usage of an average of 6 h a day (ß=-0.085). Moreover, the male nursing students obtained lower clinical decision-making scores (ß= -0.408) compared with the female nursing students. CONCLUSION: Social media usage and gender have a considerable effect on the clinical decision making of the nursing and midwifery students. Therefore, the confounding factors that can affect the clinical decision making of nurses should be discussed further, and strategies to address such factors should be implemented.

An Agreement Among Nurse Educators on Infection Prevention and Control Practices to Ensure Safe Clinical Training Post-COVID-19.

Background: Infection Prevention and Control (IPC) practices during nursing students' clinical training are based on standardized precautions. However, the spread of COVID-19 raised the need to revise these practices. We aimed in this study to assess nurse educators' agreement on items that represent precautionary guidelines, which enhance safety during clinical training of students. It aimed to reach an agreement among nurse educators on IPC practices to ensure safe clinical training. Materials and Methods: This descriptive explorative, cross-sectional study included 243 Jordanian and Omani educators. The study questionnaire was based mainly on evidence reported in the literature. The study questionnaire comprised items for trainers to practice and items to supervise students. It was developed based on available evidence and recommended training practices during COVID-19 suggested by the WHO and the literature. Both the face and content validity processes were adopted to validate the study questionnaire. The final version was composed of 26 items for trainers and 20 items for students subsumed in the following themes: protecting self, protecting others, and essential training needs. Results: All questionnaire items were rated above the midpoint indicating agreement among participants on including the new IPC practices. All suggested practices (26 items for the trainers and 20 items for the students) were supported by the study participants. Conclusions: Clinical training is an important component of nursing students' preparation. Findings suggest the importance of adding new IPC practices to improve student IPC practices, protect themselves and others, minimize cross-infections, and enhance students' training within a safe clinical environment.

Nurses' and Midwives' Awareness of the Recommended Breastfeeding Practices During the Pandemic of COVID-19 and the Associated Factors in Jordan.

Introduction: The COVID-19-related restrictions imposed to reduce viral transmission have highlighted the need to support the importance of maternal breastfeeding. Clear guidelines for consistent practices across settings have been drawn up on the basis of the best available data. Emerging recommendations call to increase nurses' and midwives' awareness of these guidelines. Objective: This study aimed to explore nurses' and midwives' awareness of the recommended breastfeeding practices and associated factors in Jordan during the COVID-19 pandemic. Methods: An online descriptive cross-sectional design was adopted. This study was conducted in clinical settings representing Jordan's North, Middle, and Southern regions. One hundred seventy nurses and midwives were selected through a convenient sampling technique. Results: The mean total score of the awareness was 7.78 (SD = 1.60); 62.9% of participants were highly aware of the recommended breastfeeding practices. Nurses and midwives who were aware of the recommended breastfeeding practices during the pandemic of COVID-19 (90.7%) were more likely to perceive COVID-19 preventive measures as effective than those who were not aware of breastfeeding practices (74.6%) (χ2 = 7.886, p = .005), while work experience in years (χ2 = 8.966, p < .01) was significantly associated with awareness of the breastfeeding recommended practices. Conclusion: Most Jordanain nurses and midwives were highly aware of the recommended breastfeeding practices during COVID-19 pandemic. This awareness was positively associated with working experience and perceiving that the preventive measures of COVID-19 are effective. Educational programs for nurses and midwives about breastfeeding practice recommendations are necessary to help mothers obtain appropriate care and education.

Identifying psychosocial problems, needs, and coping mechanisms of adolescent Syrian refugees in Jordan.

Background: Refugees who have fled war zones are at a heightened risk of psychosocial problems that can impact their ability to function in day-to-day life and place a significant burden on the family structure. This study aimed to assess the psychosocial problems and needs and coping mechanisms of Adolescent Syrian refugees in Jordan. Methods: Between October and December 2018, we conducted a qualitative study using semi-structured interviews with a sample of key and individual informants. Our sample included 20 primary healthcare professionals, 20 schoolteachers, 20 Syrian parents, and 20 adolescents aged 12-17 years. All interviews were transcribed verbatim, and we utilized thematic analysis to group, categorize, and analyze the original Arabic language transcripts. To ensure thorough analysis, we adopted a bottom-up inductive approach that covered the six-phase iterative process proposed by Braun and Clarke. Results: The main psychosocial problems encountered by Syrian adolescents included stress, depression, loneliness, lack of a sense of security, isolation, aggressiveness, fear of war, and family disintegration. Almost all schoolteachers reported that they observed that Jordanian adolescents are more settled, self-confident, and financially stable relative to their Syrian peers. The Jordanian government and community were praised for their support, including education, recreational centers, health services, and awareness campaigns. Going to school, praying and reading the Holy Quran, listening to music, and talking to friends and engaging with them were reported as the main coping mechanisms. The majority of respondents said that more services are still needed for adolescents, including more places for entertainment, psychosocial support and psychological counseling, medical care, job creation, and providing health insurance. Conclusion: Syrian refugees are aware of the psychological aspects of their situation, but they are not always able to access clinic-based humanitarian assistance for mental health and psychosocial support. Stakeholders must interact with refugees to learn about their needs and develop services that are appropriate for their culture.

Measuring the prevalence of psychological symptoms and the predictors associated with seeking counseling and psychological help among university students.

Objective: To investigate the prevalence of psychological symptoms (PS) among university students and the predictors associated with seeking counseling and psychological help among students. Participants: A total of 663 students from three Jordanian universities participated in this study. Methods: A cross-sectional, correlational design was applied. Participants reported on the Attitude toward Seeking Professional Help Scale and the Hopkins Symptoms Checklist-21. Results: Students reported higher mean scores on the symptom checklist and had a poor attitude toward seeking counseling with low confidence in the counseling services. PS predicted that less than 7% of students would seek counseling with no difference among all age groups, gender, or specializations. Conclusion: High prevalence and low confidence influenced students' behavior toward seeking counseling and psychological help. There is a need to incorporate topics explaining the importance of counseling into different university courses, while emphasizing that it is neither stigmatizing nor shameful to seek professional help.

A multi-institute, follow-up, observational study measuring nursing students' adherence to infection prevention and control protocols in Saudi Arabia.

Background: Nursing students learn principles of infection prevention and control (IPC) and hand hygiene (HH) in clinical courses, and their learning is reflected in their practice. Objectives: The knowledge, attitude, and practice of principles of IPC and HH of the students were measured prior to and after attending an educational workshop. The adherence of the students to the IPC and HH protocols at the hospital was also observed. Methods: This study included a pretest-posttest time series follow-up and an observational part. During the first part of the study, students attended a workshop, which was preceded by a pretest. It was then followed by a posttest directly after finishing the workshop and in 12 weeks. Participants were submitted to an observational part by a trained observer to document certain skills taught earlier during the workshop. Settings: Students from three nursing schools in Saudi Arabia participated in the study. Participants: A total number of 130 completed the study protocol, and 100 completed the observation part. Results: Students were found to experience an improvement in their knowledge, beliefs, and commitment scales after the workshop. The attitude scale remained relatively unchanged over different tests. Most students performed the skills properly and adequately, but some failed to perform certain skills, like hand rub, and the proper use of disinfectants.

The impact of stress associated with caring for patients with COVID-19 on career decisions, resilience, and perceived self-efficacy in newly hired nurses in Jordan: A cross-sectional study.

Background and Aims: The decision to stay in nursing has been challenged by the recent coronavirus disease 2019 (COVID-19) pandemic. New nurses joined the workforce and provided care to patients with COVID-19 although they received limited training, which could have influenced their intention to stay in nursing. We aimed in this study to examine the impact of caring for patients with COVID-19 on career decisions, resilience, and perceived self-efficacy among newly hired nurses in Jordan. It also tested the predictors of intentions to stay among new nurses. Methods: This cross-sectional quantitative study was conducted using an online electronic questionnaire form. The sample included newly hired nurses (n = 300) working in public hospitals and providing care to patients with COVID-19 in different levels of acuity units. The perceived stress scale and Connor-Davidson resilience scale 25 were used to measure stress and resilience among nurses. Results: The majority chose nursing as their career, but they were not satisfied with the current work conditions or autonomy in decision-making. Many nurses reported having moderate to high work-related stress and low to moderate resilience. Among all variables in this study, financial income predicted mild intention to stay in nursing. Conclusions: Nurses expressed the presence of work-related stress and low to moderate levels of resilience. As new nurses, exposure to these stress levels might lead to burnout. Nursing managers should take necessary measures to promote better work conditions and improve resilience to avoid nurses leaving the profession at times when there is a shortage.

Reasons for delay in seeking healthcare among women with acute coronary syndrome from rural and urban areas in Jordan.

We aimed to explore reasons for delay in seeking healthcare among women with acute coronary syndrome (ACS) for the first time from urban and rural areas in Jordan. A qualitative descriptive design was used through face-to-face interviews with 33 women. Themes that explained why women delayed seeking healthcare when experiencing ACS were: Knowledge deficit about coronary artery disease; the effect of disparity in healthcare services on women decision; and life priorities of women during the ACS attack. Educational needs should be addressed based on variations in both areas.Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.1955889 .

Factors Influencing University Students' Acceptance to Undertake the COVID-19 Vaccine in Jordan.

Vaccines are effective measures that can mitigate the high burden of diseases. However, vaccine refusal poses serious challenges for achieving coverage for population immunity. With the availability of coronavirus disease-2019 (COVID-19) vaccines, limited information is available about the university students' acceptability and attitudes toward COVID-19 vaccines. This article reports study findings regarding factors that influence university students' decision of acceptability to the COVID-19 vaccine in Jordan. Results highlight the continued need for clear and consistent information about the vaccine by health care decision-makers and university administrations.

Professional Values Development Among Jordanian Baccalaureate Nursing Students.

AIM: The aims of the study were to identify professional values among third- and fourth-year baccalaureate nursing students at private and public universities in Jordan and to investigate the demographic variables correlating with professional values. BACKGROUND: Educational curricula reinforce professional values among nursing students. METHOD: A cross-sectional design was used; the questionnaire included a demographic variable survey and the Nurses Professional Values Scale-3. RESULTS: The mean score for the overall value scale was moderate (3.5, SD = 0.4, range 1-5). The caring subscale was the highest (3.9); the professionalism and the activism subscales had the same mean (3.3). Male students, studying in private universities and employed in health care, scored higher (p = .002, .001, and .01, respectively). Study track and age were insignificantly correlated. CONCLUSION: The development of professional values is associated positively with practice and employment status; clinical experience improved students' sense of professionalism.

Development and validation of the nursing clinical assessment tool (NCAT): a psychometric research study.

OBJECTIVES: The aim of this pilot psychometric study was to develop and assess the reliability, validity, and applicability of a nursing clinical assessment tool (NCAT) to assess students' clinical performance in the clinical training. METHODS: Total of 325 forms were completed by 36 clinical raters for undergraduate nursing students who were selected using convenience sampling. International quality and safety education for nurses (QSEN) and Benson and Clark's (Benson, J., & Clark, F. (1982). A guide for instrument development and validation. The American Journal of Occupational Therapy, 36(12), 789-800) model guided the construction of the NCAT. Following literature review, a cross-cultural adaptation and psychometric testing were used. RESULTS: This newly developed tool showed substantial overall internal consistency reliability (Cronbach's alpha = 0.74). Three factors (i.e. Care Provider, Leadership & Team Work and Professionalism and Ethical Considerations) were identified for construct validity using exploratory factor analysis (EFA). CONCLUSIONS: This study suggests that the NCAT is a reliable, valid and applicable tool. It can be used in clinical and educational settings. Further testing of the tool in similar and different cultures is recommended.

Knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among people diagnosed with schizophrenia in a long-term care facility.

PURPOSE: This study assessed the level of knowledge about schizophrenia, insight into illness, and internalized stigma and their associated factors among patients with schizophrenia in Jordan. DESIGN AND METHODS: A cross-sectional survey was conducted on 135 patients diagnosed with schizophrenia, who had been admitted to the largest psychiatric hospital in Jordan. FINDINGS: The participants had a low level of knowledge, insight, and a high level of internalized stigma. No correlation was found between these variables. Meanwhile, the educational level and vacation were found to be predictors of knowledge. PRACTICE IMPLICATIONS: This can help psychiatric nurses to identify which area needs to be improved to ensure the best service and care is provided to patients diagnosed with schizophrenia.

Lived Experience of Jordanian Parents Having a Child with Duchenne Muscular Dystrophy.

BACKGROUND: Duchenne muscular dystrophy (DMD) is a congenitally inherited disease characterized by progressive muscle damage and loss of function in children, which currently has no cure. Parents of children with DMD go through significant challenges when caring for a child with this condition. PURPOSE: The aim of this study was to explore the lived experience of Jordanian parents caring for a child with DMD. DESIGN AND METHODS: We utilized qualitative, descriptive, phenomenological design. Ten pairs of parents of children with DMD were interviewed at their homes from the southern region of Jordan. The Participant verbal as well as nonverbal cues were recorded during the interview. Data were analyzed using Colaizzi's 7-step method. RESULTS: Parents experienced psychosocial, emotional, and financial problems, which affected family dynamics and the quality of life. Themes emerged were face the new disease, caring for our child and handling the situation, staying in contact with the outside world, and career options and opportunities. CONCLUSIONS: Parents experienced feelings of stress and anxiety mixed with emotions of hopelessness. Parents relieved anxiety by sharing feelings with others, assuring themselves and accepting the reality of child's illness. PRACTICE IMPLICATIONS: It is necessary that parents undergo psychological counseling individually or by joining groups who had similar experiences. Follow-up by experts through the coping process. Addressing equity services in the country is necessary.

Influence of the perceived educational environment on future career planning among nursing students in Egypt.

PURPOSE: The aim of this study was to examine attitudes and knowledge regarding career planning after graduation, as well as the perceived educational environment of a pediatric clinical course, among nursing students at Menoufia University in Egypt. This study also investigated the influence of the perceived educational environment on future career planning among nursing students. METHODS: A descriptive cross-sectional study was used, with a structured interview questionnaire that included demographic characteristics, a section that measured students' attitudes and knowledge toward their career planning, and the Dundee Ready Educational Environment Measure Scale (DREEM). RESULTS: The mean total score for the DREEM scale was 109.61, and most students perceived many areas within the program as more positive than negative. However, they had low levels of knowledge regarding career planning. CONCLUSION: Based on the findings of this study, further efforts should be made to stimulate students' interest in pediatric nursing, to integrate theoretical content with practice, and to improve their planning activities early during their study. It is important to engage students in discussions concerning their ideas and worries about factors they perceive as less enhancing and more threatening in clinical settings.

Nursing students' experience of clinical supervision and contributing factors in Jordan.

BACKGROUND: Although clinical supervision is a vital component of nursing education, data on students' experiences of clinical supervision and contributing factors remain limited. AIM: The study explores nursing students' experience of clinical supervision and contributing factors in Jordan. DESIGN/METHODS: An explorative design with a qualitative approach using focus group discussions (n = 6) was used. A convenient sample consisting of 48 participants was recruited from second, third and fourth year nursing students. Data were thematically analysed using N VIVO 12. RESULTS: The analysis revealed two overlapping experiences. First, the empowering supervision experience comprising: "being willing and patient" and "working hand-in-hand" with students. Second, the disempowering supervision experience, including: abuse of power and grade obsession, incompetent supervision and lack of time detected for students. While the former has positivity which enhanced students' clinical learning, the latter reduced their motivation for gaining knowledge and skills and negatively impacted their self-confidence. CONCLUSION: Students' experience of clinical supervision is multifaceted. Thus, there is a pressing need for establishing a preparation programme for newly employed supervisors focusing on annual training updates, identifying their competency level and understanding the way their supervisory role is operationalised.

A systematic review of randomized controlled trials of psychoeducation interventions for patients diagnosed with schizophrenia.

BACKGROUND: Schizophrenia is one of the most complicated psychiatric disorders, and, although medication therapy continues to be the core treatment for schizophrenia, there is a need for psychotherapy that helps in providing patients comprehensive mental health care. Psychoeducation is one of the most recognized psychosocial interventions specific to schizophrenia. Further knowledge about the impact of this type of intervention on patients diagnosed with schizophrenia needs to be acquired. AIM: This review aimed to explore the effects of psychoeducational interventions on improving outcome measures for patients diagnosed with schizophrenia. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was used in this systematic review. Two reviewers were involved in screening articles for inclusion and in the data extraction process. The selected studies were assessed for quality using the 'Consolidated Standards of Reporting Trial (CONSORT)' checklist. Out of the 441 records identified, 11 papers were considered for full review (from 2000 to 2018). RESULTS: The psychoeducational interventions showed a consistent improvement in many outcome measures. Most of the reviewed studies focused on outpatients and the method of delivering the psychoeducational interventions was mostly in lecture format. CONCLUSION: This systematic review of randomized controlled trial studies emphasizes the positive impact of psychoeducational interventions for patients diagnosed with schizophrenia concerning various outcome measures. The findings of this review have important implications for both nursing practice and research, as the information presented can be used by the administrators and stakeholders of mental health facilities to increase their understanding and awareness of the importance of integrating psychoeducational interventions in the routine care of patients diagnosed with schizophrenia.

Cross-sectional survey on the diabetes knowledge, risk perceptions and practices among university students in South Jordan.

BACKGROUND: Diabetes mellitus is a major health problem in Jordan. This study measured the knowledge, risk perception and practice of diabetes in a sample of Jordanian university students. It also explored predictors to the relationship between the KAP sections and each section with the associated characteristics. METHOD: A cross-sectional study was carried out in seven university campuses in South Jordan. A total of 3000 participants received and were asked to fill in a self- administered structured questionnaire about their diabetes knowledge, risk perception and practice. RESULTS: A total of 2158 respondents (1031 male and 1127 females) with ages ranging between 18 and 50 years (97.2% < 30 years) were included in the final analysis. Participants' scoring was poor in diabetes knowledge (41.9%), moderate (52.5%) in risk perception of diabetes and slightly higher (61.9%) in practice. Prediction of diabetes knowledge included: age, studying health sciences, being in the first or fifth academic year, with a family history of diabetes, overweight and caring for a relative with diabetes. Without a family history of diabetes and caring for a relative with diabetes significantly predicted diabetes risk perception. Diabetes knowledge and caring for a relative with diabetes were the only predictors of diabetes practice. CONCLUSION: In spite of the educational status, university students' level of DM- related knowledge and the perceived risks and practices toward the disease were not adequate. Programs aiming to increase awareness about diabetes for students in all levels and for the general public should be initiated in order to help prevent or delay the occurrence of the disease.

Do surgical patients' characteristics and behaviours affect nurses' pain management decisions? A qualitative inquiry.

BACKGROUND: Despite a growing body of literature investigating the impact of patients' age and sex differences on pain, there is little research on how patients' characteristics and behaviours affect nurses' pain management decisions. AIM: This study examined surgical nurses' views and experiences toward pain management in relation to the patients' characteristics and behaviours in a Jordanian university hospital. METHODS: Focus group discussions (n = 4) were used with a convenience sample of 27 female Registered Nurses. RESULTS: The study revealed differences in postoperative pain management related to patients' characteristics. Male patients were seen as more tolerant of postoperative pain than female patients and thus required less nursing attention. As a consequence, nurses might assess female surgical patients inaccurately or judgementally. Nurses label female patients as "demanding" or "over-sensitive" without intending to be judgemental. Nurses also reported that patients accompanied by relatives received quicker nursing responses and closer monitoring than unaccompanied patients. CONCLUSIONS: If patients' pain following surgery is to be treated effectively, health care policymakers and educators should work together to eliminate and prevent potential biases that might lead to disparities in pain management.