Nurses' knowledge and attitudes regarding pain management: Cross-sectional survey in the Eastern Province of Saudi Arabia.

AIM: This study aims to investigate the nursing staff's knowledge and attitudes regarding pain management in the Eastern Province of Saudi Arabia. DESIGN: A quantitative descriptive cross-sectional survey. METHODS: Between January and March of 2020, 183 registered nurses from two hospitals in the Eastern Province of Saudi Arabia completed the Nurses' Knowledge and Attitude Survey Regarding Pain. We determined the average mean score for both the individual and the aggregate scores and the t-test. RESULTS: The nurses had an inadequate level of knowledge and attitudes regarding pain based on the average mean score for this factor. There was a statistically significant correlation between length of time spent working as a registered nurse and the nurses' reported scores on tests measuring their knowledge and attitude toward pain.

Socio-demographic predictors of structural empowerment among newly qualified nurses: Findings from an international survey.

Objective: To examine the socio-demographic predictors of structural empowerment among an international sample of newly qualified nurses. Methods: A cross-sectional survey was conducted on 367 newly qualified nurses with up to 18 months of clinical experience. The nurses were recruited from 15 acute care hospitals across KSA, Jordan, and the UK. Data analysis was conducted using the t-test, ANOVA, and hierarchical regression analysis. Results: Significant differences in the total structural empowerment score were found among participants based on the type of universities where they graduated from (t = 2.36, p < 0.05), if they have received assertive communication training during undergraduate nursing education (t = 3.53, p < 0.05), number of months as qualified nurses (F = 4.79, p < 0.05), type of clinical ward settings they were working in (F = 5.1, p < 0.05), and the country where they were recruited from (F = 14.66) (p < 0.05). Furthermore, the country, type of clinical ward settings they were working in, and type of the university the participants graduated from were found to be significant predictors of the participants' total structural empowerment score (F = 16.6, p < 0.05). Conclusions: The findings underscore the unique contributions of the cultural contexts, type of clinical ward setting, and type of former educational setting towards the level of structural empowerment among newly qualified nurses.

Psychometric evaluation of the Arabic version of the Irish Assertiveness Scale among Saudi undergraduate nursing students and interns.

BACKGROUND: Irish Assertiveness Scale is commonly used to examine the individual' level of assertiveness. There is no adequately validated Arabic instrument that examines the level of assertiveness among Arabic-speaking undergraduate nursing students. OBJECTIVES: The purpose of this study was to translate, then evaluate the psychometric properties of the Arabic version of the Irish Assertiveness Scale among Saudi undergraduate nursing students and interns. DESIGN: Cross-sectional survey. SETTINGS: Three nursing colleges from three provinces in Saudi Arabia: Riyadh, Eastern and Makkah provinces. PARTICIPANTS: 283 questionnaires were completed by 3rd and 4th year undergraduate nursing students, and nursing interns. METHODS: A standard procedure including forward-backward translation, cultural adaptation and pilot testing was adopted to translate the Irish Assertiveness Scale into Arabic language. Content validity was measured using content validity index. Scale reliability was measured using cronbach's alpha coefficient and mean inter-item correlation. The sample was randomly split, and exploratory and confirmatory factor analysis was then conducted on each sample to examine the construct validity of the proposed scale. A subsequent convergent validity and discriminant validity were also tested. RESULTS: The item-level content validity index ranged from 0.9 to 1.0, and the overall content validity index was 0.93. The exploratory factor analysis resulted in 23-items, four-factor solution explaining 49.4% of the total variance. The mean inter-item correlation for each factor ranged between 0.22 and 0.4. Cronbach's alpha coefficients for the overall scale was 0.80. The confirmatory factor analysis showed that the proposed four-factor solution had the best model fit. Whilst discriminant validity was supported in the new model, convergent validity was partially met. CONCLUSIONS: This study contributed toward establishing the Arabic version of the Irish Assertiveness Scale. Considering the limitations of the convergent validity demonstrated in the new instrument, a modified version of the Irish Assertiveness Scale might be needed to ascertain the most feasible model which best captures the level of assertiveness in Arabic cultural context.

Potentials of organic manure and potassium forms on maize (Zea mays L.) growth and production.

Worldwide, maize (Zea mays L.) is considered an important food and fodder crop. Compost as a soil amendment and potassium (K) could enhance the maize yield. Therefore, two field experiments were carried out in the two seasons 2017 and 2018 to study the effects of compost at three levels and four forms of potassium fertilization on the yellow maize hybrid 'Pioneer SC 30N11' yield components. To conduct the field trials, a split plot system in three replications was established. Three compost levels (0, 5 and 10 ton/ha) were in the main plots, and four potassium forms (untreated, nano-potassium fertilizer, humic acid and potassium sulfate) were in the subplots. Plot size was 10.50 m2, with 5 ridges with 3 m length and 0.7 m width. The results indicated that the application of compost (as organic manure) and the potassium forms significantly affected the plant height, ear length, grains number/rows, grains number/ear, 100- grain weight, straw and biological yields, grain protein and K contents in both seasons. Increasing the compost from 5 to 10 ton/ha increased the yield, its components, protein and K contents. The foliar application of nano-potassium followed by humic acid increased all the studied characteristics. The interaction between compost manure (10 ton/ha) and nano-potassium (500 cm3/ha) or humic acid (10 ton/ha) recorded the highest mean values for all parameters during both harvest seasons.

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.

Development of assertive communication skills in nursing preceptorship programmes: a qualitative insight from newly qualified nurses.

BACKGROUND: Being able to speak up is a prerequisite for establishing safe communication in healthcare settings. The nursing preceptorship programme represents an opportunity for newly qualified nurses to develop and practise assertive communication skills. AIM: To examine newly qualified nurses' views on how nursing preceptorship programmes contribute to shaping their assertive communication skills. METHOD: 42 newly qualified nurses from four acute hospital trusts in east England completed open-ended questions included in a cross-sectional survey. Participants' qualitative comments were analysed using thematic analysis. FINDINGS: Three themes related to speaking up during the nursing preceptorship programme emerged: enthusiastic versus sceptical, the role of a supportive working culture, and logistical challenges. CONCLUSION: Nursing preceptorship programmes can develop newly qualified nurses life-enhancing assertive communication skills if they provide inspiring preceptors who act as role models, create a supportive working culture and support nursing preceptors to deliver effective preceptorship. It is imperative that nursing preceptorship programmes are adapted to enable newly qualified nurses to learn and practise assertive communication skills.

A Cross-Sectional Survey of British Newly Graduated Nurses' Experience of Organization Empowerment and of Challenging Unsafe Practices.

BACKGROUND: Newly graduated nurses perceive the transition into their new professional role as highly stressful, which may affect their organizational empowerment and assertive communication skills. This study examined newly graduated nurses' perceived level of organizational empowerment, as well as their perceived assertive communication skills, in given hypothetical scenarios. METHOD: A cross-sectional survey was conducted among 84 newly graduated nurses in four hospitals in eastern England. The study took place between 2015 to 2016. RESULTS: Fifty-one nurses completed the survey, for a 61% response rate. The participants reported a moderate level of organizational empowerment but a high level of perceived assertive communication skills. A statistically significant correlation was found between the participants' total empowerment average score and their average score on the given hypothetical speaking up scenarios. CONCLUSION: The findings underscore the importance of empowering newly graduated nurses in their work settings and its association with consolidating their assertive communication behavior. J Contin Educ Nurs. 2018;49(10):474-481.

Integrating Patient Safety Education in the Undergraduate Nursing Curriculum: A Discussion Paper.

BACKGROUND: This paper explores the opportunities and challenges for integrating patient safety education in undergraduate nursing curriculum. METHODS: Four dimensions of undergraduate nursing education are examined: National accreditation of nursing programs, building a competency-based nursing education, a model of nursing education and building faculty capacity in patient safety education and research. RESULTS: Incorporating patient safety in a nursing curriculum can be "institutionalized" by making it a pre-requisite for granting program accreditation. At the operational level, transforming undergraduate nursing education to incorporate inquiry-based learning and moving toward competency-based patient safety education are two key requirements for engaging the students with patient safety science. Building faculty capacity who are experts in both patient safety teaching and research remains a key challenge that needs to be addressed to enable a shift in the patient safety "mindset" for future nursing workforce. CONCLUSION: Efforts to introduce patient safety in nursing education are both necessary and timely, and should accommodate students' unique needs and cultural context.

Evaluation of World Health Organization Multi-Professional Patient Safety Curriculum Topics in Nursing Education: Pre-test, post-test, none-experimental study.

The Multi-professional Patient Safety Curriculum Guide was launched by the World Health Organization to develop a patient safety-friendly curriculum in health education. The aim of this study was to evaluate the impact of teaching related to two topics from the Patient Safety Curriculum Guide on student nurses' knowledge and attitudes toward patient safety. A pretest, posttest, nonexperimental design was used. Patient safety education questionnaires were distributed to a convenience sample of 181 nursing students before the intervention, and 141 questionnaires after the intervention in one university in the East of England. The intervention consisted of two face-to-face lectures and one facilitated group work discussion. Seventy-one responses from pre- and posttest stages were matched. Paired t test, McNemar's test, and frequency measures were used for data analysis. The findings suggest that there are statistically significant differences in the subscales of the error and patient safety and personal influence over safety. The differences in the students' answers on patient safety knowledge before and after the interventions were not statistically significant. Although the student nurses highly commended the teaching delivered in this study, the use of experimental design in future curriculum evaluation may provide a more complementary insight to the findings of this study.

Factor analysis of nursing students' perception of patient safety education.

AIM: The aim of this study is to investigate the factor structure of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS) when completed by a group of nursing students from one University in the UK. BACKGROUND: The quality, content and delivery of nursing education can have a significant impact on the future students' safety behaviours in clinical settings. The Health Care Professionals Patient Safety Assessment Curriculum Survey HPPSACS has been developed in the US to establish undergraduate nursing students' perceived awareness, skills, and attitudes toward patient safety education. The instrument has not been reported to be used elsewhere; therefore, some psychometric properties remain untested. DESIGN: Pre-registration nursing students (n=272) from three campuses of a university in East of England completed the HPPSACS in 2012. Principal component analysis was conducted to explore the factors emerging from the students' responses. FINDINGS: 222 students (82%) returned the questionnaires. Constraining data to a 4-factor solution explained 52% of the variance. Factors identified were: "Willingness to disclose errors", "Recognition and management of medical errors", "The Perceived interprofessional context of patient safety" and "The perceived support and understanding for improving patient safety". The overall Cronbach's alpha was 0.64, indicating moderate internal consistency of the instrument. LIMITATIONS: Some demographical and descriptive questions on the HPPSACS instrument were modified to accommodate the participants' educational context. However, all items in the HPPSACS which were included in the factor analysis remain identical to the original tool. CONCLUSION: The study offers empirical findings of how patient safety education is contextualised in the undergraduate, pre-registration nursing curriculum. Further research is required to refine and improve the overall reliability of the Health Care Professionals Patient Safety Assessment Curriculum Survey (HPPSACS' instrument).

Safeguarding in medication administration: understanding pre-registration nursing students' survey response to patient safety and peer reporting issues.

AIM: To explore nursing students' experiences of patient safety and peer reporting using hypothetical medication administration scenarios. BACKGROUND: Pre-registration nurse training is tasked with the preparation of students able to provide safe, high quality nursing care. How students' contextualise teaching related to patient safety, risk recognition and management in the clinical setting is less clear. METHOD: A total of 321 third year students enrolled in the final semester of an adult branch pre-registration nursing programme in 2011 in a UK university were surveyed. Using free texts, the questionnaire contained hypothetical medication administration scenarios where patient safety could potentially be at risk. Students' qualitative responses were analysed using thematic analysis. FINDINGS: The response rate was 58% (n = 186). Four themes were identified from the scenarios: (1) Protecting patient safety (2) Willingness to compromise; (3) Avoiding responsibility; (4) Consequences from my actions. CONCLUSION: The findings underscore the importance of contextual teaching about risk management, practical techniques for error management and leadership for optimal patient safety in nursing curricula. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are role models for nursing students in the clinical setting. Nursing management must lead, by example, the patient safety agenda in the clinical setting.

Investigating the safety of medication administration in adult critical care settings.

BACKGROUND: Medication errors are recognized causes of patient morbidity and mortality in hospital settings, and can occur at any stage of the medication management process. Medication administration errors are reported to occur more frequently in critical care settings, and can be associated with severe consequences. However, patient safety research tends to focus on accident causations rather than organizational factors which enhance patient safety and health care resilience to unsafe practice. The Organizational Safety Space Model was developed for high-risk industries to investigate factors that influence organizational safety. Its application in health care settings may offer a unique approach to understand organizational safety in the health care context, particularly in investigating the safety of medication administration in adult critical care settings. PURPOSE: This literature review explores the development and use of the Organizational Safety Space Model in the industrial context, and considers its application in investigating the safety of medication administration in adult critical care settings. SEARCH STRATEGIES (INCLUSION AND EXCLUSION CRITERIA): CINAHL, Medline, British Nursing Index (BNI) and PsychInfo databases were searched for peer-reviewed papers, published in English, from 1970 to 2011 with relevance to organizational safety and medication administration in critical care, using the key words: organization, safety, nurse, critical care and medication administration. Archaeological searching, including grey literature and governmental documents, was also carried out. From the identified 766 articles, 51 studies were considered relevant. CONCLUSION: The Organizational Safety Space Model offers a productive, conceptual system framework to critically analyse the wider organizational issues, which may influence the safety of medication administration and organizational resilience to accidents. However, the model needs to be evaluated for its application in health care settings in general and critical care in particular. Nurses would offer a valuable insight in explaining how the Organizational Safety Space Model can be used to analyse the organizational contributions towards medication administration in adult critical care settings.

Current assessment of patient safety education.

The purpose of this literature review was to examine current evidence on how student nurses and nursing faculty members perceived the integration of patient safety education in preregistration/undergraduate nursing training. Databases searched from January 2000 to April 2011 included CINAHL, PsycINFO, British Nursing Index, PubMed, AMED, Academic Science, Midline, Cochrane Library Database, Web of Knowledge, Ovid Nursing Database, Wiley Online Library and Science Direct. In total, 77 articles were initially found, although only 15 were included in the author's review. Of these, 5 papers were research-based articles that examined aspects of patient safety education in undergraduate/pre-registration nursing training, and 9 papers were literature review and discussion based, which provided insight into the experience, assessment, evaluation or implementation of patient safety education curriculum in nursing education. The author's literature review highlights the continuing lack of research on patient safety education in undergraduate/preregistration nursing training and, in particular, outlines areas in nursing education which need to be addressed to develop patient-safety-friendly nursing curricula.

Methodological and ethical challenges in investigating the safety of medication administration.

AIM: The aim of this article is to highlight some of the methodological and ethical challenges that the researcher faced when conducting a study of the safety of medication administration. BACKGROUND: Investigating a sensitive topic, such as the safety of medication administration, can be methodologically demanding, time-consuming and ethically challenging. Moreover, it can be particularly difficult to balance methodological with ethical and legal challenges. This article presents the considerations involved in the sampling, recruitment and ethical issues related to participants' involvement in a medication safety study. DATA SOURCES: The article draws on the methodological and ethical approaches related to one qualitative study that investigated the nurse's views of the organisational contributions toward the safety of medication administration in adult critical care. The study was completed in 2009. DISCUSSION: The study used a questionnaire to recruit the paticipants and this gave the researcher the advantage of being able to select critical care nurses from particular backgrounds, enriching the views and perspectives relating to the topic under investigation. Approaching the participants for 'expert' opinions, rather than 'error-makers', helped to established early rapport with the participants. Research rigour and data trustworthiness were demonstrated by several operational techniques, including providing a detailed account and justification for the research process. CONCLUSION: Research into patient safety may have particular methodological and ethical challenges and therefore needs an appropriate research approach to balance practicality, the participants' integrity and research rigour. IMPLICATIONS FOR PRACTICE AND RESEARCH It is anticipated that this approach will provide an insight into some challenges that may arise in conducting patient safety research, providing a useful guide for others to consider in their future research.

How domestic abuse affects the wellbeing of older women.

AIM: The aim of this study was to explore older women's experience of domestic abuse and its effect on their health and lives. METHOD: A qualitative research design was used and data were collected using in-depth interviews with 16 participants. FINDINGS: The consequences of domestic abuse for older women have a significant effect on their long-term health and emotional wellbeing. CONCLUSION: There are little available data about older women and domestic abuse. This is increasingly being recognised as a significant deficit in awareness and understanding in society as a whole, and more particularly for those responsible for support and care provision.

Permanent induction of morphological abnormalities in the penis and penile skeletal muscles in adult rats treated neonatally with diethylstilbestrol or estradiol valerate: a dose-response study.

This study evaluated the effects of neonatal exposure to different doses of diethylstilbestrol (DES) or estradiol valerate (EV) on penile morphology, penile skeletal muscles, and fertility. Male pups received DES or EV at a dose of 10 microg, 1 microg, 100 ng, 10 ng, or 1 ng per rat on alternate days from postnatal days 2-12. Fertility was tested at 120 days, and tissues were examined at 150 days. Generally, DES and EV induced similar effects within the 10- and 1-microg groups. Fertility was reduced to 0; the weight, length, and diameter of the penis and the weight of penile skeletal muscles, especially bulbocavernosus muscle, were decreased (P <.05) in a dose-dependent manner; the preputial sheath was partially released or its release was delayed; testicular descent was delayed; and the cavernous spaces and smooth muscle cells in the corpora cavernosa penis were replaced by fat cells. Conversely, all of the above parameters were similar in controls and the lower dose groups, except in the 100-ng DES group, in which 4 of 7 males did not sire pups (compared with 1 of 7 in controls and 2 of 6 in the 100-ng EV group). The loss of fertility in these 4 males of the DES group and 1 male of the EV group was associated with partial release of the preputial sheath and abnormal penile morphology. Plasma testosterone was reduced (P <.05) in the 100-ng and higher dose groups for DES and EV. Hence, neonatal exposure to DES or EV at a cumulative dose of 600 ng per rat or more lowers fertility, which is associated with permanent alterations in penile morphology and penile skeletal muscles and decreased testosterone.