COVID-19 vaccine acceptance and associated factors among pregnant and lactating women attending maternity care clinics in refugee camps in Jordan.

BACKGROUND: Despite the advantages of vaccination in preventing maternal and fetal problems, there were many concerns in the medical community regarding vaccine safety for pregnant women, and this has put obstetricians in a challenging situation when it comes to advising their pregnant patients on whether to obtain the vaccine. AIM: This study was performed to define the level of acceptance of COVID-19 vaccination and assess the impact of COVID-19 attitudes and knowledge on vaccine acceptance between pregnant and lactating Syrian women who are seeking prenatal care services at the clinics in Azraq refugee camp in Jordan. METHOD: A quantitative, cross-sectional study utilizing a non-probability convenience sample. A validated and reliable self-administered questionnaire consisting of four sections was used. RESULTS: A total of 412 pregnant/lactating women was recruited The acceptance rate of the COVID-19 vaccine among participants was 86.5%. There was a significant positive moderate association between respondents' attitudes and knowledge around the COVID-19 vaccine and their acceptance of the vaccine (r = .468, p < .001, r = .357, p < .001), respectively. CONCLUSION: To effectively mitigate the COVID-19 pandemic and achieve collective protection, decision-makers must intensify the efforts in promoting the importance of maternal vaccination, especially in vulnerable communities that suffer the most from pandemic outcomes.

Alarm fatigue and perceived stress among critical care nurses in the intensive care units: Palestinian perspectives.

OBJECTIVE: The frequency of alarms generated by monitors and other electro-medical devices is undeniably valuable but can simultaneously escalate the workload for healthcare professionals, potentially subjecting intensive care unit nurses to alarm fatigue. The aim of this study is to investigate alarm fatigue and stress levels among critical care nursing personnel. Additionally, the study aims to assess predictors for both alarm fatigue and perceived stress. METHODOLOGY: A descriptive cross-sectional study recruited 187 Intensive Care Unit (ICU) nurses from hospitals located in the northern and central regions of the West Bank, Palestine. Data were gathered through online surveys due to logistic concerns using the Alarm Fatigue Scale and the Perceived Stress Scale. The research was conducted between November 2023 and January 2024. RESULTS: The mean overall alarm fatigue score was 23.36 (SD = 5.57) out of 44. The study showed that 62.6% of the participating ICU nurses experience average to high degree of alarm fatigue, while 69.5% experience average to high levels of perceived stress. A significant positive Pearson correlation was found between stress and alarm fatigue (0.40, P < 0.01). Important predictors of alarm fatigue include perceived stress, nurse-to-patient ratio, gender, and years of experience, while important predictors of perceived stress include alarm fatigue, type of working shift and hospital unit. CONCLUSION: Alarm fatigue can compromise the timely intervention required to prevent adverse outcomes by causing delayed responses or missed critical alarm, which can have major ramifications for patient safety. Addressing stress is crucial for mitigating alarm fatigue and fostering a supportive work environment to ensure optimal patient care. Consequently, exploring strategies to alleviate the negative impacts of alarm fatigue on critical care nurses' stress merits further investigation in future research studies.

Assessing the Level of Electrocardiographic Interpretation Competency among Emergency Nurses in Palestine.

Introduction: The use of electrocardiograms (ECGs) is widespread among emergency room (ER) nurses for diagnosis and triage, making it crucial for them to have the appropriate level of competency in interpreting ECGs. This can lead to better healthcare and patient outcomes. Objectives: This study aims to assess the competency level of emergency nurses in Palestine in interpreting normal ECG and certain cardiac arrhythmias, and to explore the association between socio-demographic characteristics and their ECG interpretation competency. Methods: The study used a cross-sectional descriptive design, and 196 ER nurses were conveniently recruited to fill out a self-administered questionnaire based on previous literature. The data collected were analyzed using SPSS with strict adherence to ethical considerations. Results: The results showed that 70.9% of the nurses were males, 65.3% held a bachelor's degree in nursing, 46.9% had 1-5 years of experience, and 60.7% had received previous courses on ECG interpretation. The mean competency level of the ER nurses was satisfactory at 60.714%, but 38.8% had a poor level of competency. This was significantly higher among nurses with higher educational levels (p-value < 0.001), those who had taken previous ECG courses (p-value = 0.045) and life support (p-value < 0.05), and those who were exposed to more ECG interpretations per day (p-value = 0.001). Conclusion: There is a need to focus more on ECG competency levels in Palestinian literature and compare them between different departments. It is also essential to evaluate nurses' needs for continuous education.

Insights into pressure injury prevention: Assessing the knowledge, attitudes, and practices of Palestinian nursing students.

AIM: To assess the knowledge, attitudes, and practices of Palestinian nursing students towards pressure injury prevention. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted with 455 nursing students recruited from Arab American University-Palestine, employing a total population sample. Data collection forms include socio-demographic information, the Pressure Ulcer Knowledge Assessment Tool, Attitude towards Pressure Ulcer Prevention Instrument and Pressure Injury Preventive Practices scale. RESULTS: The study found that students had a mean knowledge score of 54% (14.04/26), a positive attitude score of 75.8% (39.42/52), and demonstrated a fair level of practice 75.3% (30.12/40). Significant differences were observed in the Knowledge, Attitude, and Practice total scores, linked to academic year, clinical experience, and the number of attended departments during clinical training (p < 0.001). Additionally, weak but significant positive relationships were found between practice and attitude scores (r = 0.303, p < 0.001), practice and knowledge score (r = 0.211, p < 0.001), and a moderate positive significant relationship between knowledge and attitude scores (r = 0.567, p < 0.001). CONCLUSION: The study revealed insufficient knowledge, positive attitudes, and somewhat unsafe practices among nursing students regarding pressure injury prevention. It highlights the need for specific revisions in the nursing curriculum. Improvements can be achieved through detailed coverage in classrooms and laboratories, integrating simulation methods. Additionally, ensuring that students gain adequate experiences in clinical units, with a specific emphasis on pressure injury prevention, is crucial for improving students' capability and contribute to better pressure injury management.

Prevalence of Depression and Its Associated Factors Among Hemodialysis Patients in Hodeida City, Yemen.

Background: Depression has a negative impact on the health outcomes of hemodialysis (HD) patients, including decreased quality of life and increased morbidity and mortality rates. Therefore, this study aimed to determine the prevalence of depression and its associated factors among HD patients in Hodeida city, Yemen. Methods: A cross-sectional study involving 200 HD patients at the Dialysis Center in Hodeida was conducted from February to May 2022. Data on depression were collected using the 9-item Patient Health Questionnaire (PHQ-9). Association of sociodemographic characteristics of patients with depression were assessed using chi-square, subsequently by multivariable logistic regression. Statistical significance was set at P-values <0.05. Results: The response rate was 98% (200/204). Depression was prevalent among 63% of HD patients at the Dialysis Center in Hodeida city. Sex was significantly associated with depression, where female patients were more frequently depressed than males (82.4% vs 56.4%, P < 0.001). In addition, employment status and medical insurance were significantly associated with depression, where unemployed patients were more frequently depressed than employed patients (67.6% vs 52.5%, P = 0.041) and patients with medical insurance were less frequently depressed than their counterparts (47.1% vs 66.3%, P = 0.035). Conclusion: Depression is highly prevalent among HD patients in Hodeida city. Female sex, unemployment and lack of medical insurance are predictors of depression among HD patients. These findings emphasize the urgent need for targeted interventions. Implications for practice: Depression is common among HD patients, so that, psychiatric physicians and nurses are increasingly needed in HD centers to implement mental health assessment of patients for depression signs and symptoms to help in early diagnosis and management of depression in order to improve patients' quality of life and preventing negative outcomes.

Women's attitudes, prevalence, related factors, and perceived barriers of birth companionship in Saudi Arabia.

BACKGROUND: The World Health Organization recommends companionship as a critical element of respectful maternity care. However, there is paucity of literature regarding women's attitudes, related factors, and barriers of implementation in Saudi Arabia. OBJECTIVE: This study aimed to assess women's attitudes toward birth companionship during labor and delivery, related factors, and barriers of implementing labor companionship in Saudi Arabia. DESIGN/METHODS: This study was carried out in Al Ahsa, Saudi Arabia, using a cross-sectional design. The data collection took place over a period of approximately 6 months, specifically from 16 August 2021 to 20 February 2022. A total of 418 women who had given birth at three governmental hospitals and three private hospitals in Al Ahsa participated in the survey. The study included women between the ages of 18 and 49 years who had delivered during the study period. RESULTS: The study revealed that while around 82.8% of mothers expressed a desire for companionship during labor, only 43.2% actually had a labor companion present during delivery. The primary obstacle to labor companionship reported by 21.5% of respondents was hospital policies. Other barriers identified included husbands' fear of being present during labor (4.7%) and limited availability of time for companionship (3.8%). CONCLUSION: The study concludes that birth companionship is highly desired by women in the study area. However, various physical, emotional, and institutional barriers, such as hospital policies and regulations, impede its implementation. Addressing these barriers and promoting supportive policies are essential to facilitate the provision of birth companionship and improve the childbirth experience for women in Al Ahsa.

Enhancing pulmonary function and arterial blood gas readings through immediate chest physiotherapy among extubated patients in ICU.

OBJECTIVE: To examine the effect of immediate chest physiotherapy (ICPT) on pulmonary function and arterial blood gases among extubated patients. METHOD: This prospective study enrolled patients aged 20-60 years who had been intubated for 48 h. They were randomly assigned to either a control or study group. The study group received ICPT by trained critical care nurses and physiotherapists, which included early mobilization, breathing exercises and airway clearance. The control group received standard nursing chest care (positioning, oral and endotracheal suctioning) without ICPT. Researchers evaluated participants using pulmonary function tests, arterial blood gas tests and mechanical ventilation parameters. RESULTS: The study enrolled 70 patients. There were no significant differences in the sociodemographic characteristics and medical data before intubation between the two groups except for preparatory education. After extubation, the vital capacity was significantly higher in the study group compared with the control group. There were also significant differences between the two groups in other lung function tests and arterial blood gas tests. After extubation, the total lung capacity, functional residual capacity and residual volume were significantly higher in the study group compared with the control group. CONCLUSION: The use of ICPT improved both pulmonary function and arterial blood gases.

Evaluation of Clinical Competence and Job Satisfaction and Their Related Factors Among Emergency Nurses in Palestinian Hospitals.

Introduction: Nurses are responsible for providing primary care to millions of patients, and emergency nurses serve on the frontline in providing care for mildly to severely critically ill patients. Objectives: This study aims to assess and evaluate the clinical competence and its related factors among emergency nurses in Palestinian hospitals. Methods: A cross-sectional study was conducted among 170 nurses working in the emergency units of hospitals in the West Bank, Palestine. Data collection utilized the Nurse Competence Scale, and the Job Satisfaction Scale. Results: The results showed that only 33(19.4%) of the participants exhibited a good level of clinical competence, with none reaching the very good level. Among them, the highest proportion of good level 60 (35.3%) was in the helping role, while the lowest 38 (22.4%) was in ensuring quality. About 35% of nurses reported very low or low job satisfaction, while 58% had high or very high job satisfaction. Additionally, the results revealed a statistically significant relationship between clinical competence and job satisfaction (P < 0.05). Both clinical competence and job satisfaction were positively correlated with age and experience. Conclusion: The study found a significant relationship between demographic characteristics (e.g., education, experience, and marital status) and clinical competency among emergency nurses. Notably, less than half of the participants demonstrated good clinical competency, with none reaching a very good level. The highest scores were observed in the helping role domain, while the lowest were in the ensuring quality domain. Furthermore, clinical competence was found to be significantly associated with job satisfaction. Consequently, enhancing nurses' clinical competency will lead to an improvement in the quality of patient care.

Assessing the Prevalence, Predictors, and Consequences of Secondary Traumatic Stress Among Emergency Nurses in Palestine During the COVID-19 Pandemic.

Introduction: Emergency nurses who are working in direct contact with COVID-19 patients are at an increased risk of developing secondary traumatic stress disorder. This study aimed to assess the prevalence, predictors, and consequences of secondary traumatic stress among emergency nurses in Palestine during the COVID-19 pandemic. Methods: The study utilized a cross-sectional design and recruited a total of 189 emergency nurses from multiple healthcare centers in Palestine. Data collected from January 21, 2021, to March 31, 2021. Results: The study revealed that emergency nurses had a high degree of secondary traumatic stress with the prevalence of high to severe symptoms of secondary traumatic stress being 61% of the total participants. In terms of predictors, the results showed that years of experience, level of education, burnout, and organizational support were significantly correlated with secondary traumatic stress and thus that years of experience and burnout are predictors of secondary traumatic stress. Conclusion: Based on our findings, nurses in emergency departments in Palestine have a high degree of secondary traumatic stress disorder which impacts their lives on a personal and professional level.

Impact of Nurse Leaders Behaviors on Nursing Staff Performance: A Systematic Review of Literature.

Nursing leadership is critical in facilitating and improving nurse performance, which is essential for providing quality care and ensuring patient safety. The aim of this study is to explore the relationship between nursing leadership and nurse performance by understanding the leadership behaviors and factors that motivate nurses to perform well. To study the factors that nurses believe motivate them to perform better, a systematic review was undertaken, correlating these factors to leadership behaviors/styles. The PRISMA guidelines were followed to identify relevant articles. After applying the selection criteria, 11 articles were included in the final analysis. Overall, 51 elements that influence nurses' motivation to perform better were found and categorized into 6 categories, including autonomy, competencies, relatedness, individual nursing characteristics, relationships and support, and leadership styles/practices. It has been discovered that both direct and indirect nursing leadership behaviors affect nurses' performance. A better understanding of the factors that motivate nurses to perform well and facilitating them in the work environment through leadership behaviors/styles can improve nurses' performance. There is a need to increase research on nurse leadership and nurses' performance in the current innovative and technologically integrated work environment to identify new factors of influence.

Sicilians' knowledge, perceptions, prevention and practices during the pandemic in relation to vaccination: A questionnaire-based survey.

BACKGROUND: COVID-19 has influenced Sicily, Italy as any other part of the world, and people had various types of reactions to this global epidemic. This study aimed to assess the behavior, perception, and willingness of the Sicilian population to accept vaccination, as well as their attitudes toward conspiracy theories, which have been a concern for governments around the globe. METHODS: Study design: cross sectional-descriptive study. The data were collected through a survey developed based on a protocol from the World Health Organization's regional office in Europe, which was distributed in two waves. The first wave took place in April and May 2020, and a modified survey was distributed during June and July. RESULTS: Sicilians showed a very good knowledge of the virus, while their positive attitude has changed toward vaccination in the second wave. Furthermore, Sicilians showed an average trust in the governmental institutions, which allow the doubts of conspiracy to exist in the population. CONCLUSIONS: Although the results indicate a good level of knowledge and positive attitude toward vaccination, we believe that further studies should be conducted in the Mediterranean to better understand how to face future epidemics with limited resources in the healthcare system, as compared with other countries.

The Relationship Between Stress and Resilience of Nurses in Intensive Care Units During the COVID-19 Pandemic.

The coronavirus infection COVID-19 has been a risk to world health, particularly for individuals who are vulnerable to it. Critical care nurses have described experiencing extremely high levels of stress under these struggling conditions. This study aimed to assess the relationship between stress and resilience of intensive care unit nurses during the COVID-19 pandemic. A cross-sectional study was conducted on 227 nurses who are working in the intensive care units in the West Bank hospitals, Palestine. Data collection utilized the Nursing Stress Scale (NSS) and the Brief Resilient Coping Scale (BRCS). Two hundred twenty-seven intensive care nurses completed the questionnaire; (61.2%) were males, and (81.5%) had documented COVID-19 infection among their friends, family, or coworkers. Most intensive care nurses reported high levels of stress (105.9 ± 11.9), but low levels of resilience (11.0 ± 4.3). There was a moderate negative correlation between nurses' stress and their resilience (P < .05) and a small to moderate negative correlation between nurses' stress sub-scales and resilience (P < .05). Also, the results revealed a statistically significant difference between the stress score mean and the nurses who had documented COVID-19 infection among their friends, family, or coworkers (P < .05), and between the resilience mean score and the nurses' gender (P < .05). During the COVID-19 outbreak, intensive care nurses' stress levels were high, and their resilience was low. Thus, controlling nurses' stress levels and identifying possible stress sources related to the COVID-19 pandemic are important to maintain patients' safety and improve the quality of care.

Nursing Students' Understanding of Palliative Care in Palestine.

Palliative care is a method of preventing and alleviating suffering for patients who have been diagnosed with terminal diseases by early detection, accurate assessments, and pain and symptom management. Patients and their families can then mitigate related physical, psychological, and spiritual challenges and thus will have a better quality of life. This article reports a study that evaluated undergraduate nursing students' knowledge of and attitude and self-efficacy toward palliative and end-of-life care in Palestine. A descriptive, cross-sectional design was used among a convenience sample of 449 undergraduate nursing students at the end of their second, third, and fourth years. The results of this research revealed that nursing students had low levels of knowledge about palliative care and low self-efficacy toward end-of-life care. The majority of students reported a positive disposition toward the provision of end-of-life care. The most important predictors of knowledge, attitudes, and self-efficacy were age, having attended a seminar/lecture on the issue, experiencing death while providing care, and having experienced a death in the family or close friends. Furthermore, elevated levels of knowledge were significantly associated with higher level of attitude (P < .001) about palliative care.

The Factors Influencing Nurses' Clinical Decision-Making in Emergency Department.

In an emergency, making the correct decision is vital. It is a necessary element of professional nursing care, and the ability of nurses to make successful clinical decisions is the most critical element influencing care quality. The purpose of this study was to assess the factors influencing nurses' clinical decision-making in the emergency department of Palestinan hospitals. A cross-sectional study was targeted at all nurses working in emergency departments at the Palestinian hospitals. The study was completed with 227 nurses, and collecting data was performed with the Clinical Decision Making in Nursing Scale. Results of the study revealed that the average score for the total clinical decision-making score was 3.3 (SD = 0.23). The subscales of clinical decision making were "search for alternatives or options," "canvassing of objectives and values," "evaluation and reevaluation of consequences," and "search for information and unbiased assimilation of new information." Furthermore, multiple linear regression analysis revealed that degree and work hours accounted for 11.7% of the variance in clinical decision-making. The study confirmed the average score for clinical decision-making was slightly higher than the average score. Also, it approved that nursing degree and work hours were predictors of clinical decision-making among nurses in emergency departments.

Developing Nursing Standards for Maintaining Shift Handover in the Intensive Care Unit: A Methodological and Cross-Sectional Study.

Patient handover, which is a method of moving the clinical data of patients to another individual or professional community, is a high-risk area for the safety of patients due to errors which can happen during staff break time, changeover shifts, and when patients are moved in and out of units. Standards for critical care nurses will improve bedside handover due to the presence of clear plans implemented by nurses who are well informed about them. To develop nursing standards for maintaining handover in the intensive care unit. A methodological and cross-sectional study was conducted at Mansoura University Hospital and included 15 experts and 150 staff nurses. Twelve items were excluded from the tool because their CVR ratio was less than 0.7. Therefore, after eliminating 12 items, the number of tool items produced was 66. The Kaiser-Meyer-Olkin value = 0.713, with the recommended value being 0.6 or above. The cut-off score for the analysis model was 0.3, and the KMO value criterion was greater than 1, which defined eight-factor loadings as the best fit for the results, accounting for 69.5% of the variance. The aim of this study was satisfactorily achieved, with 0.9055 validity and reliability for the handover instrument, which consisted of 60 items with a total reliability score.

Effect of Progressive Muscle Relaxation Exercise on Anxiety Among Male Nursing Students Undergoing Maternity Clinical Training.

Introduction: Student in a maternity nursing program must be engaged in practical training and they must be well prepared and directed along the way to becoming qualified professionals. Objective: The study aimed to investigate the effect of progressive muscle relaxation exercise on anxiety among male nursing students undergoing maternity clinical training. Methods: A quasi-experimental, pre-post study was conducted on nursing at Arab American University Palestine. The sample of the study consisted of 48 male nursing students enrolled in the maternity nursing course. They were selected through convenience sampling. This study was conducted on one group of male nursing students that received Jacobson's progressive muscle relaxation exercise for five consecutive days per week. The S-anxiety scale (STAI Form Y-1) was applied to collect data before and after the intervention. Results: The magnitude of anxiety reduction after the progressive muscle relaxation exercise was greater than before (t (47) = 21.2, p < .05). Conclusion: The current study's findings indicated the influence of progressive muscle relaxation on maternity clinical setting anxiety reduction among male nursing students.

Predictors of Knowledge, Attitudes, Practices and Barriers Regarding Sepsis and Sepsis Management Among Emergency Nurses and Physicians in Palestine: A Cross-Sectional Analysis.

Sepsis is a widespread problem that can create clinical and economic difficulties. This study aimed to determine the knowledge, attitudes, practices, and barriers related to the sepsis and sepsis management among emergency nurses and physicians. Data was collected using a self-questionnaire completed by the participating nurses and physicians (n = 243), with a 61% response rate. The study found that both emergency nurses and physicians had poor-to-moderate levels of sepsis knowledge, with emergency physicians having better attitudes regarding sepsis and sepsis management than emergency nurses. However, moderate knowledge levels of sepsis practice and management were shown among both nurses and physicians. It is evident that for emergency nurses and physicians, the biggest barrier to providing quality care to patients with sepsis is the lack of monitoring equipment. Both nurses and physicians need consistent sepsis management information provided by continual education programs. Development of an approved protocol can improve nurses' knowledge, attitudes, and practices.

Early perception, behavior, knowledge, and preventive practices related to COVID-19 among Palestinians.

It is necessary to understand early perception, behavior, and knowledge of coronavirus disease 2019 (COVID-19) and preventive practices in relation to suggested policies and information accessible to the Palestinian population during the early stages of the pandemic. The aim of this research is to contribute to this understanding for the purpose of affecting future practical preventive policies that can be implemented and adapted in Palestine in order to shape a new reflective practices model to face any future epidemic crisis of any type. A cross-sectional design was used to conduct the study over 3 weeks in April 2020 and an online survey was disseminated in all areas of Palestine. A total of 1040 responses were collected from persons who were over 18 years of age. A high level of knowledge related to COVID-19 was found, including symptoms and characteristics of the virus, prevention practices, and at-risk groups. Respondents believe that they are more susceptible to influenza than COVID-19 and more likely to be infected by the influenza virus than the COVID-19 virus but expect that infection of influenza would be less severe than infection of COVID-19. Respondents were more inclined to find COVID-19 worrying and stressful than they were to find it fear-inducing. Around two-thirds of respondents believe that different types of COVID-19-related conspiracy theories are true to some degree. Going forward, it is crucial and essential to provide basic awareness among large populations around diseases, which can contribute to positively influencing people's knowledge and attitudes and their perception toward such diseases and combat conspiracy theories.

Delirium in Intensive Care Units: Perceptions of Physicians and Nurses.

Delirium is an indicator of morbidity and mortality in intensive care unit (ICU) patients. It can lead to negative outcomes and longer hospital stays, thus increasing hospital costs. Despite national recommendations for daily assessment of delirium, it remains underdiagnosed. Many studies point to a lack of knowledge among health care professionals to accurately detect and manage ICU delirium. The aim of our study was to assess the knowledge, attitudes, and practices of Palestinian health care professionals regarding ICU delirium. The results of a cross-section observational study revealed that delirium appears to be often underrecognized or misdiagnosed in ICUs in Palestine. Therefore, it is critical to further educate the medical and nursing teams and to promote the use of validated tools that can aid in the assessment of this condition. In this way, the length of hospital stays and related health care costs can be reduced.