Barriers to nursing pain management in the emergency department: A qualitative study.

BACKGROUND: Although pain is a common complaint among patients presenting to emergency departments (EDs), there is a dearth of nursing literature about barriers to pain management. PURPOSE: The study aimed to uncover and understand barriers to pain management in the ED from the registered nurse (RN) perspective. METHODS: Semistructured interviews were conducted with 12 ED nurses in a Jordanian hospital. Data were collected throughout August 2016. RESULTS: Two broad categories with subcategories emerged. The first category describes the idea of types of patient, which included three particular groups. These were patients who are violent, patients with relatives who are, and patients with expectations of care that nurses view as unrealistic. The second category describes the taxing ED environment, with two subcategories of staff shortages and physician dominance of pain management. Nurses reported feeling as if they are the victims of external factors and perceived that barriers affected teamwork and led to distress which impairs pain management. CONCLUSIONS: The role of ED nurses in pain management is multifaceted. Therefore, implementing policies to overcome barriers such as violence among ED attenders and the perceived hostility of the ED environment through mandatory security systems, and continuing nursing education including for violence prevention may be beneficial.

The Effects of Oral Care Protocol on the Incidence of Ventilation-Associated Pneumonia in Selected Intensive Care Units in Jordan.

PURPOSE: This study aims to evaluate the effects of oral care protocol on the incidence of ventilator-associated pneumonia (VAP) at selected intensive care units (ICUs) in Jordan using clinical pulmonary infection score. METHODS: A quasi-experimental design was used, and 1 large teaching hospital from the Jordanian capital, along with 2 hospitals from the southern region, was selected. A total of 218 patients participated, among which VAP risk in 2 independent groups was evaluated through the Clinical Pulmonary Infection Score sheet. RESULTS: The VAP incidence rate was significantly lower in the intervention group (n = 102) as compared with control group (n = 116) (21.6 vs 35.3, respectively; P = .018); in addition, ICU stay and intubation period were significantly shorter among the intervention group. A higher risk of VAP was independently predicted by previous lung diseases (odds ratio [OR], 1.441; 95% confidence interval [CI], 1.185-1.88), open suctioning system (OR, 2.536; 95% CI, 1.261-5.101), and duration of intubation (OR, 1.770; 95% CI, 0.845-2.220). The oral care protocol has effectively improved ventilated patients' oral health, which has statistically reduced the incidence of VAP. It occurred more frequently among patients who have lung disease and those who were intubated for more than 7 days and have an open suctioning system. CONCLUSION: Health care teams should ensure that effective care protocol is implemented among patients.

Nurses' perception and attitudes towards oral care practices for mechanically ventilated patients.

OBJECTIVES: To explore the perception and attitudes of intensive care unit (ICU) nurses towards oral care practice for mechanically ventilated (MV) patients. METHOD: A descriptive cross-sectional design was used in this study. A convenience sample of 96 ICU nurses completed a questionnaire on their perception and  attitudes towards oral care. The study setting was 3 representative Jordanian hospitals in Al-Karak and the capital, Amman, over a 6-month period between February and September 2016. RESULTS: Ninety-six nurses participated in the study. The response rate was 76.8%. The results revealed that 65% only follow a specific oral care protocol. Nurses did not adhere to minimal standards. Although nurses' attitude towards oral care was strongly positive, 68% of them perceived it as an unpleasant task and 29% agreed that they had insufficient training; 78% agreed to learn more about the best way to perform oral care. Standard descriptive statistics were calculated for all baseline information (sociodemographic characteristics). Binary variables were expressed as proportions, and normally distributed continuous variables as means and standard deviations. CONCLUSION: The poor perception and attitudes of ICU nurses regarding oral care for MV patients require the urgent attention of clinical administrators. In-hospital training regarding oral care protocol could improve nurses' perception and attitudes.