Indicators of Healthcare Services Utilization among the Syrian Refugee Population in Jordan: An Observational Study

BACKGROUND

Sufficient healthcare services utilization among the Syrian refugee population is one of the most important human rights. Vulnerable populations, such as refugees, are often deprived of sufficient access to healthcare services. Even when healthcare services are accessible, refugees vary in their level of utilization of these services and their health-seeking behavior.

PURPOSE

This study aims to examine the status and indicators of healthcare service access and utilization among adult Syrian refugees with non-communicable diseases residing in two refugee camps.

METHODS

The cross-sectional descriptive design was conducted by enrolling 455 adult Syrian refugees residing in the Al-Za'atari and Azraq camps in northern Jordan, using demographical data, perceived health, and the "Access to healthcare services" module, which is a part of the Canadian Community Health Survey (CCHS). A logistic regression model with binary outcomes was used to explore the accuracy of the variables influencing the utilization of healthcare services. The individual indicators were examined further out of 14 variables, according to the Anderson model. Specifically, the model consisted of healthcare indicators and demographic variables to find out if they have any effect on healthcare services utilization.

RESULTS

Descriptive data showed that the mean age of the study participants (n = 455) was 49.45 years (SD = 10.48), and 60.2% (n = 274) were females. In addition, 63.7% (n = 290), of them were married; 50.5% (n = 230) held elementary school-level degrees; and the majority 83.3% (n = 379) were unemployed. As expected, the vast majority have no health insurance. The mean overall food security score was 13 out of 24 (±3.5). Difficulty in accessing healthcare services among Syrian refugees in Jordan's camps was significantly predicted by gender. "Transportation problems, other than fee problems" (mean 4.25, SD = 1.11) and "Unable to afford transportation fees" (mean 4.27, SD = 1.12) were identified as the most important barriers to accessing healthcare services.

CONCLUSION

Healthcare services must imply all possible measures to make them more affordable to refugees, particularly older, unemployed refugees with large families. High-quality fresh food and clean drinking water are needed to improve health outcomes in camps.

Emergency Room Nurses' Attitudes toward Family Presence during Resuscitation: A Cross-Sectional Study

INTRODUCTION

Although there are guidelines that encourage the family presence during cardiopulmonary resuscitation, literature that reported on the healthcare team's attitudes suggested that this practice is often discouraged, and it remains a debatable topic.

AIM

To assess the Emergency Room Nurses' Attitudes toward family presence during cardiopulmonary resuscitation procedures.

RESEARCH DESIGN

A cross-sectional descriptive correlation research design was used for this study.

PARTICIPANTS AND RESEARCH CONTEXT

A non-probability convenience sample for this study comprised 222 registered nurses who have worked in emergency departments. The study used Family Presence During Resuscitation scale to collect the data related to nurses' attitude toward family presence during CPR.

ETHICAL CONSIDERATIONS

This study was approved by the ethics committee at Al-Zaytoonah University of Jordan.

RESULTS

Jordanian nurses had a positive attitude toward the health beliefs with a mean score of (3.71 ± 0.81), followed by cues and triggers (3.60 ± 0.82). The least attitude endorsed by nurses was perceived self-efficacy with a mean score of (2.87 ± 0.80). Point-biserial correlation yielded a positive correlation between marital status and cues or triggers (r = 0.055; p = 0.043). Moreover, person correlation showed a positive relationship between age and health beliefs (r = 00.134; p = 0.040) and a negative correlation between experience and self-efficacy (r=-0.141; p = 0.043).

CONCLUSION

Enhancing nurses' confidence based on evidence-based practice would prepare nurses to handle family presence during resuscitation.

Exploring the factors that influence healthcare providers care quality in Jordanian hospitals: the perspectives of nurses, pharmacists and physicians

Objectives

The key point of this investigation is to explore factors that influence healthcare providers’ quality care in government hospitals in Jordan, from the perspective of nurses, pharmacists and physicians.

Method

A qualitative technique (case study) was executed in this project. Semi-structured interviews (face-to-face) were used. The thematic analysis was applied in this study. The interviews were conducted with five physicians, five pharmacists and five nurses at different levels, including different specialists from Jordanian government hospitals.

Key findings

Four vital factor influencing of nu healthcare providers’ quality care were recognised in the sampled hospitals: manager ability and leadership support of staff, adequate and qualified hospital nurses and physicians, building a trusting work environment and good salaries and incentive.

Conclusions

This examination attempted to offer an in-depth comprehending factor that impacts healthcare providers’ quality care. Furthermore, it contributes to healthcare theory and practice by developing a conceptual framework that offers policymakers and managers a practical understanding of factors that influence healthcare providers’ quality care.

The impact of obesity on self-esteem and academic achievement among university students

BACKGROUND

Previous studies showed that obesity was correlated with many negative social and health outcomes including poor academic achievement and low self-esteem.

PURPOSE

To determine the prevalence of obesity and to identify the impact of obesity on self-esteem and academic performance among university students.

METHOD

The study used a correlational design to achieve the study objectives. It was conducted at the University of Jordan (UJ). The study population was all university students in at UJ. A convenience sampling technique was conducted to select 419 students. A self-administered questionnaire was designed to collect data from the sample. The body of the questionnaire was divided into two sections: a demographic data section, and the second section aimed to measure the students' self-esteem using the Rosenberg Self-Esteem Scale (SES).

RESULTS

The response rate in this study was 91.1%. The results showed that 33 students were obese (7.88%), 116 students were overweight (27.68%), 266 students were normal weight (63.48%), and four students were underweight (0.95%). The results showed that there was a significant negative relationship between obesity and self-esteem (total item) (r = -0.231, 0.000*). The results showed that there was a significant negative relationship between obesity and academic achievement (r = -0.131, 0.002).

CONCLUSION

There was a significant impact of obesity on the self-esteem and academic performance among university students.

Predictors of nurses' stress working with older people admitted to acute care setting

AIM

To identify the predictors of nurses' work stressors who care for older people (i.e., over age 65 years) in Jordan.

BACKGROUND

Nurses sometimes experience stress which could occur as results of caring for older people, for example, with multiple physical and psychological needs. This stress could affect the job satisfaction and reduce the quality of care provided to older people. Thus, identifying sources of stress and predictors that cause stress for nurses is required to enhance quality of care for older people.

DESIGN

A cross-sectional design.

METHODS

Cluster random sampling was used to select study settings (i.e., 3 public hospitals, 3 private hospitals and 17 healthcare centres) in Amman, Jordan. A convenience sampling method was used to select 485 nurses. The Quality-Work-Competence questionnaire and Nurses' Working Life Questionnaire were used. Multiple linear regressions were used to identify predictors of job stress for nurses providing care for older people. The data were collected between June 2016 and January 2017.

RESULTS

Job satisfaction, competence, development skills, gender, organisational climate and employee development, all have demonstrated significant correlations with stress. The regression analysis showed that the model significantly predicted a sizable portion of variance (R²  = 0.27, p < 0.001) in the physical and psychological stress among nurses working in the older people care settings.

CONCLUSION

The nursing profession and the employing agencies should support nurses who care for older people in practice by conducting special training programmes to cope with stress. Interventional studies should be conducted to confirm the association between the nurses' work stress who care for older people and job satisfaction, competence, development skills, gender, organisational climate and employee development.

IMPLICATIONS FOR PRACTICE

It is recommended that rotating appropriate competent nurses who care for older people, in particular dementia patients who are usually very ill may have greater needs due to their cognitive status, through other wards would temporarily reduce the nurses' stress. The nursing profession and the employing agencies should support nurses who care for older people in practice by conducting special training programmes focusing on the teaching skills and knowledge of how to deal with stress.

The influence of leadership behavior, organizational commitment, organizational support, subjective career success on organizational readiness for change in healthcare organizations

Purpose The purpose of this study is to investigate the influence of leadership behavior, organizational commitment, organizational support and subjective career success on organizational readiness for change in the healthcare organizations. The authors want to determine if nurses who had higher levels of organizational commitment, organizational support and subjective career success relationships were more open and prepared for change. Design/methodology/approach Cross-sectional, descriptive-correlational survey design was conducted using self-reported questionnaires to collect data from registered nurses. Findings The subjective career success was the strongest predictors ( β = 0.36, p < 0.001) followed by leadership behavior ( β = -0.19, p = 0.03) and participants' age ( β = -0.13, p = 0.049). Research limitations/implications This study highlights the influence of leadership behavior, organizational commitment, organizational support and subjective career success on the organizational readiness for change in healthcare organizations. Therefore, this study forms baseline data for future local and national studies. Moreover, it will strengthen the research findings if future research includes a qualitative approach that explores other healthcare professionals regarding readiness for organizational change. Practical implications This study provides information to policymakers and healthcare leaders who seek to improve management and leadership skills and respond to organizational change efforts. Social implications It is important to know the extent to which healthcare professionals, especially nurses, understand how the influence of organizational support and organizational commitment on organizational readiness for change, as well as why specific leadership behavior and subjective career success, is important in implementing the change. Originality/value This study examined the nurses' readiness for change in hospitals. Organizational readiness for change could occur in situations where nurses can exert extra efforts at work because of leaders' behaviors and the relationship between nurses and the institution.

The effects of leadership competencies and quality of work on the perceived readiness for organizational change among nurse managers

Purpose

This paper aims to set a leadership guidance program that can promote nurses’ knowledge of leadership and, at the same time, to enhance their leadership competencies and quality of work to promote their readiness for change in healthcare organizations.

Design/methodology/approach

A pre-experimental, one-group pretest-posttest design was utilized. Out of 90 invited to participate in this study, 61 nurses were accepted to participate.

Findings

The statistical analyses suggested several significant differences between pre- and in-service nurse managers about leadership competencies, quality of work and readiness for change. Yet, findings from the background characteristics were not found to be significant and had no effects on the perceived readiness for change.

Research limitations/implications

The present study highlights the importance of leadership competencies and quality of work that healthcare policymakers identify for the success of organizational change efforts.

Practical implications

Healthcare policymakers, including directors of nursing, should focus on applications that increase leadership competencies and overall satisfaction of the nurse managers to support the changes in hospitals and supporting learning organization. Hence, they should establish policies that decrease the possible negative impact of planned change efforts.

Originality/value

Competent nurse managers enhance their readiness for change, which in turn helps nurses in constructive change processes. A leadership guidance program should be set for nurse managers. This study has important implications for hospital administrators and directors of nursing.

Mental Health Nurses Attitudes and Practice Toward Physical Health Care in Jordan

Patients with mental illnesses are at high risk for physical disorders and death. The aim of this study is to describe mental health nurses' attitudes and practice toward physical health care for patients with mental illnesses. A descriptive cross-sectional design was used to collect data using self- reported questionnaire from 202 mental health nurses working in mental health settings in Jordan. The study adopted translated version of Robson and Haddad Physical Health Attitudes Scale to the Arabic language. There was significant positive correlation between the participants' positive attitudes and their current practice (r = .388, p = .000), mental health nurses who have more positive attitudes regarding physical health care involved physical health care more in their current practice. Mental health nurses' attitudes affect the quality of care provided to patients with mental illnesses. The results provide implications for practice, education, and research.

Nurses' caring and empathy in Jordanian psychiatric hospitals: A national survey

Nurses working in psychiatric hospitals need to acquire the skills of therapeutic communication and empathy, and have higher levels of caring. The present study aims to investigate the level of caring and empathy among nurses working in psychiatric hospitals. A cross-sectional survey was utilized to collect data from 205 nurses recruited from three psychiatric hospitals in Jordan. The Background Information Questionnaire, Modified Caring Dimensions Inventory, and Toronto Empathy Questionnaire were administered to the recruited participants. The findings revealed that the sampled nurses had a high level of caring and empathy. Significant correlations were found between caring and having a specialized training in mental health nursing, and having organizational and managerial support. However, no significant correlations were found between empathy and participants' characteristics. Specialized training in mental health nursing, having organizational and managerial support, and empathy were found predictors for caring.

The perception of hospital safety culture and selected outcomes among nurses: An exploratory study

The objectives of this study were to examine nurses' perceptions of the hospital safety culture in Jordan and to identify the relationships between aspects of hospital safety culture and selected safety outcomes. Data from 242 registered nurses in five Jordanian hospitals were analyzed. Aspects of hospital safety culture and outcomes were measured using the Hospital Survey on Patient Safety Culture. Among various aspects of hospital safety culture, teamwork within units had the highest average percentage of positive responses (49.8%). Additionally, participants reported deficits in other aspects of safety culture, particularly in staffing and nonpunitive response to errors, with average percentages of positive responses of 30.4% and 30.7%, respectively. Pearson correlation analysis revealed that 9 of 10 subscales of hospital safety culture were significantly correlated to one or more of the hospital safety outcomes. The findings of this study can help policymakers and healthcare administrators identify the weaknesses and strengths of hospital safety issues in order to propose effective strategies to improve patient safety and quality of care.

Investigating critical care nurses' perception regarding enteral nutrition

BACKGROUND

Evidences showed that nurses lack the needed knowledge to administer nutritional care. Besides, nutritional information was found to be incomplete in patients' record, and nurses' responsibilities regarding EN were not well understood. In Jordan, literature regarding nurses' perceptions of EN is scarce.

AIM

To investigate critical care nurses' perceptions regarding enteral nutrition (EN) of critically-ill adult patients.

METHODS

A descriptive, cross-sectional, comparative design was used to collect data from 151 Jordanian critical care nurses utilizing the Nurses' Perception of Enteral Nutrition Questionnaire.

RESULTS

Nurses in private hospitals scored the highest in regard to responsibility and support from documentation. Education, internet, and nursing school were the primary sources of EN knowledge. Besides, female nurses differ significantly from male nurses in regard to the perception of responsibility of EN.

CONCLUSION

Awareness of responsibility, supportive documentation system, and implementation of the current evidences of EN in the actual daily practices can be used to improve EN practices.

Violence Against Nurses in Emergency Departments in Jordan

Violence against nurses in emergency departments (EDs) has become a widespread phenomenon affecting nurses’ job satisfaction and work performance. Literature is scarce regarding prevalence rates and causes of violence directed toward nurses in Jordan. The present study investigated violence experienced by Jordanian nurses in EDs and causes of violence from their perspectives. This descriptive study collected data from 174 Jordanian ED nurses. The majority of the participants (91.4%) reported experiencing violence (verbal 95.3% vs. physical 23.3%). According to participants, the most common causes of violence in the ED were crowding and workload (75.9%), and the least was care of patients with dementia or Alzheimer’s disease (35.6%). Violence is common in Jordanian EDs, giving rise to many heath and behavioral consequences. Health care administrators are obligated to protect nurses from violent incidents by providing adequate safety measures, beneficial administrative procedures, and sincere efforts to overcome the causes of this phenomenon.

Jordanian women's personal practices regarding prevention and early detection of breast cancer

BACKGROUND

Breast cancer, as a leading cause of mortality, is responsible for 12.5% of all deaths in Jordan.

OBJECTIVES

The aim of this study was to describe Jordanian women's personal practices and perceptions of breast cancer screening tests.

METHODS

A quantitative cross-sectional survey using a proportionate stratified sample of 331 women was conducted. The target population includes all Jordanian women living in high- and low-density neighborhoods. The population involved women from the 12 governorates areas.

RESULTS

Perception of susceptibility, confidence in performing breast self-examination (BSE) barriers of the group that had previously performed BSE were significantly higher than those who did not practice (t = 8.38, p = .02; t = 9.90, p = .00; t = -0.98, p = .01, respectively).

CONCLUSION

The results of this study provide information to policy makers and healthcare leaders who seek to improve breast cancer prevention and response to cancer control efforts.

Jordanian nursing students' knowledge of, attitudes towards, and compliance with infection control precautions

Nursing students' noncompliance with infection control precautions has its effects not only on patients, but also on nursing students themselves. Little is known about the actual status of infection control knowledge and compliance among Jordanian nursing students. This correlational descriptive study used a cross-sectional survey design to explore Jordanian nursing students' knowledge of, attitudes toward, and compliance with infection control precautions. The target population was all nursing students at the faculty of nursing-University of Jordan. Participants were found to have inadequate knowledge about infection control precautions (M=49.64%), positive attitudes (M=89.8%), and moderate compliance (M=75.91%). Participants' attitudes toward infection control precautions was the only variable that predicts (B=.410, p=0.000) and correlates (r=.51, p<0.01) with their compliance score. Special courses for infection control precautions within nursing schools in Jordan are recommended with special focus on students' attitudes.

Compliance of nursing students with infection prevention precautions: effectiveness of a teaching program

BACKGROUND

In Jordan's nursing schools, infection prevention precautions are not taught in special courses. Instead, most nursing schools include the topic as a 1-hour lecture within the clinical courses, which is believed to be insufficient. This study aimed to test the effectiveness of a nursing infection prevention educational program presented to nursing students before graduation, to promote their knowledge of infection prevention precautions.

METHODS

A true experimental design was used to examine the effects of the infection prevention educational program on students' educational knowledge. This study involved a random assignment of subjects to experimental and control groups, and administration of the pretest and the posttest to all subjects in both groups separately.

RESULTS

Participants in the experimental group demonstrated significantly better knowledge (t = 19.15; df = 95; P = .000) and attitude scores (t = 2.29; df = 46; P = .04) than participants in the control group after particpating in the infection prevention educational program. However, compliance scores were not significantly differernt between the 2 groups (t = 1.92; df = 95; P = .067); indeed, compliance was found to be significant within the experimental group (t = 10.65; df = 46; P = .000).

CONCLUSIONS

It is important that nursing students be competent in infection prevention precautions; however, there may be deficits in their education in this area. The nursing curriculum should include additional emphasis on practice as a means to help translate theory into clinical behavior.

Knowledge and attitudes regarding pain management among Jordanian nursing students

BACKGROUND

The presence of pain is one of the main reasons why people seek health care, however pain is often undertreated. Inadequate treatment has been linked to health care professionals' failure to assess pain and to intervene appropriately. It may also result from the limited attention given to pain management in nursing curricula.

OBJECTIVES

The objectives of this study were to explore the current knowledge and attitudes regarding pain management among baccalaureate nursing students and the factors that might influence such knowledge and attitudes, and nursing students perceived barriers to adequate pain management during clinical practice.

METHODS

The descriptive design included a sample of 240 baccalaureate nursing students in three nursing schools in three governmental universities in Jordan. The Knowledge and Attitudes Survey Regarding Pain scale was used to measure knowledge and attitudes regarding pain management. Data were analyzed by descriptive statistics and independent sample t test. Data were collected over a period of three months from April 2012 to June 2012.

RESULTS

Of the 340 distributed questionnaires; 240 completed questionnaires were returned. The data showed that nursing students were found to have inadequate knowledge and attitudes related to pain and its management. The mean correct score for the entire scale was 34.1%. (SD=9.9). Findings revealed that there were significant differences found in the students' scores related to pain management training and frequency of using pain assessment tools (p<0.05).The most frequently identified barriers were lack of knowledge and training regarding pain management followed by not using pain assessment tools by nurses who are working in the clinical areas.

CONCLUSION

The study findings demonstrated that nursing students have insufficient knowledge and attitudes regarding pain and its management and could benefit from additional education and training on that issue.

Investigating Jordanian nurses' handwashing beliefs, attitudes, and compliance

BACKGROUND

Low rates of handwashing compliance among nurses are still reported in literature. Handwashing beliefs and attitudes were found to correlate and predict handwashing practices. However, such an important field is not fully explored in Jordan.

OBJECTIVES

This study aims at exploring Jordanian nurses' handwashing beliefs, attitudes, and compliance and examining the predictors of their handwashing compliance.

METHODS

A cross-sectional multicenter survey design was used to collect data from registered nurses and nursing assistants (N = 198) who were providing care to patients in governmental hospitals in Jordan. Data collection took place over 3 months during the period of February 2011 to April 2011 using the Handwashing Assessment Inventory.

RESULTS

Participants' mean score of handwashing compliance was 74.29%. They showed positive attitudes but seemed to lack knowledge concerning handwashing. Analysis revealed a 5-predictor model, which accounted for 37.5% of the variance in nurses' handwashing compliance. Nurses' beliefs relatively had the highest prediction effects (β = .309, P < .01), followed by skin assessment (β = .290, P < .01).

CONCLUSION

Jordanian nurses reported moderate handwashing compliance and were found to lack knowledge concerning handwashing protocols, for which education programs are recommended. This study raised the awareness regarding the importance of complying with handwashing protocols.