Adverse pregnancy, fetal and neonatal outcomes in women with sickle cell disease in a Middle Eastern country.

BACKGROUND: Sickle cell disease in pregnancy is associated with high maternal and fetal mortality. However, studies reporting pregnancy, fetal, and neonatal outcomes in women with sickle cell disease are extremely limited. OBJECTIVES: The objectives of the study are to determine whether women with sickle cell disease have a greater risk of adverse pregnancy, fetal, and neonatal outcomes than women without sickle cell disease and identify the predictors of adverse pregnancy, fetal, and neonatal outcomes in women with sickle cell disease. DESIGN: A retrospective pair-matched case-control study was conducted to compare 171 pregnant women with sickle cell disease to 171 pregnant women without sickle cell disease in Muscat, Sultanate of Oman. METHODS: All pregnant Omani women with sickle cell disease who delivered between January 2015 and August 2021 at Sultan Qaboos University Hospital and Royal Hospital, who were either primipara or multipara and who had a gestational age of 24-42 weeks, were included as patients, whereas women who had no sickle cell disease or any comorbidity during pregnancy, who delivered within the same timeframe and at the same hospitals, were recruited as controls. The data were retrieved from electronic medical records and delivery registry books between January 2015 and August 2021. RESULTS: Women with sickle cell disease who had severe anemia had increased odds of (χ2 = 58.56, p < 0.001) having adverse pregnancy outcomes. Women with sickle cell disease had 21.97% higher odds of delivering a baby with intrauterine growth retardation (χ2 = 17.80, unadjusted odds ratio = 2.91-166.13, p < 0.001). Newborns born to women with sickle cell disease had 3.93% greater odds of being admitted to the neonatal intensive care unit (χ2 = 16.80, unadjusted odds ratio = 1.97-7.84, p < 0.001). In addition, the children born to women with sickle cell disease had 10.90% higher odds of being born with low birth weight (χ2 = 56.92, unadjusted odds ratio = 5.36-22.16, p < 0.001). Hemoglobin level (odds ratio = 0.17, p < 0.001, 95% confidence interval = 0.10-3.0), past medical history (odds ratio = 7.95, p < 0.001, 95% confidence interval = 2.39-26.43), past surgical history (odds ratio = 17.69, p < 0.001, 95% confidence interval = 3.41-91.76), and preterm delivery (odds ratio = 9.48, p = 0.005, 95% confidence interval = 1.95-46.23) were identified as predictors of adverse pregnancy, fetal, and neonatal outcomes in women with sickle cell disease. CONCLUSION: As pregnant women with sickle cell disease are at increased risk for pregnancy, fetal, and neonatal adverse outcomes; improved antenatal surveillance and management may improve the outcomes.

Professional identity and preparedness for hospital practice among undergraduate nursing students: A cross-sectional study.

BACKGROUND: Professional identity is a crucial characteristic that undergraduate nursing students must possess to ensure effective and safe clinical practice. It has been identified as a factor influencing nursing student retention and their intention to remain in the nursing profession. However, the influential factors that impact the development of professional identity among nursing students currently are not well known. OBJECTIVES: To identify factors determining professional identity among undergraduate nursing students and to confirm the relationship between nursing students' professional identity and their preparedness for hospital practice. DESIGN: A cross-sectional study. SETTINGS: The largest public nursing college in Oman. PARTICIPANTS: 180 full-time undergraduate nursing students in their third and fourth years who had completed at least one clinical course. METHODS: Students completed validated, self-administered paper questionnaires through convenience sampling, including professional identity and preparedness for hospital practice scales. RESULTS: The mean total score for professional identity was 63.3 (SD = 10.5), indicating a moderate level of professional identity. The findings showed a low level of preparedness for hospital practice among nursing students, with, a mean total score of 165.8 out of 246 (SD = 30.4). We found a significant positive association between professional identity and preparedness for hospital practice (r = 0.43, p < 0.001), the number of clinical courses taken (r = 0.15, p = 0.041), enrolment in fourth-year clinical courses (H (4) = 19.9, p = 0.001), grade (H (3) = 7.8, p = 0.049) and the selection of nursing profession as the first choice (H (3) = 28.0, p = 0.05). CONCLUSIONS: The study has implications for identifying students with lower readiness for hospital practice and providing them with the necessary training. Nursing educators should prioritize reinforcing professional identity among students who have chosen nursing as a secondary option or have a lower grade. This can be achieved by promoting a positive nursing image and fostering a supportive clinical learning environment.

Effectiveness of Nurse-led Lifestyle Modification Intervention on Obesity Among Young Women in India.

Background: Obesity management in young women necessitates interventions that include dietary modification and physical exercise. High-intensity lifestyle modification is effective in managing obesity in young women. Objectives: The study determined the effectiveness of a nurse-led lifestyle modification intervention (NLLMI) on obesity among young women in India. Methods: The study adopted a quasi-experimental pre- and post-interventional control group research design. The study was conducted among obese young women in the communities of Jabalpur, Madhya Pradesh, India. The participants were selected using convenient sampling technique. The sample included 150 women in the study group and 150 in the control group. The NLLMI comprising of exercises and dietary modifications were taught to the participants for 30 min three times a week for 24 weeks. Thereafter, they were encouraged to follow the diet and perform the exercises on their own for the next 12 weeks. Practice diary was maintained by the participants and they were encouraged to continue the intervention through the phone. The participants in the control group did not engage in the NLLMI until the post-test. However, they did receive the same NLLMI after the trial was over. Results: There was a high statistically significant difference (p = 0.001) between the study group and the control group the after 12th and 24th weeks of NLLMI. The study group had a significant reduction in BMI after the intervention. Conclusions: Young obese women may benefit from a NLLMI if they regularly follow the healthy eating habits and physical exercise.

Stress and Burnout Among Frontline Nurses During COVID-19 Pandemic in a Middle Eastern Country.

Introduction: The COVID-19 pandemic has resulted in an unanticipated shift in nursing practice to meet the sudden increase in demand for pandemic-related care, leaving nurses unable to provide acceptable services to patients in the way they were taught and expected to do. It put the nurses under more stress and most of them were dissatisfied with their work due to excessive burnout. Objectives: The study determined the level of stress and burnout among front-line nurses working at the Ministry of Health Hospitals in Najran, Saudi Arabia during the COVID-19 pandemic. Methods: A total of 1594 nurses were chosen using a convenience sampling approach. Google Forms were used to collect data from the nurses. COVID-19 stressors questionnaire and an abbreviated Maslach Burnout Inventory were used to assess stress and burnout among nurses. Results: Our study reported that the majority of nurses experienced extreme levels of stress as their colleagues became ill; that they would spread COVID-19 infection to their family and friends; upsetting to see COVID-19 patients dying in front of them; not knowing when the COVID-19 pandemic will be under control; and emotional exhaustion and physical fatigue. A vast majority of nurses felt there were not adequate protective measures; there was a shortage of staff at times; were nervous and scared and thought of quitting their job; and they would quit their job if a COVID-19 outbreak recur and they would fall sick. Likewise, 41.9% of the nurses experienced a high level of burnout. A significant association was found between the area of working and the level of burnout among nurses. Conclusion: As nurses experienced extreme levels of stress and severe burnout, it is vital to design regular programs to assist frontline nurses in maintaining their mental health.

Operating Room Nurses' Understanding of Their Roles and Responsibilities for Patient Care and Safety Measures in Intraoperative Practice.

Introduction: Surgical care has been a vital part of healthcare services worldwide. Several patient safety measures have been adopted universally in the operating room (OR) before, during, and following surgical procedures. Despite this, errors or near misses still occur. Nurses in the OR have a pivotal role in the identification of factors that may impact patient safety and quality of care. Therefore, exploring the OR nurses' understanding of their roles and responsibilities for patient care and safety in the intraoperative practice, which could lead to optimal patient safety, is essential. Objective: This study explored the understanding of OR nurses regarding their roles and responsibilities for patient care and safety measures in the intraoperative practice. Methods: The study was conducted in one of the tertiary care hospitals in the United Arab Emirates. Qualitative, descriptive, exploratory research design was utilized. The data were collected using semi-structured face to face interviews. Purposive sampling included eight nurses. Data analysis was performed following Colaizzi's seven-step strategy. Results: Seven emerging themes were identified. The main themes are: patient safety, preoperative preparation, standardization of practice, time management, staffing appropriateness, staff education and communication, and support to the patient in the OR. Conclusion: OR nurse leaders may take into consideration the current findings as a reference for quality improvement projects in the hospital, considering the specific characteristics of each local setting. Although the participants consider that the environment is safe and the quality of care is high in the study setting, there is still room for improvement on workflows and processes. OR workflow should be improved especially by addressing the potential patient safety issues.

Preferences for printed books versus E-books among university students in a Middle Eastern country.

Background: Learning styles vary among the students at the university level which has changed from traditional to more technology pervaded strategies involving digital gadgets. The Academic libraries are being challenged to upgrade from old fashioned hard copy resources to digital libraries including electronic books. Purpose: The main purpose of the study is to assess the preferences of using printed books versus e-books. Methods: A descriptive cross sectional survey design was used to collect the data. A total of 607 students were included in the study. Data collected was analyzed using descriptive and inferential statistics. Results: Results showed that 86.8% of the students were in undergraduate program with 48.9% students in the second year of the program, 95.6% in the age group of 17-26 years and 59.5% of them being females. The study concluded that 74.6% of students prefer e-books in terms of easy to carry and 80.6% of them spent more than 1 h reading from e-books, while 66.7% of the students preferred printed books due to the ease in studying and 67.9% favored as it is easy to make notes. However, 54% of them felt studying from the digital copies difficult. Conclusion: The study concludes that the students prefer e-books as they spent more time reading from e-books and are easy to carry; while traditional printed copy is comfortable to use and easy to take notes and study for exams. Implications for practice: As many changes are happening in the instructional design strategies with the introduction of hybrid methods of teaching and learning, the findings of the study will guide the stake holders and educational policy makers to design novel and modernized educational design that has a psychological, and social impact among the students.

Prediction of Breast Self-Examination Behavior Among Omani Undergraduate Students Using Champion's Health Belief Model.

Introduction: Breast cancer (BC) is a most common and frequently occurring malignancy of women worldwide. Breast self-examination (BSE) is important for the early detection and prevention of BC and to limit the morbidity and mortality. Young students are ideal people to understand and motivate other women to perform BSE. Objective: BSE behavior of undergraduate students was predicted using Champion's Health Belief Model Scale (CHBMS). Methods: A descriptive cross-sectional design was adopted. This study was conducted in all nine colleges of Sultan Qaboos University, , Oman. Three-hundred eighty-one female undergraduate students were selected through convenient sampling technique. The health belief towards BSE was predicted using CHBMS. Results: The mean and SD of beliefs about the benefits of performing BSE showed 10.84 and 3.2, respectively. Mean and SD of confidence in performing BSE indicated 56.24 and 10.8. Likewise, the mean and SD of barriers in performing BSE are 13.58 and 4.2. Source of information is found to be a statistically significant predictor of barrier in performing BSE at p < .05. Conclusion: If the self- confidence of women in performing BSE improves, the women will uptake BSE more frequently thereby they can be prevented from developing the adverse consequences of advanced stages of breast cancer.

Challenges Experienced by Nurses in Providing Pediatric Palliative Care: An Interpretive Phenomenological Analysis.

Objectives: Pediatric leukemia is the most common cancer among children younger than 14 years of age. Children with leukemia require palliative care as additional support from the health care team. Providing palliative care to children is challenging. Thus, this study explored the challenges experienced by nurses in providing pediatric palliative care to children with leukemia. Methods: Semi-structured face-to-face interviews were conducted on a purposive sample of 11 nurses in the hematology-oncology units of a tertiary care hospital in Oman. Results: Interviews were transcribed and analyzed using interpretive phenomenological analysis, which revealed three main themes and seven subthemes related to challenges in providing pediatric palliative care: Personal challenges: Nurses were unable to neutralize their emotions, which burdened them emotionally; due to multitasking, nurses were unable to manage their tasks within the expected time frame; nurses were stressful when they participated in explaining the diagnosis to the parents; and nurses felt powerless when the health condition of some children deteriorated. Educational challenges: Nurses felt unprepared to meet the physical/psychosocial aspects of caring for children with leukemia. Organizational challenges: Nurses stated that families and nurses required rooms to pray, rest, and read Quran, and they needed a private place to speak to families; and nurses mentioned that there are limited number of psychologists to meet the psychological and social needs of children and their families. Conclusion: Prioritizing and implementing strategies for a supportive workplace, guided clinical practice, and maximizing nurses' satisfaction are crucial.

Prevalence of Urinary Incontinence and its Relationship With Sociodemographic and Obstetrical Variables Among Omani Women.

Objective: Urinary incontinence (UI) is defined by the International Continence Society as any complaint of involuntary urine leakage. This research study highlights the prevalence, types, and associated factors of UI among women in Oman. Methodology: A descriptive cross-sectional design was used to collect data using purposive sampling technique from 400 women between 20 and 60 years; who were attending outpatient department of a referral hospital in Oman. Women were assessed using the Questionnaire for Urinary Incontinence Diagnosis to determine the type of UI. The severity and the impact of UI in women were assessed using the female urinary tract symptoms module (ICIQ-UI-SF). Descriptive statistics were used to determine the prevalence and type of UI, and the Chi-square test was used to find the association between UI and sociodemographic and obstetrical variables. Results: In our study, 28.25% of the women belonged to the age of 50-59 years. The point prevalence (per 1000) of UI among Omani women who were between 20 and 60 years was 44%. In the women who had UI, the majority were having stress UI (41.6%). In the women who had UI, the severity of UI, according to the ICIQ-UI-SF scoring, 15.2% of the women had slight, 50.3% had moderate, 33.1% had severe, and only 1.3% had very intense. Conclusion: Understanding the prevalence of UI in every community and associated factors is essential for the policy makers and healthcare providers to consider the early diagnosis, prevention, health promotion, and management of UI.

Sources of Work-Related Stress Among Omani Nurses: A Cross-Sectional Study.

Nurses experience high levels of stress as they deal with the patients having complex health care problems. Stress in nursing affects the practice of nursing profession worldwide. In response to this, the investigators explored the sources of work-related stress (WRS) among Omani Nurses. Samples were selected through proportionate population sampling from 5 selected tertiary care hospitals. Data were collected through self-administered nursing stress scale (NSS). The study included 383 Omani nurses. Descriptive and inferential statistics were used to analyze the data. The sources of WRS among nurses showed the percentage mean scores ranging from 8.5% to 21%. The overall mean score for the NSS was 42.85 ± 17.705. Out of 7 subscales, the highest level of WRS was on workload with a mean score of 8.99 (21%) followed by emotional issues related to death and dying 8.72 (20.4%). The lowest mean score was seen on the lack of support 3.65 (8.5%) and inadequate preparation to meet the emotional demands of patients and their families 3.86 (9%) of the total mean. WRS was associated with the nursing position as staff nurses, performing night shift and reduced job satisfaction. The study's results may help in developing human resource strategies aimed at minimizing nurses' stress and improving quality of health care and task force performance.

Knowledge, attitudes and acceptance toward Human papillomavirus (HPV) vaccination: Perspectives of Muslim women and men.

OBJECTIVES: Human papillomavirus (HPV) infection is the leading risk factor for the development of anogenital cancers. Most Arab countries lack both HPV education and national HPV vaccination programs. The objective of this study was to assess knowledge, attitudes, and acceptance toward HPV vaccination in men and women from Oman, a country in the Middle Eastern North Africa region. METHODS: This cross-sectional quantitative study used convenience sampling to recruit male and female participants, aged 18 years and above from all 11 governorates of Oman to complete a validated self-administered questionnaire online in the Arabic language. The questionnaire comprised five sections, with a total of 32 questions. The questionnaire, including Arabic and English versions, was content validated and piloted. RESULTS: A total of 1403 participants, including 952 parents and 369 healthcare providers, completed the survey. The results showed a lack of knowledge regarding HPV infection and vaccines, including among healthcare providers. Less than a quarter of the participants had heard of HPV infection, with digital sources of information being the most common. Factors such as being a woman or a healthcare provider or completing higher levels of education were independently and significantly positively association with HPV awareness (p < 0.001). The majority of the participants lacked vaccine safety knowledge, had concerns about the vaccine's side effects, and sought reassurance of its protection against HPV infection (62%, 71.5%, and 84.6%, respectively). Nevertheless, nearly two-thirds of the participants agreed to take the HPV vaccine, with support for both boys and girls being vaccinated. There was almost universal agreement among the participants regarding the need for parental and adolescent HPV educational programs. CONCLUSION: Omani women and men showed a high level of acceptance and favorable attitude toward HPV vaccination. The study findings support future efforts to implement school and public-level HPV education and a national HPV vaccination program in Oman.

Efficacy of Virtual Cognitive Behavioral Therapy on COVID-19 Pandemic Related Anxiety in a Middle Eastern Country: An Interventional Study.

Introduction: Emotional stress and anxiety during COVID-19 pandemic has gained a lot of attention. The capacity to withstand from the manipulated thinking and COVID-19 related stress and anxiety depends on the resilience level of an individual. Cognitive behavioral therapy (CBT) has patronizing benefits for people affected with altered mental health. Relieving COVID-19 related anxiety using CBT has beneficial impact on health and improves quality of life of people. Objective: Aimed to relieve the anxiety of Omani population during COVID-19 pandemic using CBT. Methods: This research utilized a pre-experimental one group pre-test post-test design. A non-probability convenient sampling technique was used to select 96 Omani people who fulfilled the inclusion criteria. The pre-anxiety level was assessed using CAS (Corona virus Anxiety Scale). The participants who scored above nine in the scale were given three sessions of CBT. Post-anxiety level was assessed using CAS after three CBT sessions. Results: The study revealed that the level of anxiety reduced during post-test (6.35) after intervention when compared to pre-test (13.22). The CBT intervention was effective in reducing the anxiety in the post-test at p ≤ .000. Conclusion: CBT is effective in reducing COVID-19 related anxiety among the Omani population. Therefore, this strategy is highly recommended in people having mental health issues.

Dystrophic Epidermolysis Bullosa in a Preschooler in a Middle Eastern Country.

Epidermolysis Bullosa (EB) is a very rare genetic skin disorder associated with skin fragility. It results in blister formation on the skin. The purpose of this paper is to update the progress of a child with Dystrophic EB (DEB) who survived from infancy to preschool years and later died with recurrent skin blisters, bone marrow transplantation, and life support measures. A case analysis was done to evaluate the progress of the child. The mother of the child signed the written informed consent and granted permission to publish the details of the child with images and without disclosing the identifying information. The management of EB requires a multidisciplinary team approach. The care of the child should be aimed at protecting the child's skin from injury, nutritional support, meticulous wound care, and management of complications as required. The prognosis varies from case to case.

The Association between Nursing Students' Happiness, Emotional Intelligence, and Perceived Caring Behavior in Riyadh City, Saudi Arabia.

BACKGROUND: Caring behavior is a major focus of the nursing profession and an important dimension of nursing practice that sets nurses apart from other healthcare professionals. Effective patient-centered care requires ensuring nurses have the emotional intelligence and happiness to address the daily demands of practice. The purpose of this study is to examine the emotional intelligence and happiness among nursing students and their relationship with caring behaviors. METHODS: A cross-sectional, descriptive correlational study was conducted on nursing students (n = 363) from Riyadh, Kingdom of Saudi Arabia, via an online survey. Measures include demographic data survey, Oxford Happiness Questionnaire, Trait Emotional Intelligence Questionnaire, and Caring Behaviors Inventory scale. Descriptive and multiple regression analyses were conducted for this study. RESULTS: Nursing students reported their highest degree of caring was in terms of 'respectful differences to others', while their lowest was in 'knowledge and skills'. Emotional intelligence and happiness were significant predictors of caring behaviors and explained the variance in assurance of human presence (17.5%), knowledge and skills (17.5%), respectful differences to others (18%), and positive connectedness (12.9%). In the final regression model, emotional intelligence and happiness were significant predictors of caring behaviors and explained 19.5% of the variance. CONCLUSIONS: Emotional intelligence and happiness among nursing students were found to be important factors to improve their caregiving behaviors. Therefore, nursing educators should consider integrating emotional intelligence and happiness interventions for students into their curriculum.

Effectiveness of Nurse-led Intervention on Quality of Life of Patients with Knee Osteoarthritis.

Knee osteoarthritis (KOA) is the most common type of arthritis affecting people of older age. The study assessed the effectiveness of nurse-led intervention on quality of life (QOL) of patients with KOA. A quasi-experimental pretest-posttest control group research design was adopted. Data was collected from 200 patients with KOA. The pre- and post-interventional QOL were assessed on the 15th day, 30th day, 60th day, and 90th day with a 36-item short-form health survey. A remarkable statistically significant improvement in QOL of patients with KOA in the study group was found in the IV test conducted on the 90th day (P < .001). The study concluded that a 12 weeks' nurse-led intervention has resulted in significant improvement in the QOL of patients with KOA.

Nursing Student's Satisfaction With Virtual Learning During COVID-19 Pandemic in India.

Introduction: The COVID-19 pandemic significantly impacted the world in 2020. Every country adopted quarantine measures to prevent the transmission of the coronavirus infection. These measures resulted in dramatic changes in the daily lives of most people. In the academic world, students faced a shift from the traditional classroom-based teaching to virtual distance learning platforms. This shift in nursing education posed challenges both to the instructors and students as they were not fully prepared for this transition. Objective: The study assessed the nursing students' satisfaction with the virtual learning experience during the COVID-19 pandemic in selected nursing colleges in India. Methods: The study was conducted in four nursing colleges in India. A total of 1,166 Diploma, Post Basic BSc (N), BSN, and MSN nursing students participated in the study. Ethical approval was obtained from all the nursing colleges included in the study. The Google Forms satisfaction survey included student, teacher, course, technology, environmental, and practical dimensions. Results: The response rate was 86.31% (n = 1,166). The overall satisfaction with virtual theory and practical classes has a mean and SD score of 67.14 + 11 and 16.21 + 3.46, respectively. The results showed that overall 51% of the students had good satisfaction with virtual theory classes while 48% had moderate satisfaction. In terms of overall satisfaction with virtual practical classes, approximately 39% had good satisfaction, 58% had moderate satisfaction and nearly 3% had poor satisfaction. In addition, the students expressed that they had good satisfaction with Teacher dimension (64.3%), Student dimension (63%), and Course dimension (57.2%). On the contrary, they expressed poor satisfaction in the Technical dimension (11.3%) and Environmental dimension (5.6%). The results showed that the courses, the place of attending class, and health issues were significantly associated with the student's level of satisfaction with virtual learning. Conclusion: Although the majority of the students rated their satisfaction level as being "good" in virtual theory classes and "moderate" in virtual practical learning, most of them were dissatisfied with the Technical and Environmental dimensions of virtual learning. This results calls for blended learning strategies to be designed to enhance better learning outcomes and, to ensure deepened level of satisfaction with virtual learning activities.

Objective structured clinical examination vs traditional clinical examination to evaluate students' clinical competence: A systematic review of nursing faculty and students' perceptions and experiences.

BACKGROUND: Assessment of clinical competence of nursing students is an essential requirement in professional nursing education. This article summarizes the current published evidence indicating the nursing faculty and students' perceptions and experiences on benefits of OSCE over TCE. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Electronic databases including Scopus, Medline, Science Direct, CINAHL, EBSCO, PsychINFO, and Pubmed Central were used to identify relevant articles. The studies published between January 1, 2010 and December 31, 2020 and fourteen full-text articles that met all the inclusion criteria were included in the review. RESULTS: The review identified five themes namely: a) Student's perception of OSCE; b) student's satisfaction regarding OSCE as an examination approach; c) students' perception of TCE as an examination approach; d) student's level of stress and anxiety towards OSCE vs TCE; and e) faculty member's perception and experience of OSCE. CONCLUSION: We conclude that OSCE is a more credible assessment format to evaluate the clinical competence of undergraduate nursing students compared to the TCE method.

Health Related Quality of Life of Caregivers of Children and Adolescents With Phenylketonuria: A Systematic Review.

Introduction. Caregivers of children with chronic illness are at risk of having impairment in their quality of life (QOL). We systematically reviewed the available literature related to the Health Related Quality Of Life (HRQOL) of caregivers of children with Phenylketonuria (PKU). Methods. We comprehensively searched in electronic databases including Scopus, Science Direct, CINAHL, Medline, PubMed, Google scholar, and ProQuest. The search criteria included studies with samples more than one, children suffering from PKU, exploring parents or primary caregiver's HRQOL, published from 2010 to 2020, full article available for download and published in English. Eight studies including 5 cross sectional studies, 1 open label trial, and 2 surveys were systematically reviewed. Results. Seven out of 8 studies have established a negative correlation between PKU and parent's HRQOL in at least 1 of the domains. In one study, the HRQOL of parents is higher than their population norms. Conclusion. Most of the caregivers had poor to moderate HRQOL. More studies are required to explore HRQOL of caregivers of children with PKU using similar tools and outcome measures addressing all the domains of HRQOL in order to have more clarity on the impact of PKU on caregiver's HRQOL. Interventional studies might help in improving the HRQOL of caregivers.

Case Study Analysis as an Effective Teaching Strategy: Perceptions of Undergraduate Nursing Students From a Middle Eastern Country.

Background: Case study analysis is an active, problem-based, student-centered, teacher-facilitated teaching strategy preferred in undergraduate programs as they help the students in developing critical thinking skills. Objective: It determined the effectiveness of case study analysis as an effective teacher-facilitated strategy in an undergraduate nursing program. Methodology: A descriptive qualitative research design using focus group discussion method guided the study. The sample included undergraduate nursing students enrolled in the Maternal Health Nursing Course during the Academic Years 2017 and 2018. The researcher used a purposive sampling technique and a total of 22 students participated in the study, through five (5) focus groups, with each focus group comprising between four to six nursing students. Results: In total, nine subthemes emerged from the three themes. The themes were "Knowledge development", "Critical thinking and Problem solving", and "Communication and Collaboration". Regarding "Knowledge development", the students perceived case study analysis method as contributing toward deeper understanding of the course content thereby helping to reduce the gap between theory and practice especially during clinical placement. The "Enhanced critical thinking ability" on the other hand implies that case study analysis increased student's ability to think critically and aroused problem-solving interest in the learners. The "Communication and Collaboration" theme implies that case study analysis allowed students to share their views, opinions, and experiences with others and this enabled them to communicate better with others and to respect other's ideas which further enhanced their team building capacities. Conclusion: This method is effective for imparting professional knowledge and skills in undergraduate nursing education and it results in deeper level of learning and helps in the application of theoretical knowledge into clinical practice. It also broadened students' perspectives, improved their cooperation capacity and their communication with each other. Finally, it enhanced student's judgment and critical thinking skills which is key for their success.