Exame das ações prioritárias para o fortalecimento do papel das enfermeiras para conseguir a cobertura universal em saúde

Objetivo: explorar las acciones prioritarias para el fortalecimiento del papel de las enfermeras con práctica avanzada para el logro de la Cobertura Universal de Salud según la percepción de informantes clave de la salud en Jordania. Métodos: se utilizó diseño cualitativo exploratorio, utilizando una encuesta semi-estructurada. Una muestra intencional de diecisiete informantes clave de diversos sectores de enfermería y cuidados de la salud fue reclutada para el propósito de este estudio. Se utilizó análisis de contenido usando el método del marco de cinco etapas para el análisis de datos. Resultados: los resultados revelaron que la política y la regulación, la formación de enfermería, la investigación y la fuerza laboral fueron identificados como los principales elementos que influyen en el papel de la enfermeras con práctica avanzada para contribuir a la consecución de la Cobertura Universal de Salud. Las acciones prioritarias fueron identificadas por los participantes para los cuatro elementos principales. Conclusión: los hallazgos del estudio confirman la necesidad de fortalecer el papel de la enfermeras con práctica avanzada para lograr la Cobertura Universal de Salud a través de una transformación importante en la formación, la práctica, la investigación, el liderazgo, y el sistema de regulación. Las enfermeras deben unirse para alcanzar competencias consistentes de enfermería relacionados con la enfermeras con práctica avanzada, la Atención Primaria de Salud , Cobertura Universal de Salud, liderazgo y formulación de políticas, para fortalecer su posición como actores principales que influyen en el sistema de salud y la generación de evidencias.Objetivo: analisar as ações prioritárias para o fortalecimento do papel da enfermeira em prática avançada na Cobertura Universal de Saúde , segundo a percepção dos informantes-chave na Jordânia. Métodos: foi utilizado desenho qualitativo exploratório, com um questionário semiestruturado. A amostra intencional de dezessete informantes-chave de vários setores de enfermagem e de saúde foi recrutado para o propósito do estudo. A análise de conteúdo utilizando a abordagem do quadro de cinco estágios foi utilizada para a análise de dados. Resultados: os resultados revelaram que as políticas e regulações, educação em enfermagem, pesquisa e força de trabalho foram identificados como os principais elementos que influenciam o papel da enfermeira em prática avançada em contribuir para a realização da Cobertura Universal de Saúde. As ações prioritárias foram identificadas pelos participantes para os quatro principais elementos. Conclusão: os resultados do estudo confirmam a necessidade de reforçar o papel da enfermeira em prática avançada para alcançar Cobertura Universal de Saúde através de uma grande transformação no ensino de enfermagem, prática, pesquisa, liderança e sistema regulatório. A Enfermagem deve unir-se para obter competências consistentes relacionadas com a enfermeira em prática avançada, atenção primaria de saúde, Cobertura Universal em Saúde, liderança e elaboração de políticas para reforçar sua posição como atores principais que influenciam o sistema de saúde e a geração de evidências.Objective: to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs) towards the achievement of Universal Health Converge (UHC) as perceived by health key informants in Jordan. Methods: an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. Results: the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. Conclusion: study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation

Direct and Moderating Effects of Work Environment and Structural Empowerment on Job Stress and Job Satisfaction Among Nurses in the Sultanate of Oman

Objective: This paper seeks to explore the relationships between nurses’ work environment, job stress, and job satisfaction, as well as the moderating effects of work environment and empowerment on the job stress–job satisfaction relationship. Methods: A descriptive correlational design was utilized. The study encompassed a convenience sample of 1,796 hospital nurses from the 11 governorates in Oman. A self-report questionnaire that included a set of instruments was used to collect data. Results: The results showed that nurses who perceived higher levels of job stress reported lower levels of satisfaction and empowerment, and perceived their work environment as less favorable and supportive. The findings only confirmed the direct effects of work environment and empowerment on satisfaction; there was no support for indirect or moderating effects. The hierarchical regression model showed that 46.5% of the variation in the level of job satisfaction was explained by the study variables. Conclusion: The results of this study demonstrate the importance of implementing strategies that empower staff, provide a supportive and positive work environment, and tackle job stress to enhance levels of job satisfaction. Keywords: Work Environment; Empowerment; Job Stress; Job Satisfaction; Nurses; Oman

Determinants of Physicians’ Job Satisfaction: A national multi-centre study from the Sultanate of Oman

Objectives: Physician satisfaction with their job can lead to a better quality of care, fewer chances of making errors, and better patient outcomes. The purpose of the study was to examine physician satisfaction; and to assess job satisfaction across several factors, such as quality of care, ease of practice, relationship with leadership, and inter-professional collaboration. Method: A descriptive cross-sectional design was used. Data were collected between July 2019 and January 2020. Participants provided demographic information and completed surveys related to physician satisfaction (13-item Likert type items on a scale from 1 to 5), and inter-professional collaboration (15-item, 4-point Likert scale, ranging from 1 for “strongly disagree” to 4 for “strongly agree”). Multiple linear regressions were used to determine the relationship between overall job satisfaction and demographic features and inter-professional collaboration. Results: Out of 396 physicians who were contacted, 354 responded (response rate = 89.4%). The median age was 40 years, and there were 208 male and 124 female physicians. The vast majority (238/354 = 62%) were expatriates. Seventy percent had a post-graduate degree. The vast majority (308 = 87%) worked in government hospitals. Results showed that 15 (5%) of the physicians were not satisfied with their job (<3.00), 179 (40%) expressed a moderate level of satisfaction (3.00 – 3.75), and 129 (55%) were highly satisfied (>3.76). There was no difference in mean job satisfaction score among different groups of study participants, except for gender, and the working grade (p < 0.05). The overall job satisfaction rates were higher for the quality of care (M = 3.93, SD = 0.61), and for ease of practice (M = 3.89, SD = 0.55) and lower for the relationship with leadership (M = 3.67, SD = 0.86). Having a clinical postgraduate degree together with a PhD, a senior level of responsibility and good inter-professional relationship were associated with higher job satisfaction rates (p = 0.003 and 0.007, respectively). Conclusion: Overall, the job satisfaction rate was high. There was no difference among different groups of study participants, except for the working grade. Having a clinical postgraduate degree, a senior level of responsibility, and good inter-professional relationship were associated with higher job satisfaction rates. The overall job satisfaction rates were higher for the quality of care, and for ease of practice, and lower for relationship with the leadership. Relationship with the leadership is a modifiable factor and efforts at enhancing the physician-leadership relationship may lead to even higher satisfaction rates. Keywords: Interprofessional relations; Job Satisfaction; Leadership; Oman; Physician; Quality of health car

Access to Care and Prevalence of Hypertension and Diabetes Among Syrian Refugees in Northern Jordan.

Importance: The management of noncommunicable diseases in humanitarian crises has been slow to progress from episodic care. Understanding disease burden and access to care among crisis-affected populations can inform more comprehensive management. Objective: To estimate the prevalence of hypertension and diabetes with biological measures and to evaluate access to care among Syrian refugees in northern Jordan. Design, Setting, and Participants: This cross-sectional study was undertaken from March 25 to April 26, 2019, in the districts of Ramtha and Mafraq, Jordan. Seventy clusters of 15 households were randomly sampled, and chain referral was used to sample Syrian households, representative of 59 617 Syrian refugees. Adults were screened and interviewed about their access to care. Data analysis was performed from May to September 2019. Exposures: Primary care delivered through a humanitarian organization since 2012. Main Outcomes and Measures: The main outcomes were self-reported prevalence of hypertension and diabetes among adults aged 18 years or older and biologically based prevalence among adults aged 30 years or older. The secondary outcome was access to care during the past month among adults aged 18 years or older with a diagnosis of hypertension or diabetes. Results: In 1022 randomly sampled households, 2798 adults aged 18 years or older, including 275 with self-reported diagnoses (mean [SD] age, 56.5 [13.2] years; 174 women [63.3%]), and 915 adults aged 30 years or older (608 women [66.5%]; mean [SD] age, 46.0 [12.8] years) were screened for diabetes and hypertension. Among adults aged 18 years or older, the self-reported prevalence was 17.2% (95% CI, 15.9%-18.6%) for hypertension, 9.8% (95% CI, 8.6%-11.1%) for diabetes, and 7.3% (95% CI, 6.3%-8.5%) for both conditions. Among adults aged 30 years or older, the biologically based prevalence was 39.5% (95% CI, 36.4%-42.6%) for hypertension, 19.3% (95% CI, 16.7%-22.1%) for diabetes, and 13.5% (95% CI, 11.4%-15.9%) for both conditions. Adjusted for age and sex, prevalence for all conditions increased with age, and women had a higher prevalence of diabetes than men (adjusted prevalence ratio, 1.3%; 95% CI, 1.0%-1.7%), although the difference was not significant. Complications (57.4%; 95% CI, 51.5%-63.1%) and obese or overweight status (82.8%; 95% CI, 79.7%-85.5%) were highly prevalent. Among adults aged 30 years or older with known diagnoses, 94.1% (95% CI, 90.9%-96.2%) currently took medication. Among adults aged 18 years or older with known diagnoses, 26.8% (95% CI, 21.3%-33.1%) missed a medication dose in the past week, and 49.1% (95% CI, 43.3%-54.9%) sought care in the last month. Conclusions and Relevance: During this protracted crisis, obtaining care for noncommunicable diseases was feasible, as demonstrated by biologically based prevalence that was only moderately higher than self-reported prevalence. The high prevalence of complications and obese or overweight status, however, suggest inadequate management. Programs should focus on reinforcing adherence and secondary prevention to minimize severe morbidity

Adaptation of a community health volunteer strategy for the management of hypertension and diabetes and detection of COVID-19 disease: a progamme for Syrian refugees in northern Jordan.

BACKGROUND: During humanitarian crises and severe epidemics, life-saving care for non-communicable disease must be sustained. Data from a 2019 household survey showed high rates of hypertension (39·5%), diabetes (19·3%), or both conditions (13·5%) in Syrian refugees aged 30 years and older in northern Jordan. Patients with comorbidities are known to be at risk of severe COVID-19 disease and, as refugees, Syrians might be under-detected by current COVID-19 surveillance programmes. Furthermore, refugee health clinics were temporarily closed in March, 2020 because of COVID-19 control measures. Here, we describe how an existing community health volunteer (CHV) strategy was modified during the COVID-19 pandemic to support non-communicable disease care in Syrian refugees with hypertension and diabetes living in northern Jordan. METHODS: In June, 2020, nurses enrolled a cohort of Syrian patients with hypertension, diabetes, or both conditions from clinics in Ramtha and Mafraq, Jordan, to establish their disease stability and medication needs. Jordanian and Syrian CHVs who were originally recruited for a study of non-communicable disease care followed up every patient with a monthly telephone call to provide education on self-management and psychosocial support, ensure sufficient medication, assess adherence to medication, and screen for complications that required urgent referral and COVID-19 symptoms. We undertook a cohort analysis of routine data to analyse monthly trends in adherence as well as incidence of critical incidents such as urgent complications, medication stockouts, and symptoms of COVID-19. FINDINGS: Between June 28 and Oct 1, 2020, we enrolled 1140 patients; 1119 patients (98%) with verified telephone numbers were contacted with at least one telephone call and 953 patients (85%) with three calls. Most patients were female (696 [62·5%]), mean age was 57·5 years (IQR 49·4—65·6); 601 patients (54%) had both hypertension and diabetes, 419 patients (37·7%) had hypertension, and 93 patients (8·4%) had diabetes. Self-reported monthly adherence to medications over the past 5 days and 30 days remained greater than 90% and did not differ between conditions. Of 3143 consults, 159 (5%) were escalated for urgent needs, and 69 (2%) indicated suspected COVID-19 symptoms with two cases meeting the criteria for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. By month 3, the incidence of urgent complications, medication stockouts, and COVID-19 symptoms remained low (19·9, 68·2, and 12·6, respectively, per 1000 population) and could be responded to rapidly. INTERPRETATION: The CHV programme enabled continuous monitoring of refugees with hypertension and diabetes during severely disrupted clinical services as well as screening for COVID-19 symptoms. Community health volunteers can extend primary care for noncommunicable diseases to refugees and counter poor continuous access to care and service disruptions caused by protracted crises and severe epidemics. FUNDING: Enhanced Learning and Research for Humanitarian Assistance/Research for Health in Humanitarian Crises

Rapidly adapted community health strategies to prevent treatment interruption and improve COVID-19 detection for Syrian refugees and the host population with hypertension and diabetes in Jordan.

BACKGROUND: We evaluated community health volunteer (CHV) strategies to prevent non-communicable disease (NCD) care disruption and promote coronavirus disease 2019 (COVID-19) detection among Syrian refugees and vulnerable Jordanians, as the pandemic started. METHODS: Alongside medication delivery, CHVs called patients monthly to assess stockouts and adherence, provide self-management and psychosocial support, and screen and refer for complications and COVID-19 testing. Cohort analysis was undertaken of stockouts, adherence, complications and suspected COVID-19. Multivariable models of disease control assessed predictors and non-inferiority of the strategy pre-/post-initiation. Cost-efficiency and patient/staff interviews assessed implementation. RESULTS: Overall, 1119 patients were monitored over 8 mo. The mean monthly proportion of stockouts was 4.9%. The monthly proportion non-adherent (past 5/30 d) remained below 5%; 204 (18.1%) patients had complications, with 63 requiring secondary care. Mean systolic blood pressure and random blood glucose remained stable. For hypertensive disease control, age 41-65 y (OR 0.46, 95% CI 0.2 to 0.78) and with diabetes (OR 0.73, 95% CI 0.54 to 0.98) had decreased odds, and with baseline control had increased odds (OR 3.08, 95% CI 2.31 to 4.13). Cumulative suspected COVID-19 incidence (2.3/1000 population) was suggestive of ongoing transmission. While cost-efficient (108 US${\$}$/patient/year), funding secondary care was challenging. CONCLUSIONS: During multiple crises, CHVs prevented care disruption and reinforced COVID-19 detection

Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage

ABSTRACT Objective: to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs) towards the achievement of Universal Health Converge (UHC) as perceived by health key informants in Jordan. Methods: an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. Results: the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. Conclusion: study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation

Editorial: The Birth of Jordan Journal of Nursing Research

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Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage

ABSTRACT Objective: to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs) towards the achievement of Universal Health Converge (UHC) as perceived by health key informants in Jordan. Methods: an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. Results: the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. Conclusion: study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation