Sustainable pressure injury prevention.

The quality department used adaptive leadership and the plan-do-study-act cycle to decrease pressure injury (PI) rates. After identifying gaps, the pressure injury prevention bundle was developed and implemented to bring evidence-based nursing practice to frontline nurses. Organisational rates of PI was followed for 4 years (2019-2022) and a smaller subset of 88 patients were followed in the prospective arm. Using statistical analysis, the decrease in PI rates (90%) and severity is significant (p<0.5) and sustained compared with the year prior to interventions.

The Experience of Being Male Nurse: Exploring the Enhancing Factors and Barriers of Jordanian Nursing Students.

Introduction: Despite advances in health care and education, males continue to be considered a minority in nursing programs. Little is known about the decision of Jordanian male nursing students to become nurses. Objective: The purpose of this research was to explore the factors that encourage or discourage Jordanian male nursing students from pursuing a career in nursing. Methods: A qualitative narrative approach was used for this study. Data were collected using semi-structured individual interviews. Purposive sampling was used in the research. In this study, interviews were conducted with a sample of 28 male college students. Results: The current study discovered that the following six themes exemplified the male nursing students' lives: "helping and caring," "job security and economic stability," "parents and peer influence," "level of autonomy," "social stigma," and "long working hours." Conclusion: The study's findings highlighted the importance of researching male nursing students' motivating and inhibiting factors.

Nurses' experiences of psychosocial care needs of children with thalassaemia and their families in Jordan: A phenomenological study.

AIM: To explore the experiences of Jordanian nurses regarding the psychosocial care needs of children with thalassaemia and their families. DESIGN: A descriptive phenomenological approach was employed. METHODS: A purposive sampling strategy was used to select 10 nurses who had experience in caring for children with thalassaemia. Unstructured, face-to-face interviews were conducted. Coliazzi's data analysis process was applied. RESULTS: The analysis revealed three major themes: (1) valuing psychosocial support; (2) caring for paediatric patients needs certain competencies in nurses and (3) barriers to providing psychosocial care. Nurses expressed the importance of providing psychosocial care. A lack of specialists in psychosocial care as well as a lack of screening tools, and entertainment facilities for children was identified to be impeding effective psychosocial care. Implementing training programmes for nurses concerning providing psychosocial care and making the appropriate changes in nursing curricula at the educational level are recommended.

Estimating the time point for nutritional failure in patients suffering from acute brain attacks in the intensive care unit.

BACKGROUND: Severe brain attack patients demonstrate hypermetabolic state and gastrointestinal dysfunction, leading to faster onset of nutritional failure. AIM: To estimate the time point where the development of nutritional failure is more probable among patients with acute brain attacks in the intensive care unit (ICU). METHODS: Direct bedside observation for selected nutritional parameters was performed. When enteral nutrition was initiated, observation was performed at five points over 9 days. FINDINGS: 84 patients with 55% mortality risk and on mechanical ventilation were included. Over the observation period, gastric residual volume increased (144 ml vs 196 ml), body weight decreased (79.4 kg vs 74.3 kg), and serum albumin reduced (3.6 g/dl to 3.1 g/dl). Caloric attainment and malnutrition score deteriorated, and feeding-related complications increased. Nutritional failure was evidently prevalent between the third and fifth day of observation. CONCLUSION: An earlier period of enteral nutrition entails higher probability of nutritional failure among severe brain attack patients in the ICU.

Measurement invariance of the Childhood Autism Rating Scale (CARS) across six countries.

The Childhood Autism Rating Scale (CARS) is a simple and inexpensive tool for Autism spectrum disorder (ASD) assessments, with evidenced psychometric data from different countries. However, it is still unclear whether ASD symptoms are measured the same way across different societies and world regions with this tool, since data on its cross-cultural validity are lacking. This study evaluated the cross-cultural measurement invariance of the CARS among children with ASD from six countries, for whom data were aggregated from previous studies in India (n = 101), Jamaica (n = 139), Mexico (n = 72), Spain (n = 99), Turkey (n = 150), and the United States of America (n = 186). We analyzed the approximate measurement invariance based on Bayesian structural equation modeling. The model did not fit the data and its measurement invariance did not hold, with all items found non-invariant across the countries. Items related to social communication and interaction (i.e., relating to people, imitation, emotional response, and verbal and nonverbal communication) displayed lower levels of cross-country non-invariance compared to items about stereotyped behaviors/sensory sensitivity (i.e., body and object use, adaptation to change, or taste, smell, and touch response). This study found that the CARS may not provide cross-culturally valid ASD assessments. Thus, cross-cultural comparisons with the CARS should consider first which items operate differently across samples of interest, since its cross-cultural measurement non-invariance could be a source of cross-cultural variability in ASD presentations. Additional studies are needed before drawing valid recommendations in relation to the cultural sensitivity of particular items.

From Learning on Mannequins to Practicing on Patients: Nursing Students' First-Time Experience of Clinical Placement in Jordan.

INTRODUCTION: Although clinical nursing placement is an indispensable component of student nurses' education, data on students' first clinical experiences is scarce in developing countries. OBJECTIVES: The study aim is to uncover nursing students' first-time clinical placement experience and identify related influencing factors in Jordan.Methods: Focus group discussions (n=4) were used. RESULTS: The results showed that the transition from learning with mannequins to practicing on real patients in the clinical placement involved both effective learnings through hands-on practice to dealing with clinical challenges. Students perception of nursing ranged from positive comments such as "humanistic" and "nursing almost medicine" to negative images such as "nursing is all about bedside care" and "nursing has poor social status." CONCLUSION: Students' experience in their first clinical placement is multifaceted, and incorporation of student's perspective in the first clinical placement is a crucial component of educational planning.

Community-Acquired Pressure Injuries in the Acute Care Setting.

OBJECTIVE: To explore the population of patients with a community-acquired pressure injury (CAPI) admitted to an acute care facility from December 2018 to December 2019. The specific aims of the study were to identify the (1) number of patients admitted with a CAPI, (2) type and frequency of pressure injury (PI), (3) location of residence prior to admission, (4) general demographics of the patient, and (5) condition of the PI at discharge. METHODS: In this retrospective descriptive study, participants were identified and pulled from the hospital database at a 260-bed level 2 trauma center. Patients' charts were identified by searching for nursing documentation of CAPIs. The exclusion criterion was charts that did not include verification of PI by a certified wound nurse. Data were pulled from the electronic medical record, verified by the certified wound nurse, and reviewed for participant demographics and implementation of PI prevention and treatment. RESULTS: Over the course of the year, 88 patients had a CAPI. The majority lived at home (86.4%), were male (68.2%), and had stage 2 PIs (37%) on the sacrum (30.7%) or coccyx (51.1%). All participants had multiple comorbidities. Few PIs were from postacute care settings (11%) or another acute care hospital (1.1%). On average, patients had more than one PI. All patients had decreased or impaired mobility and mean body mass index of 26.38 ± 7.23 kg/m2. No one developed a new PI while in the acute care setting, and many of the CAPIs either healed (69.3%) or stabilized (22.7%). CONCLUSIONS: Providers have an opportunity to make a difference in the prevalence of PIs occurring outside of acute and postacute care settings.

Skin and Mucosal Damage in Patients Diagnosed With COVID-19: A Case Report.

Patients admitted to the intensive care unit (ICU) are at a high risk for developing pressure injuries. A patient requiring multiorgan support is at a higher risk for pressure injuries related to immobility, sedation, vasopressors, and hypoxia. To mitigate pressure injuries, our hospital utilizes a bundle approach to prevent skin injury. However, despite efforts to prevent pressure injuries, we found our patients in the ICU with the diagnosis of COVID-19 went on to develop significant pressure and mucosal injuries. This is a case report of 4 patients diagnosed with COVID-19 who developed significant skin and mucosal injuries during their ICU admissions in the month of March 2020. We found that patients developed skin conditions that were initially thought to be deep-tissue injuries (DTIs) early in the admission. The DTIs progressed over the course of the admission in the ICU and evolved to thick adherent eschar that appeared to be unstageable pressure injuries, which extended beyond the soft tissue directly over the bony prominence. We also found that skin damage to the mucosa of the nares, tongue, lips, and urethra presented first as inflammation and then progressed to thick eschar. Despite maximum pressure relief with the use of a pressure-relieving turn and position system, bordered foam dressings, fluidized positioners, specialty beds, and leadership support for twice-a-week skin checks, our patients diagnosed with COVID-19 developed extensive skin damage across the fleshy portion of the buttocks and on the mucosa of the nares, tongue, lips, and urethra during minimal exposure to pressure. Although the initial presentation of the skin damage appeared to be related to pressure, the extent of the skin damage suggests a vascular inflammatory process beyond skin damage related to pressure.

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.

Factors Associated with Prehospital Delay among Men and Women Newly Experiencing Acute Coronary Syndrome: A Qualitative Inquiry.

BACKGROUND: Delaying seeking health care for patients with acute coronary syndrome (ACS) causes high mortality and morbidity with variations among men and women regarding reasons for this delay. OBJECTIVES: This study explored factors associated with prehospital delay among men and women experiencing acute coronary syndrome for the first time in Jordan. METHODS: 35 men and 33 women with ACS admitted and treated at the coronary and postcoronary care units. RESULTS: Themes emerging from the data are knowledge about ACS, the resources related to health care, and concerns around family wellbeing. Owing to the traditional roles of men and women within the family, women felt responsible for maintaining the family, assisting in the financial conditions, and supporting family coherence by delaying hospitalization. Men were worried about the structural safety and maintenance of the family. Conclusion and Implications. Prehospital delay is common among first-timer ACS patients from both sexes, and thus, increasing awareness about ACS among the public from all age groups is necessary. Availability of specialized health care centers and equity in health care services are vital to improve public confidence in these health care settings and health outcomes.

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.

"Being relieved and puzzled": A qualitative study of first time fathers' experiences postpartum in Jordan.

BACKGROUND: Although the transition to fatherhood is a point of attention for researchers, little is known about the first time father's postpartum experience. This study aims to explore the first time fathers postpartum experience in the country of Jordan. METHODS: An exploratory qualitative design was used. Semi-structured interviews were conducted with a purposive sample consisting of twelve first time fathers. The study was conducted in a public university in Jordan. The data was collected in 2017 and was thematically analysed using the colour and file index method. RESULTS: The analysis revealed two main themes. The first theme centred around a feeling of relief which can be further divided into two sub-themes of self-actualisation and continuation of the family line. The second theme centred around the feeling of puzzlement, and this can also be further divided into two sub-themes of feeling unable to deal with a newborn baby and struggling to care for a recovering wife. The study identified fathers as willing to engage in the private care of their new babies and recovering wives but at a limited level of engagement. The fathers verbalised the lack of knowledge and exhibited sociocultural stereotypes related to masculinity and the role of the man in the family. CONCLUSIONS: The first time fathers' experiences ranged from feelings of relief to puzzlement. The fathers experiences were shaped by religion, culture, and masculinity which suggests education during antepartum may enhance the experience.

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.

Barriers to nursing pain management in the emergency department: A qualitative study.

BACKGROUND: Although pain is a common complaint among patients presenting to emergency departments (EDs), there is a dearth of nursing literature about barriers to pain management. PURPOSE: The study aimed to uncover and understand barriers to pain management in the ED from the registered nurse (RN) perspective. METHODS: Semistructured interviews were conducted with 12 ED nurses in a Jordanian hospital. Data were collected throughout August 2016. RESULTS: Two broad categories with subcategories emerged. The first category describes the idea of types of patient, which included three particular groups. These were patients who are violent, patients with relatives who are, and patients with expectations of care that nurses view as unrealistic. The second category describes the taxing ED environment, with two subcategories of staff shortages and physician dominance of pain management. Nurses reported feeling as if they are the victims of external factors and perceived that barriers affected teamwork and led to distress which impairs pain management. CONCLUSIONS: The role of ED nurses in pain management is multifaceted. Therefore, implementing policies to overcome barriers such as violence among ED attenders and the perceived hostility of the ED environment through mandatory security systems, and continuing nursing education including for violence prevention may be beneficial.

Depression in Arab Adolescents: A Qualitative Study.

Depression rates among Arab adolescents are expected to rapidly increase necessitating research-based data to aid in planning effective strategies to implement primary prevention and treatment interventions. The current study aimed to capture Jordanian adolescents' experience of depression, identify perceived contributing factors, and assess their attitudes toward depression interventions. An exploratory, qualitative design was used to collect data from 92 participants (age range = 14 to 17) through 12 focus groups. Two main analytical themes and related subthemes were identified. The first theme focused on participants' perceived mental health status, Being a Depressed Adolescent, with two related subthemes: Symptom Profiles and Feelings of Uncertainty and Perceived Roots of Depression. The second theme focused on the experience of Living With Depression and encapsulated two subthemes: Seeking Supportive Resources and Escaping From Labeling. The study revealed gender differences in the recognition of depression symptoms, willingness to seek care, the ability to communicate symptoms, expectations of care, and views on the best sources of help. For girls and boys, the fear of being labeled as mentally ill contributes to poor engagement in, adherence to, and use of mental health services. A comprehensive approach that considers Arab adolescents' beliefs, attitudes, and experiences in conjunction with the family and social context is needed to address the burden of adolescent depression in Arab nations. [Journal of Psychosocial Nursing and Mental Health Services, 57(10), 34-43.].

Comparison of the performance of the Beck Depression Inventory-II and the Center for Epidemiologic Studies-Depression Scale in Arab adolescents.

BACKGROUND AND PURPOSE: Few instruments have been established as valid and reliable to screen for depression among Arab adolescents. The purpose of this study was to examine and compare the performance of two of the most widely used depression screening instruments, the Beck Depression Inventory-II (BDI-II) and the Center for Epidemiologic Studies-Depression scale (CES-D), with Arab adolescents. METHODS: A nationwide school survey was conducted in Jordan. A total of 3,292 adolescents (1,766 females; 54%) aged 13-17 years completed and returned the survey that included the BDI-II, CES-D, sociodemographics, and health information. Comparisons were made between the BDI-II and CES-D on internal consistency and the reported prevalence of depression in the whole population and subgroups. Multivariate ordinary least squares and logistic regressions were used to assess factors associated with adolescent depression. Agreement regarding recommended cutoffs was also examined using Cohen's k. RESULTS: Depression prevalence was significantly higher with the CES-D compared to the BDI-II among the same set of sample subgroups. Depression scores from both instruments showed different statistical associations with established risk factors for adolescent depression. The two instruments showed a moderate agreement (kappa = 0.55), indicating that the instruments do not completely identify the same cases. Different cutoff scores of the CES-D seemed to perform better for different age groups. CONCLUSIONS: Our results varied systematically as a function of the measure used to identify depression prevalence. Caution in the interpretation of associations of depression scores with risk factors is required, as associations may be measurement artifacts. However, given the limited availability of mental health care resources in Arab countries, screening instruments like the BDI-II and CES-D may be a critical first step in preliminarily identifying cases, albeit neither can replace the clinical interview. We cautiously recommend using the CES-D with the risk of over diagnosing, but with the benefit of finding issues which are not typically addressed when there is a lack of mental health services. With the growing social and political unrest in Arab countries, increasing depression rates over time is expected to be a major public health issue. Methodical consideration for how to invest in community-based screening is warranted.

Postoperative Patients in Jordan: Pain Prevalence, Characteristics, Beliefs, and Satisfaction.

BACKGROUND: Unrelieved postoperative pain contributes to soaring medical costs and poor quality of life. Whilst much has been written about postoperative pain prevalence in the literature, few empirical studies have explored pain care in Middle Eastern countries. AIMS: This study aimed to determine pain prevalence, its characteristics, beliefs and satisfaction among postoperative patients in Jordan. DESIGN: This is a descriptive survey design. SETTINGS: This study was conducted in a 200-bed Jordanian public hospital located in the southern province of Jordan. PARTICIPANTS: A convenient sample of 143 surgical patients was selected. METHODS: Data were collected by the American Pain Society Patient Outcomes questionnaire, Brief Pain Inventory scale and beliefs towards pain scale. Data were analyzed using SPSS version 21. RESULTS: Pain prevalence following surgery during the first 24 hours was 87%. The overall Mean of satisfaction of all participants was moderate (66.6%). The analysis found that the greatest interference of pain was with activity (Mean ± SD = 6.27 ± 3.30). The belief "people get addicted to pain medicine easily" was the most common misunderstanding (Mean ± SD = 3.48 ± 1.71). Male participants had worse average pain experience but were more satisfied with pain management than females (ps = .012, .017, respectively). Participants aged 30 or more had better pain management experience and satisfaction than those aged under 30 (p = .021). CONCLUSIONS: The study revealed high pain prevalence among surgical patients that remains undertreated. If patients' postoperative environment is to be a "Pain Free Zone", nurses' training programs and the application of various screening tools in the postoperative context taking into account the role of gender and culture are urgently needed.

Coping strategies as moderating factors to compassion fatigue among critical care nurses.

PURPOSE: This study measured levels of compassion fatigue, burnout and satisfaction among critical care and emergency nurses. It investigated coping strategies as moderating factors and as predictors to levels of compassion fatigue. METHODS: Using a cross-sectional design, this study was conducted on 228 (84.4%) out of 270 from four Jordanian hospitals. Nurses worked in different types of critical care units and emergency departments. Nurses completed a demographic questionnaire on the professional quality of life and coping strategies indicator scales. RESULTS: Nurses had low to average compassion satisfaction, burnout and secondary stress syndrome. Problem-solving and avoidance ranged between very low and average levels. Nurses reported having very low to average levels on seeking social support scale. Female nurses had better compassion satisfaction compared with their male colleagues, and the type of unit had a significant impact on the secondary stress syndrome, problem-solving, and seeking social support. Nurses from the surgical cardiovascular ICU scored the highest mean scores on the secondary stress syndrome. Better coping strategies were associated with higher compassion satisfaction and lower levels of secondary stress syndrome. Problem-solving significantly predicted compassion satisfaction, avoidance significantly predicted secondary traumatic syndrome. CONCLUSIONS: Coping strategies are moderating factors that could improve compassion satisfaction among critical care nurses. Managers could use findings to create healthier and supportive work environments. We recommend focusing on activities that promote better coping strategies, including improving the social support system. We also recommend replicating this study using a qualitative approach to identify further causes of compassion fatigue.