Decision Making Near End of Life: A Qualitative Exploration of the Lived Experiences of Jordanian Healthcare Providers.

BACKGROUND: Discussions related to a patient's prognosis and interventions near end of life are challenging and stressful for healthcare providers. Many reported experiencing emotional distress and discomfort during the decision-making process. OBJECTIVES: The aim of this study was to describe the lived experience of nurses and physicians who participate in decision making near the end of a patient's life. METHODS: A descriptive, phenomenological approach was used with a purposive sample of 7 nurses and 6 physicians from 2 palliative and end-of-life care institutions in Jordan. Data derived from focus group discussions conducted online via the ZOOM video communication application, and analysis followed Colaizzi's qualitative methodology. RESULTS: Three major themes emerged from the healthcare providers' experiences. Initially, the participants described how they "strive toward optimal decision-making near end of life," "the overwhelming experience of decision making near end of life," and finally, their struggle in sharing details about the end of life when patients ask and whether to tell or not to tell them as "the time for hard talk." CONCLUSIONS: The healthcare providers' experiences revealed several issues of decision making near a patient's end of life, such as a lack of appropriate training and administrative support, emotional distress, fear of legal liability, and the burden of a hard talk with patients. These findings necessitate institutional support of setting appropriate policies and guidelines, staff counseling, and healthcare provider support. IMPLICATIONS FOR PRACTICE: Institutions providing palliative and end-of-life care can use this study's findings to support their staff by setting appropriate practice guidelines and providing staff training and counseling.

A model for international nursing collaboration.

This article describes arguments for the development of a model for exchange of experiences among nurses, nurse managers, and nurse educators from two countries based on theories of reflection and practice and Freire's theory of dialogical action and its characteristics. The collaboration focused on exchange of experiences within nursing practice, leadership and management, and nursing education. The model consists of several activities: careful selection of participants in the exchange program; participants' observations and studies of caring in nursing practice in the other culture; keeping a diary about one's own reflections, thoughts, and questions; and participation in reflective dialogue and meetings with colleagues. The model included selection and implementation of a subject and written assignments for planned change in nursing practice within participants' own clinical nursing setting. After an implementation period of 6 months to 1 year, the outcome of the implemented change was reported in seminars and workshops.

Involvement of Jordanian Patients and Their Families in Decision Making Near End of Life, Challenges and Recommendations.

This study aims to explore the challenges in involving patients and their families in decision making near end of life and to provide recommendations to overcome these challenges. A qualitative descriptive phenomenological approach was used with a purposive sample of 8 patients, 7 family caregivers, 7 nurses, and 6 physicians from 2 institutions that provide palliative and end-of-life care services in Jordan. Data were collected using interviews with patients and family caregivers and focus group discussions with nurses and physicians. Colaizzi's method was used to analyze the data. The thematic analysis revealed 5 themes representing the participants' experiences of challenges with decision making near end of life. The identified challenges are (1) struggle with lack of information; (2) improper communication; (3) patient's or family's decision: the cultural taboo; (4) health care providers prefer staying in their comfort zone; and (5) the paradox of surviving and letting go. In addition, the participants endorsed several recommendations to raise public awareness of palliative and end-of-life care, amplify the patients' voice, and raise the bar of communication sensitivity. Decision making near the end of life is a challenge. However, the current study highlighted several areas for improvement that can improve the process and optimize patients' and their families' involvement.

Jordanian surgical nurses' experiences in caring for patients with postoperative pain.

This qualitative study aimed to describe surgical nurses' experiences in caring for patients with postoperative pain. Twelve expert Jordanian surgical nurses participated to provide data for this study. Texts were analyzed using Kvale's guidelines for analyzing qualitative data. Five themes emerged from the texts: being faced with patients' suffering, being caught between ideals and work conditions, facing neglect and misconceptions, being confronted with families' concerns and hostility, and facing the feelings of the necessity to change. Results suggested that health care organizations need to understand and empower nurses so that effective quality care can be delivered to patients.

The effect of postoperative pain management program on improving nurses' knowledge and attitudes toward pain.

Effective postoperative pain treatment is an essential component to good quality of care. The purpose of this study was to explore nurses' knowledge of and attitudes toward pain in surgical wards before and after implementation of a postoperative management program at a university hospital in Jordan. The program consisted of an education program for nurses, and its effect was evaluated by using a pre- and post-intervention design. Sixty five registered nurses were asked to respond to a 21 items questionnaire, and a total of 240 patients' records were audited. After implementation of the program, the mean scores for all the questionnaire items were found to increase to 75%, with an average of 16/21 for the correct answers. There was a statistically significant difference (p < 0.05) between the number of correct answers between nurses' responses in the pre-intervention phase and their responses in the post-intervention phase for most of the questionnaire items. Also, there was a statistically significant improvement in the documentation of patients' care in 85% of the audited patients' records. It was recommended to introduce an acute pain services (APS) using a well established and safe pain management routines to increase the quality of care.

The effect of prenatal knowledge of fetal sex on birth weight: a study from Jordan.

In this article we seek to determine the effect of the knowledge of prenatal fetal sex, through the use of ultrasound, on infant mean birth weight and the proportion of low birth weight (LBW) babies. A sample population of 1,195 women (cases, n = 640; control, n = 555) were studied in relation to their knowledge of the sex of the fetus in three hospitals in Amman, Jordan. It was found that prenatally known males had the highest mean birth weights (MBWs) as compared with females. It is proposed that these differences could be attributed to behavioral factors related to son preference. The authors conclude that further research on the actual link between prenatal detection of fetal sex and health behavior as indicated by birth weight is needed.