The need of patients living with cancer for palliative care.

BACKGROUND: A comprehensive assessment of patients' problems and needs is essential for all patients with chronic diseases, including cancer. AIM: This study assesses the problems, unmet needs and requirement for palliative care (PC) among patients with cancer. METHOD: A descriptive cross-sectional design was employed using a valid self-reported questionnaire. RESULTS: On average, 62% of patients had problems that were unresolved. The need for patients to have more information about their health was identified (75.1%), followed by financial problems because of the illness and ability to afford healthcare (72.9%), and psychological issues, such as depression, anxiety and stress (67.1%). Patients stated that their spiritual needs were not being met (78.8%), and that they were experiencing psychological distress and problems with daily living that needed to be addressed through PC (78%, 75.1%, respectively). A chi-square test revealed that all problems are significantly associated with the need for PC (P<.001). CONCLUSION: Patients needed more assistance in psychological, spiritual, financial and physical domains, and this can be provided by palliative care. Palliative care in low-income countries is a human right for patients with cancer.

Preventive and Avoidant Behaviors Followed by Jordanians During COVID-19 Pandemic.

OBJECTIVE: During the coronavirus disease 2019 (COVID-19), individuals' compliance with protective behaviors was the most effective strategy to break the infection chain and prevent disease spread, even with vaccine availability and use. Understanding protective behaviors within the Jordanian context will shape health promotion campaigns and guide decision-makers to facilitate required resources and support Jordanian citizens. The objective of this study was to identify personal protective (preventive and avoidant) measures used by the Jordanian population during the COVID-19 pandemic to protect themselves from infection. METHODS: A cross-sectional study with an exploratory, descriptive design was used to collect data using an online self-reported questionnaire from Jordanian people. The survey included the Protection from Infection Scale and the Infection Avoidance Scale. RESULTS: A total sample of 1053 Jordanian citizens was included in the study. The participants exhibited a moderate level of self-care behaviors and high levels of protective and infection avoidance behaviors. Their most common behaviors were getting enough sleep, wearing masks, washing hands, and avoiding travel to infected areas. Contrariwise, the least adopted behaviors were exercising, wearing gloves, and leaving their jobs or schools. CONCLUSIONS: During pandemics, policy-makers must understand public concerns and protective behaviors, then provide them with tailored education through health promotion campaigns to enhance healthy behaviors.

Osteoporosis education: Evaluation of an awareness program among female university students.

INTRODUCTION: Osteoporosis is a major worldwide health problem represented through decreased bone density. Females at younger ages should be the target for all efforts fighting against this disease aiming toward raising their awareness and promoting healthy behaviours. PURPOSE: To evaluate the effectiveness of an osteoporosis educational program in promoting female Jordanian university students' knowledge, attitudes and self-efficacy regarding osteoporosis. METHOD: The design of the research was a randomized control using a one-day educational program as the intervention. Two times of measurement were conducted (before and four weeks after the educational program) to measure participants' knowledge regarding osteoporosis, attitudes and self-efficacy toward osteoporosis. RESULTS: A total of 184 female university students participated in this study randomly assigned to interventional (n=112, 60.9%) and control groups (n=72, 39.1%). Before attending the educational program, participants in both groups were found to have relatively low level of knowledge, negative attitudes, and poor self-efficacy toward osteoporosis. Results of the post test indicated that participants who attended the program had significant improvement in all study variables compared to those who did not. CONCLUSION: Conducting an osteoporosis education program had positive effects on the female Jordanian university students' knowledge, attitudes, and self-efficacy. Our results support the importance of conducting awareness programs for this population and confirms the need to include an osteoporosis educational program in university curricula.

Factors affecting the caring performance of newly graduated Nurses' working in critical care units.

BACKGROUND: Although many studies have discussed nurses' caring performance, few have focussed on critical care nurses. Also, none have studied this among newly graduated nurses despite their very different circumstances. AIM: The purpose of this study was to examine factors affecting the caring performance of newly graduated nurses in critical care units. METHOD: A descriptive cross-sectional design, using self-reported questionnaires, was used among a sample of 209 nurses interviewed in Jordanian hospitals. The Mental Health Professionals Stress Scale was used for measuring work-related stress and the Caring Behaviours Assessment tool to assess caring performance. Data collection was conducted from March to May 2018. RESULTS: The participants had moderate levels of caring performance (M = 182.6/315, SD = 15.46). The highest score was reported for 'Supportive/Protective/Corrective Environment' subscale, while the lowest for 'Teaching/Learning' subscale. Many significant differences were noticed in caring performance based on participants' demographics. Only working in private hospitals was a significant predictor for caring performance (P < .05) predicting 14% of variance. CONCLUSION: Caring performance of newly graduated nurses in critical care units was affected by many factors including workload, self-doubt, income and area of working. The significance was flagged of developing nursing policies concerned with stress relief and improvement of caring performance.

The impact of somatic and cognitive depressive symptoms on medical prognosis in patients with end-stage renal disease.

PURPOSE: To determine whether somatic or cognitive depressive symptoms affect hospitalization and death in patients with end-stage renal disease. DESIGN AND METHOD: In an observational retrospective design, the patients (n = 190) completed the Beck Depression Inventory-II at baseline and were followed for 5 years to collect data all-cause mortality and hospitalization. FINDINGS: High somatic (53.7%, n = 102) and cognitive (52.1%, n = 99) depressive symptoms scores significantly associated with mortality (38% vs. 19%; hazard ratio [HR] = 2; 95% CI, 1.1-3.7; p = 0.02) and hospitalization (62.5% vs. 49.4%; HR = 1.6; 95% CI, 1.0-2.6; p = 0.03), respectively. PRACTICE IMPLICATIONS: In the context of diagnosing and intervening, awareness of depressive symptoms dimensionality is crucial.

Chest drains: prevalence of insertion and ICU nurses' knowledge of care.

BACKGROUND: Even though literature revealed the problem of nurses' knowledge deficit regarding the care of chest drain in general, no study that investigated the prevalence of chest drains in ICUs and nurses' knowledge of chest drain among Jordanian nurses was found in the literature. This study aims were to describe the prevalence rate of chest drain insertion in Jordanian ICUs, and to evaluate Jordanian nurses' level of knowledge regarding chest drain care. METHODS: Anon-experimental descriptive design using cross-sectional survey was used for evaluating nurses' knowledge utilizing researchers-developed instrument. In addition, a retrospective chart review for patients who had chest drain in the previous three months to assess the prevalence rate of chest drain insertion. Data was analysis using the Statistical Package for Social Sciences (SPSS) program. RESULTS: The 3-month period prevalence of chest drain insertion was 8%. The most common indication for chest drains insertion was cardiac surgery (84.8%, n = 134) followed by pleural effusion (6.3%, n = 10). The results revealed that the mean score for nurses' knowledge regarding care of chest drain was 15.7 out of 30 (52.3%), with the majority had insufficient or intermediate level of knowledge (47.6%, n = 107 vs. 51.1%, n = 115). The areas with least level of knowledge were in the troubleshooting (31.9%), and removal (39.5%). Nurses from private hospitals had significantly higher (M = 16, SD ± 2.77) level of knowledge (F[2, 222] = 8.467, p < .001) than nurses from other sectors. CONCLUSIONS: Chest drain is prevalent in Jordanian ICUs, which requires nurses to know how to care for patients with this critical intervention. However, they seemed to lack the needed knowledge for the appropriate care. Developing, implementing and continuous monitoring of guidelines regarding chest drain care for nurses and physicians are recommended.

Association of health warning labels and motivation to quit waterpipe tobacco smoking among university students in the Eastern Mediterranean Region.

INTRODUCTION: This study aimed to determine associations between health warning label content and motivation to quit waterpipe smoking by gender and smoking location. METHODS: Convenience samples of university students in three Eastern Mediterranean countries - Egypt (n=442), Jordan (n=535) and Palestine (n=487) - completed an online survey assessing health warning labels. Multinomial logit regression models were conducted to determine the association between different variables, particularly gender and smoking location, with motivation to quit. RESULTS: In Palestine, female smokers were more motivated to quit waterpipe smoking when seeing textual warning labels related to children (T2) and pregnancy (T6) [T2: 1.8 (95% CI: 1.1-2.8), T6: 2.7 (95% CI: 1.6-4.3)] compared to males. Similar results were found in Jordan [T2: 1.6 (95% CI: 1.0-2.6), T6: 1.8 (95% CI: 1.1-3.0)]. As for the smoking location, home-only smokers in Palestine were more likely to quit in response to the following warnings: waterpipe smoking is addictive T1: 2.3 (95% CI: 1.4-3.7), harmful for children T2: 2.3 (95% CI: 1.4-4.1), harmful for the baby during pregnancy T6: 2.4 (95% CI: 1.3-4.3), and to believe that quitting reduces the health risks T9: 1.8 (95% CI: 1.0-3.1). These results were not found in Jordan nor Egypt. Smokers reported that the most noticeable location of a HWL on a waterpipe device is the mouthpiece. CONCLUSIONS: A better understanding of motivation to quit and its association with various warnings and smoking location could guide countries on which warnings to require in legislation and where best to require them particularly in relation to location.

Functional health literacy and caregiving burden among family caregivers of patients with end-stage renal disease.

Family caregivers of patients with end-stage renal disease (ESRD) experience significant caregiver-related burden, yet the contribution of their functional health literacy (FHL) to caregiving burden has not been elucidated. We investigated the magnitude of FHL and caregiving burden and their association in a descriptive, correlational cross-sectional study of family caregivers of Jordanian patients with ESRD (N = 88). The short versions of the FHL for Adults and the Zarit Burden Interview were used for assessment of caregivers. Demographic and clinical information of patients and their family caregivers were self-reported. Of family caregivers, 41% had limited FHL and 38% experienced high caregiver burden. FHL and history of comorbidity in family caregivers predicted caregiving burden independent of demographic and clinical factors. Consideration of FHL in support interventions for family caregivers may minimize some of the high perceived caregiving burden, but clinical trials of such interventions are needed to confirm this conclusion.

Poly-Tobacco Use among Young Adult Waterpipe Smokers: Insights from University Students in Three Eastern Mediterranean Countries.

INTRODUCTION: There is a tendency of waterpipe smokers to advance their practice toward concurrent use (poly-tobacco use) of other tobacco products and nicotine delivery systems. This study investigated poly-tobacco use among waterpipe smokers, and its effect on their quit intention. METHODS: Descriptive cross-sectional design was utilized to recruit a convenience sample of university students who used waterpipe in three East Mediterranean countries. Using an internet-based survey, data were collected regarding participants' demographics, use of alternative tobacco products and nicotine delivery systems, and waterpipe quitting profile. Results: A total of 2290 students agreed to participate, among which 1116 (45.3%) reported using at least one tobacco product beside waterpipe. Poly-tobacco use was highest (61.1%) in Egypt, followed by Jordan (45.1%) and Palestine (33.1%). Across countries, cigarettes were the most common product (45.2%, n = 924) followed by cigar (18.6%, n = 374) and e-shisha (17.5%, n = 353). Conversely, the least reported product was smokeless tobacco (7.5%, n = 151) preceded by regular pipe (9.5%, n = 193). Participants who were males (OR = 2.83, 95% CI: 2.18-3.65), older (22-29 years) (OR = 1.15, 95% CI: 1.09-1.22), unemployed (OR = 1.58, 95% CI: 1.22-2.04), and those who initiated waterpipe at a younger age (OR = 0.87, 95% CI: 0.87-0.91) had higher odds of being poly-smokers. Poly-tobacco users were significantly more resistant to quit waterpipe. Conclusion: This study demonstrates poly-tobacco use as a rising phenomenon among waterpipe smokers and highlights the necessity for initiating advanced interventions to help waterpipe poly-tobacco users quit this dangerous type of addiction. Various country-specific programs are needed considering the various products used by the users.

Organisational empowerment and assertive communication behaviours: a survey of Jordanian newly qualified nurses.

BACKGROUND: Newly qualified nurses (NQNs) face several challenges in their early years of practice. Being empowered and able to speak up against unsafe practice are two important pillars for practising nursing safely and competently. Little research has examined the potential correlation between those two dimensions in the context of NQNs in Jordan. AIMS: To investigate the correlation between NQNs' perceived structural empowerment in their work setting and their willingness to challenge unsafe practice in some hypothetical clinical scenarios. METHODS: A cross-sectional survey involved 233 NQNs, who completed a self-administered questionnaire between January and March 2016. FINDINGS: Participants reported moderate levels of both perceived structural empowerment and willingness to speak up against unsafe practice. There was a statistically significant positive correlation between the total structural empowerment score and the mean score for speaking up against unsafe practice. CONCLUSION: The findings highlight the impact of peer, managerial and overall organisational support on enabling NQNs to become more empowered and assertive. Concrete, collaborative and organisation-wide efforts must be considered to foster greater empowerment of NQNs, but also revisiting work priorities to include supporting and advocating assertive communication skills among the more vulnerable of the newly qualified cohort.

Predictors of Intensive Care Unit Nurses' Practice of Evidence-Based Practice Guidelines.

Although many studies discussed evidence-based practice among general nurses, few studies were found by the researchers among intensive care unit nurses. Also, no study has been conducted to investigate the predictors of evidence-based practice among intensive care unit nurses in Jordan. Therefore, this study aims to identify the predictors of evidence-based practice among intensive care unit nurses in Jordan. A descriptive cross-sectional design was used to conveniently recruit 132 participants. Self-reported questionnaires were utilized including the Evidence-Based Practice Questionnaire and Evidence-Based Practice barrier scale. Participants' rate of evidence-based practice was 60% (M = 4.2/7), which was significantly correlated with their knowledge (r = 0.739, P < .01) and attitudes (r = 0.564, P < .01) of evidence-based practice. The results revealed a 2-predictor model that explained 62.2% of the variance in evidence-based practice among intensive care unit nurses. The 2 variables were attitude (ß = 0.245) and knowledge (ß = 0.563). The outcomes of this study added new information regarding the prediction of evidence-based practice among intensive care unit nurses. An educational program for nurses regarding this issue is crucial to improve their practice aiming at enhancing nursing care. Also, nursing schools should update their curricula to explain the importance of evidence-based practice and to enhance students' competencies in research utilization and statistical skills.

Nurses' Compliance With Bar-code Medication Administration Technology: Results of Direct Observation of Jordanian Nurses' Practice.

Medication administration using bar-code medication administration technology enhances the verification of medication administration rights. Nurses' compliance with bar-code medication administration procedure is essential to maximize the benefits. This study evaluated the current rate of nurses' compliance with bar-code medication administration use through direct observation. A descriptive design was used and 134 RNs were recruited from two public hospitals located in the middle region of Jordan. Compliance with bar-code medication administration was evaluated using an evidence-based checklist of 17 items. Participants' compliance with the bar-code medication administration was 55%, which had a significant positive correlation with their level of comfort using bar-code medication administration, usefulness, and ease of use, perceived job productivity, and overall rating of bar-code medication administration. Stakeholders can benefit from assessing end-user acceptance and perceptions regarding the bar-code medication administration technology to promote acceptance and compliance.

Waterpipe Tobacco Smoking among University Students in Three Eastern Mediterranean Countries: Patterns, Place, and Price.

Background: The objective of this study was to examine waterpipe tobacco smoking patterns, places of smoking, and prices paid among university students in the Eastern Mediterranean Region. Methods: A cross-sectional online survey was administered to a convenience sample of university students in three countries. Participants were young adults (18-29 years) who were ever waterpipe smokers, from Egypt (n = 728), Jordan (n = 790), and Palestine (n = 722). Measures included past-30-day waterpipe smoking, frequency, intensity, place of smoking, and prices paid per waterpipe smoking session and for packaged waterpipe tobacco. Logistic regression models evaluated the factors associated with past-30-day waterpipe smoking. Results: Past-30-day waterpipe smoking (prevalence) was observed among 60.7%, 67.7% and 63.1% of students from Egypt, Jordan, and Palestine, respectively. Among past-30-day smokers, past-5-day waterpipe smoking (frequency) was observed among 28.9%, 51.5%, and 48.6% of participants, respectively. Smoking in a café was highest among participants from Egypt (74.0%), followed by those from Palestine (44.8%), and Jordan (43.0%). Mean price paid per session was USD 0.99 (Egypt), USD 8.07 (Jordan), USD 6.05 (Palestine). The corresponding mean prices per packet were USD 0.86, USD 4.96, and USD 5.55, respectively. Predictors of past-30-day waterpipe smoking included younger age of initiation, male gender, employment, and smoking waterpipe alone. Conclusions: This study contributes to our understanding of waterpipe smoking patterns, places of smoking, and prices paid among young adults in a region with alarmingly high smoking rates. Understanding waterpipe smoking behaviors can inform the design of policy and educational interventions to curb its rising threat.

Nurses' satisfaction with barcode medication-administration technology: Results of a cross-sectional study.

Medication administration is a critical task of nurses that, if not done appropriately, can lead to fatal errors. New technologies, including barcode medication administration, are intended to decrease medication errors and enhance verification of medication-administration rights. Therefore, in this study, we examined the effect of introducing barcode medication administration on nurses' satisfaction and identified correlates of nurses' satisfaction with barcode medication administration. A descriptive, cross-sectional design using self-reported questionnaires was utilized to recruit 207 nurses from three public hospitals. Participants reported being moderately satisfied with barcode medication administration, especially with its efficacy and safety aspects. Their satisfaction had a significant negative correlation with their age, nursing experience, and experience using barcode medication administration, and a significant positive correlation with barcode medication-administration training satisfaction, computer competence, comfort with using barcode medication administration, and perceived job productivity using barcode medication administration. This study provides important information about Jordanian nurses' satisfaction with barcode medication-administration technology and provides greater understanding of different clinical correlates to barcode medication-administration satisfaction. It is recommended that effective barcode medication-administration training and computer skills training be provided prior to establishing barcode medication administration in hospitals and that the safety features of barcode medication administration be integrated in clinical education and training.

Impact of a Breast Cancer Educational Program on Female University Students' Knowledge, Attitudes, and Practices.

Breast cancer (BC) is a worldwide fatal cancer among females. Efforts fighting against this disease should start with females at younger ages. This study evaluated the effectiveness a BC educational program in promoting female university students' knowledge and attitudes towards BC and practices of breast self-examination (BSE). A pre- and post-test design was used in two phases; pre- and post-intervention phase. A 1-day educational program was conducted with theoretical and practical educational sessions. Participants were evaluated twice (before and 2 weeks after the intervention) for the following variables: knowledge regarding BC warning signs, BC risk factors and knowledge in regard to BSE, in addition to their attitudes and practices of BSE. A total of 110 participants were randomized into either intervention (n = 64, 58.2%) or control group (n = 46, 41.8%). Analysis revealed that participants in both groups had relatively low level of knowledge, negative attitudes, and poor practice towards BC and BSE before attending the intervention. Analysis of the post test revealed that participants in the interventional group had significant improvement in knowledge, positive attitudes, and more practice of BSE compared to participants in the control group. The implementation of a BC awareness program had positive effects on the female university students' knowledge, attitudes, and practices regarding BC and BSE. Findings from this study strengthen and reinforce the importance of conducting such awareness programs for this young age group.

Knowledge and Attitudes Toward Cancer Pain Management Among Nurses at Oncology Units.

Nurses have major responsibilities to treat cancer pain in an optimal way. Their knowledge and attitudes are the key to success cancer pain management (CPM) process and impact the outcomes of pain treatment. This study aimed to evaluate the knowledge and attitudes toward CPM among Jordanian nurses working at oncology units. A cross-sectional descriptive design was used to collect data from 135 nurses who were working at four oncology units using Knowledge and Attitudes Survey Regarding Pain. The percentage of correct answers was 51.5% indicating that participants had fair knowledge and attitudes toward CPM. Nurses appeared knowledgeable about CPM guidelines but were unfamiliar regarding pharmacological management and had negative attitudes toward opioids addiction and pain assessment. Significantly, knowledge and attitudes were higher among nurses who had previous education programs (P < .001) and worked in a pain team (P < .001). Therefore, including CPM topics in nursing curricula and postgraduate educational programs is needed. Additionally, initiating pain management teams and using CPM guidelines will contribute to effective treatment of cancer pain.

Individual-level determinants of waterpipe smoking demand in four Eastern-Mediterranean countries.

The prevalence of waterpipe tobacco smoking in the Eastern Mediterranean Region is at alarmingly high levels, especially among young people. The objective of this research was to evaluate the preferences of young adult waterpipe smokers with respect to potential individual-level determinants of waterpipe smoking using discrete choice experiment methodology. Participants were young adult university students (18-29 years) who were ever waterpipe smokers, recruited from universities across four Eastern Mediterranean countries: Jordan, Oman, Palestine and the United Arab Emirates. The Internet-based discrete choice experiment, with 6 × 3 × 2 block design, evaluated preferences for choices of waterpipe smoking sessions, presented on hypothetical waterpipe café menus. Participants evaluated nine choice sets, each with five fruit-flavored options, a tobacco flavored option (non-flavored), and an opt-out option. Choices also varied based on nicotine content (0.0% vs. 0.05% vs. 0.5%) and price (low vs. high). Participants were randomized to receive menus with either a pictorial + text health-warning message or no message (between-subjects attribute). Multinomial logit regression models evaluated the influence of these attributes on waterpipe smoking choices. Across all four samples (n = 1859), participants preferred fruit-flavored varieties to tobacco flavor, lower nicotine content and lower prices. Exposure to the health warning did not significantly predict likelihood to opt-out. Flavor accounted for 81.4% of waterpipe smoking decisions. Limiting the use of fruit flavors in waterpipe tobacco, in addition to accurate nicotine content labeling and higher pricing may be effective at curbing the demand for waterpipe smoking among young adults.

Evaluating health warning messages specific to waterpipe smoking among university students in Jordan.

BACKGROUND AND PURPOSE: Health warning messages specific to waterpipe smoking (WPS) have not been tested enough in literature. This study evaluated university students' response to such messages. Specifically, this study (1) assessed the extent to which certain warning messages and pictorial signs motivate participants to quit WPS smoking; (2) identified the best location to place the warning signs of waterpipe as perceived by participants; and (3) assessed participants' intention to quit WPS. METHODS: A descriptive, cross-sectional design was used to collect data from 397 university students in Jordan using an Internet-based survey. The following data were collected: intentions regarding WPS, response to nine warning messages, and responses to four pictorial signs. RESULTS: The message that had the highest motivation to quit smoking was " WPS during pregnancy can harm your baby" (79.3%), whereas the highest pictorial sign was regarding "Protect your children" (64.2%). Most (69.5%) participants believed that WPS products and accessories should contain warnings, and the best suggested location was the pipe handle (52.4%). Participants who reported quitting WPS and those who had an intention to quit had significantly higher responses to both types of health warning labels (HWLs). CONCLUSION: Both text-only and pictorial HWLs were found to encourage quitting WPS among university students. Knowing that participants are having an intention to quit mandates extra efforts to make WPS experience less appealing through reminding them regarding its harms. IMPLICATIONS FOR PRACTICE: Support is needed by health care providers to put those effective health warning messages in action. Furthermore, providers can use such health warnings in motivating their patients to quit WPS.

ICU Nurses' Perceived Barriers to Effective Enteral Nutrition Practices: A Multicenter Survey Study.

BACKGROUND: Critically ill patients are hypermetabolic and have increased energy requirements, making nutritional support a vital intervention. In the Intensive Care Units, enteral nutrition is based on opinions rather than evidence-based practices. Therefore, there is a need to identify the barriers to evidence based practice protocols for enteral feeding of patients in Jordanian ICUs. AIMS: To explore Jordanian ICU nurses' perceived barriers for enteral nutrition that hinders them from utilizing the recommended EN guidelines. METHODS: A descriptive cross-sectional design was utilized using self-administered questionnaire. A total of 131 nurses participated from different hospitals representing different healthcare sectors in Jordan. RESULTS: The five barriers subscales' means were almost equal ranging from 4.04 (Delivery of EN to the Patient) to 4.33 (ICU Resources) (out of 7). The most important barrier was "Not enough nursing staff to deliver adequate nutrition" (M=4.80, SD=1.81, 60%), followed by "Fear of adverse events due to aggressively feeding patients" (M= 4.59, SD=1.50, 56%). Although no significant differences in the mean barrier score were revealed, minimal significant differences were revealed that were distributed among different barrier subscales. CONCLUSION: Participants moderately perceived barriers with more focus on insufficient resources in ICU and among healthcare providers. Such barriers are modifiable and manageable, making their identification and management crucial for optimal patient care. This study confirms that enteral nutrition is a multidisciplinary responsibility.

Evidence-based guidelines for prevention of ventilator-associated pneumonia: Evaluation of intensive care unit nurses' adherence.

Using self-reported questionnaires, this descriptive study assessed nurses' adherence to ventilator-associated pneumonia (VAP) guidelines, which was found to be 81.3%. Although items concerning infection control achieved the highest scores, items concerning the suctioning process achieved the lowest scores. Participants' score of VAP care knowledge had a significant positive correlation with their score of VAP guidelines adherence. Addressing the strength and weakness domains that affect nurses' adherence is crucial for health care administrators at different managerial levels, which may help in executing different strategies to improve nurses' adherence to VAP strategies.