Antenatal Education Services in Oman: A Descriptive Qualitative Inquiry of Healthcare Provider's Perspective.

Introduction: To ensure positive pregnancy and birth outcomes, healthcare providers working in antenatal clinics are expected to provide regular antenatal education to enable early detection and timely treatment of pregnancy-related morbidities to prevent complications during labor, birth, and postnatal period. Although antenatal education and services are provided through standard programs in developed countries, presently there are no well-structured programs in many developing countries. The study compares the current service with the national and international guidelines. Objective: To identify the current practices of healthcare providers in antenatal education service in Oman with the aim of identifying any major implementation gaps. Methods: A qualitative inquiry was implemented through semi-structured in-depth interviews guided by open-ended questions. The study population were healthcare providers who routinely provide antenatal services at healthcare facilities. A purposive non-probability sampling technique was used to select the key informants. Data was analyzed manually using the thematic analysis framework. Results: The antenatal education services provided fall under four themes: In relation to "Education for safe pregnancy," the findings revealed that healthcare providers did not adequately address the needs. In relation to "Education for Safe labor and Birth," the pregnant women are briefed with inadequate information about labor and birth during the antenatal period. In relation to "Education related to Postpartum," healthcare providers generally do not provide information regarding pregnant women's psychological wellbeing, breastfeeding, family planning, hygiene, and nutrition during antenatal visits. In relation to "Education related to Newborn Care," the study findings indicate that contrary to what was stipulated by the WHO (2016) to establish antenatal educational programs to help pregnant women gain the skills and knowledge regarding proper newborn care, our findings demonstrated a lack of education about newborn care by providers. Conclusion: The findings have the capacity to contribute towards the development of remedial strategies to improve maternal and neonatal outcomes in Oman. This can be achieved by addressing the practice gaps identified when comparing the current practices with international standards.

A Qualitative Inquiry of Women's Perspective of Antenatal Education Services in Oman.

Introduction: Antenatal care (ANC) provides an opportunity for systematic assessment and follow-up of pregnant women to ensure positive outcomes for mother and foetus. Pregnant women should be offered evidence-based information with support to enable them to make informed decisions. Objective: To identify the gap between the current practices and the recommended guidelines for antenatal education services in Oman. Methods: A qualitative inquiry was implemented through semistructured in-depth interviews guided by open-ended questions and probes. A purposive non-probability sampling technique was used to select 13 pregnant women who had completed 30 weeks of gestation. The women were selected from 9 antenatal healthcare facilities among them: 7 primary health centers, one polyclinic and one, tertiary hospital. Results: Antenatal education focused on four thematic areas of safe pregnancy; safe labor and birth; postpartum care; and new-born care. Regarding antenatal education for safe pregnancy, the findings indicate that most healthcare workers provided pregnant women adequate information to promote healthy dietary habits; cope with pregnancy symptoms; recognize and manage medical conditions, and to adhere to dietary supplements and medication. In addition, the findings revealed that the healthcare team did not provide the required antenatal education to meet the pregnant women's needs to ensure they had safe labor and birth, postpartum care, and new-born care. Conclusion: This study is the first of its kind in Oman to provide baseline data regarding the current antenatal education services from the perspective of pregnant women. These findings will help in developing strategies to improve maternal and neonatal outcomes in the country.

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.

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.

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.

Health-related Quality of Life of People with Multiple Sclerosis in Oman.

OBJECTIVES: Multiple sclerosis (MS) is a disabling neurological disorder with significant adverse effects on patients' quality of life (QoL). Despite the increased prevalence of MS in Arabian Gulf countries in recent years, no study has assessed the impact of MS on the health-related QoL (HRQoL) of Omani patients. Therefore, the objective of this study was to determine the impact of MS on HRQoL of Omani patients using the validated disease-specific self-administered MS International QoL (MusiQoL) instrument. METHODS: We conducted a descriptive cross-sectional survey between April and December 2019 on 177 Omani patients with MS attending Sultan Qaboos University Hospital and Khoula Hospital in Oman using the MusiQoL instrument. RESULTS: The majority (51.4%) of patients had poor HRQoL, and 48.6% had moderate HRQoL. We found that being > 30 years, female, married, separated, widowed, or divorced, and having visual and sleep problems resulted in poorer HRQoL scores. Among the different HRQoL components, relationships with the healthcare system and relationships with family and friends were the most affected by the disease process. Our results also showed that psychological wellbeing and coping domains of MusiQoL questionnaires are significantly reduced in females compared to males. CONCLUSIONS: Understanding the HRQoL of Omanis with MS provides valuable knowledge that could help optimize the management of this disease.

Communicating to Non-Speaking Critically Ill Patients: Augmentative and Alternative Communication Technique as an Essential Strategy.

INTRODUCTION: Communication with hospitalized patients is crucial to improve the quality and safety of health care. METHODS: The study assessed the communication methods used by nurses while communicating to non-speaking critically ill patients. The participants included staff nurses working in ICU, CICU, HD units of neuro- surgical, orthopedic, medical and oncology wards. Purposive sampling technique was used to recruit a total number of 194 nurses. The communication methods used were assessed by a questionnaire comprised of a list of 21 strategies used to communicate with non-speaking patients. RESULTS: The most commonly used strategies were reading the patient's mouthing words, encouraging the patient by telling them that they are doing well and nurses helping them to get better, assessing the patients for their communication ability, "thumps up" to indicate "yes", "shake head" indicating "no", use OK, or point to body parts, speaking slowly and waiting for the patient's response, spending time to listen patiently to what the patient say and touching the non-speaking critically ill patient when the nurse speaks with the patient. CONCLUSION: The study reported that the nurses used variety of communication strategies while communicating to non- speaking critically ill patients. However very few nurses used Augmentative and alternative communication strategies to communicate to non-speaking critically ill patients. The study recommends the importance of establishing Augmentative and Alternative Communication strategies in the hospitals.

Knowledge and readiness for inter professional education and collaborative practice among undergraduate nursing students in a Middle Eastern country - A pilot study.

BACKGROUND: Inter Professional Education and Collaboration (IPEC) is grounded on mutual respect, enhances collaborative practice, and increases satisfaction among health care professionals. PURPOSE: The study was conducted to assess the level of knowledge and readiness for IPEC among nursing students. METHODS: The student's level of knowledge was assessed using a 20 item questionnaire while their readiness for IPEC was measured using the Readiness for Interprofessional Learning Scale (RIPLS) comprising 19 items. A total of 125 nursing students participated in the study and data was analyzed using Statistical Package for the Social Sciences (SPSS) version 25 DISCUSSION: The mean level of knowledge was 44.41 with SD of 4.72. The mean readiness score was 79.09 with the SD of 11.77. There is no significant association between the knowledge and readiness of nursing students regarding IPEC and their demographic variables at 0.05 confidence level. CONCLUSIONS: Majority of the students had moderately adequate knowledge about IPEC and high level of readiness towards IPEC. This implies that when appropriately implemented, the students will reap the benefits of IPEC, which has the potential to improve their ability to provide holistic nursing care to their patients.

Knowledge and Competency of Novice Nursing Students in Nasogastric Tube Feeding: Is Simulation Better than Case Scenario?

OBJECTIVES: As the millennial generation enters the nursing profession, simulation takes on a key role in effective pedagogy. We sought to examine the efficacy of simulation versus case scenario as a teaching method for novice nursing students in the skill of nasogastric tube (NGT) feeding. We assessed the knowledge, competency, self-confidence, and satisfaction among these nursing students. METHODS: This quasi-experimental study was used to compare the efficacy of simulation and case scenarios in promoting knowledge, clinical competency, self-learning, and self-confidence among novice nursing students in the Middle East. The study sample included 69 students registered for the Fundamentals of Nursing Laboratory course at the College of Nursing, Sultan Qaboos University, Oman, during the spring and fall 2016 semesters. Thirty-five students were assigned to the intervention group and attended a simulation, while 34 students were assigned to the control group and were given the standard case scenario used in teaching this course. The competency of the students on NGT feeding skill was measured after a simulation or case scenario. RESULTS: In both groups, the majority of students were ≤ 20 years old, female, hailed from rural areas, and had a cumulative grade point average of > 2.5. Data showed a significant improvement in the mean scores of competency between the intervention and control groups (t (67) = 3.869, p < 0.001) suggesting that simulation was effective in gaining competency compared to the case scenario. There was a positive statistical significance between satisfaction and self-confidence among the intervention group. CONCLUSIONS: Simulation has an effective role in clinical education for teaching practical skills. However, in this study, there was a statistically significant difference in the mean scores between the two methods of teaching. This helped us to conclude that competency gained by novice students' learning a skill through simulation, was better than the competency gained through case scenario. We recommend simulation as an effective pedagogy among novice nursing students. KEYWORDS: Self Confidence; Female; Students, Nursing; Clinical Competence; Personal Satisfaction; Oman; Enteral Nutrition; Learning.

Essential methodological considerations when using grounded theory.

AIM: To suggest important methodological considerations when using grounded theory. BACKGROUND: A research method widely used in nursing research is grounded theory, at the centre of which is theory construction. However, researchers still struggle with some of its methodological issues. DISCUSSION: Although grounded theory is widely used to study and explain issues in nursing practice, many researchers are still failing to adhere to its rigorous standards. Researchers should articulate the focus of their investigations - the substantive area of interest as well as the focal population. This should be followed by a succinct explanation of the strategies used to collect and analyse data, supported by clear coding processes. Finally, the resolution of the core issues, including the core category and related categories, should be explained to advance readers' understanding. CONCLUSION: Researchers should endeavour to understand the tenets of grounded theory. This enables 'neophytes' in particular to make methodological decisions that will improve their studies' rigour and fit with grounded theory. IMPLICATIONS FOR PRACTICE: This paper complements the current dialogue on improving the understanding of grounded theory methodology in nursing research. The paper also suggests important procedural decisions researchers need to make to preserve their studies' scientific merit and fit with grounded theory.

Living Under the Constant Threat of Ebola: A Phenomenological Study of Survivors and Family Caregivers During an Ebola Outbreak.

BACKGROUND: Ebola is a highly infectious disease that is caused by viruses of the family Filoviridae and transmitted to humans by direct contact with animals infected from unknown natural reservoirs. Ebola virus infection induces acute fever and death within a few days in up to 90% of symptomatic individuals, causing widespread fear, panic, and antisocial behavior. Uganda is vulnerable to future Ebola outbreaks. Therefore, the survivors of Ebola and their family caregivers are likely to continue experiencing related antisocial overtones, leading to negative health outcomes. PURPOSE: This study articulated the lived experiences of survivors and their family caregivers after an Ebola outbreak in Kibale District, Western Uganda. Eliciting a deeper understanding of these devastating lifetime experiences provides opportunities for developing and implementing more compassionate and competent nursing care for affected persons. METHODS: Ebola survivors and their family caregivers were recruited using a purposive sampling method. Twelve (12) adult survivors and their family caregivers were recruited and were interviewed individually between May and July 2013 in Kibale, a rural district in Western Uganda close to the border of the Democratic Republic of the Congo, where Ebola virus was first discovered in 1976. Oral and written informed consent was obtained before all in-depth interviews, and the researchers adhered to principles of anonymity and confidentiality. The interviews were recorded digitally, and data analysis employed Wertz's Empirical Psychological Reflection method, which is grounded in descriptive phenomenology. RESULTS: Living under the constant threat of Ebola is experienced through two main categories: (a) defining features of the experience and (b) responding to the traumatizing experience. Five themes emerged in the first category: (a) fear, ostracism, and stigmatization; (b) annihilation of sufferer's actualities and possibilities; (c) the lingering nature of the traumatic experience; (d) psychosomatic manifestations; and (e) the inescapable nature of the experience. The second category was composed of two themes: (a) seeking self-preservation and protection and (b) transcending victimhood and becoming empowered. CONCLUSIONS: Living under the constant threat of Ebola is experienced as distressing in the physical, social, and psychological realms. In the future, prompt treatment and nursing care are recommended to minimize deaths and to reduce the widespread terror, anxiety, ostracism, and stigmatization that affected individuals and families face. Furthermore, it is recommended that the resilience of survivors and caregivers be increased to facilitate their better coping with the rampant antisocial overtones that they are likely to experience because of their association with Ebola.

Differentiating between descriptive and interpretive phenomenological research approaches.

AIM: To provide insight into how descriptive and interpretive phenomenological research approaches can guide nurse researchers during the generation and application of knowledge. BACKGROUND: Phenomenology is a discipline that investigates people's experiences to reveal what lies 'hidden' in them. It has become a major philosophy and research method in the humanities, human sciences and arts. Phenomenology has transitioned from descriptive phenomenology, which emphasises the 'pure' description of people's experiences, to the 'interpretation' of such experiences, as in hermeneutic phenomenology. However, nurse researchers are still challenged by the epistemological and methodological tenets of these two methods. DATA SOURCES: The data came from relevant online databases and research books. REVIEW METHODS: A review of selected peer-reviewed research and discussion papers published between January 1990 and December 2013 was conducted using CINAHL, Science Direct, PubMed and Google Scholar databases. In addition, selected textbooks that addressed phenomenology as a philosophy and as a research methodology were used. DISCUSSION: Evidence from the literature indicates that most studies following the 'descriptive approach' to research are used to illuminate poorly understood aspects of experiences. In contrast, the 'interpretive/hermeneutic approach' is used to examine contextual features of an experience in relation to other influences such as culture, gender, employment or wellbeing of people or groups experiencing the phenomenon. This allows investigators to arrive at a deeper understanding of the experience, so that caregivers can derive requisite knowledge needed to address such clients' needs. CONCLUSION: Novice nurse researchers should endeavour to understand phenomenology both as a philosophy and research method. This is vitally important because in-depth understanding of phenomenology ensures that the most appropriate method is chosen to implement a study and to generate knowledge for nursing practice. IMPLICATIONS FOR RESEARCH/PRACTICE: This paper adds to the current debate on why it is important for nurse researchers to clearly understand phenomenology as a philosophy and research method before embarking on a study. The paper guides novice researchers on key methodological decisions they need to make when using descriptive or interpretive phenomenological research approaches.

Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control

Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

Ebola hemorrhagic fever outbreaks: strategies for effective epidemic management, containment and control.

Ebola hemorrhagic fever, caused by the highly virulent RNA virus of the filoviridae family, has become one of the world's most feared pathogens. The virus induces acute fever and death, often associated with hemorrhagic symptoms in up to 90% of infected patients. The known sub-types of the virus are Zaire, Sudan, Taï Forest, Bundibugyo and Reston Ebola viruses. In the past, outbreaks were limited to the East and Central African tropical belt with the exception of Ebola Reston outbreaks that occurred in animal facilities in the Philippines, USA and Italy. The on-going outbreak in West Africa that is causing numerous deaths and severe socio-economic challenges has resulted in widespread anxiety globally. This panic may be attributed to the intense media interest, the rapid spread of the virus to other countries like United States and Spain, and moreover, to the absence of an approved treatment or vaccine. Informed by this widespread fear and anxiety, we analyzed the commonly used strategies to manage and control Ebola outbreaks and proposed new approaches that could improve epidemic management and control during future outbreaks. We based our recommendations on epidemic management practices employed during recent outbreaks in East, Central and West Africa, and synthesis of peer-reviewed publications as well as published "field" information from individuals and organizations recently involved in the management of Ebola epidemics. The current epidemic management approaches are largely "reactive", with containment efforts aimed at halting spread of existing outbreaks. We recommend that for better outcomes, in addition to "reactive" interventions, "pre-emptive" strategies also need to be instituted. We conclude that emphasizing both "reactive" and "pre-emptive" strategies is more likely to lead to better epidemic preparedness and response at individual, community, institutional, and government levels, resulting in timely containment of future Ebola outbreaks.

Choosing phenomenology as a guiding philosophy for nursing research.

AIM: To provide an overview of important methodological considerations that nurse researchers need to adhere to when choosing phenomenology as a guiding philosophy and research method. BACKGROUND: Phenomenology is a major philosophy and research method in the humanities, human sciences and arts disciplines with a central goal of describing people's experiences. However, many nurse researchers continue to grapple with methodological issues related to their choice of phenomenological method. DATA SOURCES: The author conducted online and manual searches of relevant research books and electronic databases. REVIEW METHODS: Using an integrative method, peer-reviewed research and discussion papers published between January 1990 and December 2011 and listed in the CINAHL, Science Direct, PubMed and Google Scholar databases were reviewed. In addition, textbooks that addressed research methodologies such as phenomenology were used. DISCUSSION: Although phenomenology is widely used today to broaden understanding of human phenomena relevant to nursing practice, nurse researchers often fail to adhere to acceptable scientific and phenomenological standards. Cognisant of these challenges, researchers are expected to indicate in their work the focus of their investigations, designs, and approaches to collecting and analysing data. They are also expected to present their findings in an evocative and expressive manner. CONCLUSIONS: Choosing phenomenology requires researchers to understand it as a philosophy, including basic assumptions and tenets of phenomenology as a research method. This awareness enables researchers, especially novices, to make important methodological decisions, particularly those necessary to indicate the study's scientific rigour and phenomenological validity. IMPLICATIONS FOR RESEARCH/PRACTICE: This paper adds to the discussion of phenomenology as a guiding philosophy for nursing research. It aims to guide new researchers on important methodological decisions they need to make to safeguard their study's scientific rigour and phenomenological validity.