Jordanian Healthcare Research Articles

Intimate partner violence screening barriers as perceived by Jordanian nurses: A qualitative descriptive study

Intimate partner violence screening is an important component of patient assessment; however, not all nurses routinely conduct this screening with their patients. The purpose of this qualitative descriptive study was to describe the barriers to intimate partner violence screening and strategies to overcome these barriers. A purposive sample of 12 male and female Jordanian nurses working at a university hospital in the city of Irbid, Jordan participated in this study. Participants were interviewed using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Steps of Colaizzi’s steps for procedural analysis were used to analyze the transcript data. Four themes were derived from the data: Jordanian culture, system-based IPV screening barriers, IPV victims as barriers to IPV screening, and nurses’ attitudes and beliefs for IPV screening. Jordanian nurses encounter many barriers that affect their ability to screen for IPV. Screening for IPV remains an important nursing function even in Jordanian healthcare settings.

Using Six Sigma to Assess Quality in the Jordanian Health Care Sector

This study applied Six Sigma methodology to selected hospitals in Jordan to evaluate their performance, compare the results, and suggest methods to improve the hospitals’ operations and reduce medical errors. Four hospitals were selected from both the public and private sectors. Using a series of interviews, archival reviews and a questionnaire, the study found that the studied public hospitals outperformed their private counterparts with some variations in the type of medication errors. Several recommendations were made to improve the processes followed, which could raise the value of the Six Sigma coefficient. This study provides an example of how applying knowledge management techniques can have a strong effect on improving customer service and reducing costs.

PCN211 - Health Technology Assessment: Is It the Right Piece for the Jordanian Health Care Puzzle?

PCN211 - Health Technology Assessment: Is It the Right Piece for the Jordanian Health Care Puzzle?

Knowledge of the Use and Benefits of Applying Biotechnology and Cell Based Therapy in Orthopaedics in Jordan : Questionnaire Survey and Regulation Assessment

New techniques have been developed, many derived from biotechnology that enhance and expand the use of human cells and tissues as therapeutic products. These new techniques hold the promise that some day they will provide therapies for many serious medical conditions. With the increasing numbers of trauma, cancer cases and diabetes mellitus cases every year in The Hashemite Kingdom of Jordan (Jordan), it is important to explore and introduce the use of new therapeutic technologies in the Jordanian health care system, i.e., biotechnology, tissue engineering, and cell based therapy. Before introducing these therapy modalities to the Jordanian market, assessing the knowledge of these new therapeutic modalities is worth performing. The current study aimed to assess the knowledge of biological growth factors and mesenchymal stem cells (MSCs) use and benefits in orthopaedics in Jordan. The assessment was made by analyzing questionnaire results filled by a sample of Jordanian orthopaedics surgeons and senior medical school students from the Hashemite University, Zarqa, Jordan. The questionnaire results reflected good knowledge and appreciation of the use and benefits of biological growth factors and MSCs in orthopaedics applications and treatments among participants. Surprisingly, higher percentages of positive answers were reported about the knowledge of mesenchymal stem cells benefits compared to biological growth factors in the year 2012. The results also showed statistically significant lower percentages of positive answers to the question of thinking that using these new technologies will reduce the treatment cost (≤36%), compared to the percentages of positive answers to the other questionnaire questions. Still, higher percentages of positive answers were reported to whether participants will agree to use biological growth factors to accelerate the healing process on themselves (82% in 2009 & 74% in 2012). The current study also presented an assessment of the Jordanian regulations and their ability to define and regulate the use of these new therapeutic technologies and their products in Jordan. The questionnaire results and the legislations assessment highlighted the necessity to reform the Jordanian laws to build a legal framework that encourage healthcare suppliers and providers to explore and evaluate new technologies that might reduce treatment cost and hospitalization time in Jordan.

Assessment of medical wastes management protocols in Jordanian healthcare institutions

Successful and effective medical waste management strategy requires adopting clear and distinct protocols that will guarantee the appropriate and correct execution of this strategy. This study presents the results of a survey that has been conducted among the nursing staff working in different Jordanian hospitals in the northern, middle and southern parts of Jordan. The survey contained questions about medical waste administrative procedures and collection protocols. The results showed that the southern part of Jordan has the least proper way of administrative procedures and collection protocols of medical waste. However, other parts still need more attention to reach safe handling and treatment of medical wastes.

Jordanian nurses' job satisfaction and intention to quit

PurposeThis study aimed to identify factors that influenced job satisfaction and dissatisfaction, and the intention of staff nurses to quit nursing in three Jordanian healthcare delivery sectors.Design/methodology/approachA cross‐sectional design was used to answer the research aims. A purposive sample of 180 critical care nurses in three hospitals during 2007 was used. Nurses completed a self‐administered questionnaire consisting of demographic items, a job satisfaction survey, as well as a question eliciting the intention to quit. The authors used descriptive and inferential statistics, ANOVA, correlational, regression and post‐hoc tests to analyze the data.FindingsThe grand mean for satisfaction for all nurses was 3.44 (±0.51) out of 6. They reported being highly satisfied with the item “I like the people I work with”, and reported the least satisfaction with the item “I have too much to do at work”. The mean value for nurses' intention to quit was 2.56 (±0.89) out of 4, with 59 per cent reporting that they “Likely” or “Very Likely” intended to leave their workplace. The nurses' level of job satisfaction significantly predicted their intention to leave their workplace (F=32.1, p < 0.001).Practical implicationsThe results can be used as a basis for decision making and future planning. Results also highlight the need to emphasize positive factors to enhance employees' satisfaction and to brainstorm solutions for improving job satisfaction and retaining nurses.Originality/valueThe study addressed an important clinical concern at a time of sparse research literature in Jordan. The findings are noteworthy and important for the delivery of proper nursing care that would lead to improved health status for the society.

Issues of asymmetric information in public-private partnership contracts within Jordanian healthcare sector

Public-private partnership (PPP) contract is a special type of governance. Under a PPP contract, a central-government agency or a local authority and a private agent bargain a long-term contractual agreement to build a public infrastructure or the providence of a public service, such that risks, returns and resources are optimally shared among partners. The health sector has applied such PPP schemes in the recent decades for two primary reasons: 1 lack of government budgetary support for the health sector and the search for an alternative source of funding 2 the emergence of privatisation in the health sector. However such schemes of contracts are fully related to issues of asymmetric information such as the problems of moral hazard, adverse selection and market for lemons. These problems undermine the shared optimal results of PPPs contracts. Jordanian Health sector has witnessed some healthcare cuts. The sector also endeavoured on such PPP contracts to lessen the deteriorating consequences of the health sector. This paper exposes the Jordanian experience of PPPs in the health sector. Related issues of asymmetric information are treated and some remedy propositions are advanced.

The Development of a Preceptor Training Program on Clinical Nursing Education in Jordan in Collaboration With Sweden

As part of the Swedish-Jordanian International Collaboration Project, this study developed, implemented, and evaluated a preceptor training program to enhance pedagogical strategies for integration of theory and practice in nursing education in Jordan. A three-phase program was developed and implemented (2006 to 2007) focusing on experiential learning using drama, case-method, and photolanguage methods. Data were collected from 12 preceptors in Jordan using questionnaires and interviews. Four themes reflected experiences gained from participating in the program, including bridging the gap between theory and practice, enhancing students' imminent potential, promoting the role of preceptor, and facing challenges in applying pedagogical strategies. Participants noted a positive effect on their personal and professional growth as a preceptor, students' learning process, and the quality of health care. Preceptors perceived that the model program helped to bridge the gap between theory and practice, improved communication and networking, and improved the quality of health care in Jordan.

Foot care within the Jordanian healthcare system: a qualitative inquiry of patient’s perspectives

Objective: The objective of this study was to elaborate patient’s views of diabetic foot care within the Jordanian healthcare system. Design: A qualitative approach with unstructured face‑to‑face interviews was used in this study. Setting: Participants were recruited from six hospitals throughout Jordan plus a university affiliated healthcare centre. Subjects: Seven patients with diabetes and suffering from a foot burn injury were recruited from a university affiliated hospital plus public hospitals located in Amman, the capital of Jordan. In addition to Amman, the facilities were located in two main Jordanian governorates; Irbid and Al‑Karak. Results: Our findings are consistent with what is known about barriers to effective diabetic foot care. Participants were not practising preventive foot care behaviours due to personal beliefs about healthcare and the structure and culture of healthcare practice in Jordan. Specifically, participants of this study believed that the presence of diabetes does not necessitate the need for regular foot examination when there are no active ulcers on their feet. Additionally, providers of healthcare were not performing foot examination as part of regular diabetes care. Conclusions: Efforts should be made to promote preventive care practices within the context of the Jordanian healthcare system. By so doing, the incidence and severity of diabetic foot ulceration and other consequences may be reduced.

Reporting of occupational exposures to sharp injuries among Jordanian healthcare workers

Abstract Objectives (a) To determine the reporting rate of sharps injuries over the last 12 months; (b) to examine the relationships between specific variables and reporting rate of sharps injuries; and (c) to identify the reasons for failure to follow the guidleines for reporting of sharps injuries. Method A cross-sectional study of healthcare workers working in public and private hospitals was undertaken using a survey that was developed by the Centers for Disease Control and Prevention. Results Two thousand surveys were distributed to healthcare workers who were working in private and public hospitals. One thousand and sixty-eight healthcare workers filled out the surveys. The highest reporting rates were found among the following subgroups: female (34%); years of experience less than 2 years (51%); dentists (57%); worked in laboratory (48%) followed by operation room (36%); and worked between 7:00 a.m. and 3:00 p.m. (50%). Respondents' experiences with the health service post-exposure were the following: care was not given in a timely manner; their questions and screenings were not answered; and place where care was given was not good. Conclusion Reporting of occupational exposures to sharps injuries is a significant dilemma facing Jordanian healthcare workers. Procedures for reporting sharps injuries must be available and clear to all healthcare workers.

The Level of Satisfaction of the Health Services Offered by the Comprehensive Health Care Center

Problem statement: Health care in Jordan and planning for health policies especially in sector of comprehensive health centers. Approach: This study aimed to explore the level of satisfaction of those who beneficiaries from services which offered by health care center at Suweileh region, west Amman. The study was implemented on four controlled variables: Transportation means to medical center, distance from home to center, number of visits the center and waiting time at center. A system random sample estimated 25% of services recipients, author analyzed the data used: frequencies, percentages, means, standard deviation, and T test for one sample. Results: The results revealed that 50% of beneficiaries used public transportation buses, average of distance from home to center was between 4_6 kilometers, more than 62% of people included in sample visited the center 2_3 times, 80% of them waited in center not more than half an hour. Conclusion/ Recommendations: The study revealed that an excellent of health care services offered by the center, there was a strong relationship between center and recipients of health services. Specialists in this area of study must conduct more studies on such centers which give decision makers headlines to improve planning towards enhancement and development comprehensive health care centers.

Piloting the development of a cost-effective evidence-informed clinical pathway: Managing hypertension in Jordanian primary care

The UK's National Institute for Health and Clinical Excellence (NICE) and the Jordan office of the Medicines Transparency Alliance embarked on a pilot project to design an evidence-based guideline for cost-effective pharmacological treatment of essential hypertension in Jordan. The project's objectives were to directly address a major health problem for Jordan by producing a guideline; and to delineate the strengths and weaknesses of Jordan's healthcare process to allow similar future efforts to be planned more efficiently. The pilot spanned a period of approximately 8 months. Activities were overseen by local technical and guideline development teams, as well as experts from NICE. NICE's hypertension guidelines and economic model were used as a starting point. Parameters in the economic model were adjusted according to input and feedback from local experts with regards to Jordanian physician and patient practices, resource costs, and quality of life estimates. The results of the economic model were integrated with the updated available clinical trial literature. The outputs of the economic model were used to inform recommendations, in the form of a clinical algorithm. A report of the process and the strengths and weaknesses observed was developed, and recommendations for improvements were made. The pilot represented the start of what is intended to be a healthcare process change for the country of Jordan. Issues emerged which can inform strategies to ensure a more cohesive and comprehensive approach to the cost-effective use of appropriate drugs in managing chronic disease in Jordan and countries operating in a similarly resource-constrained environment. Furthermore, our pilot highlights how richer countries with relevant experience in evidence-informed healthcare policy making can assist others in strengthening their decision-making methods and processes.

PCV83 PILOTING THE DEVELOPMENT OF A COST-EFFECTIVE EVIDENCEINFORMED CLINICAL PATHWAY: MANAGING HYPERTENSION IN JORDANIAN PRIMARY CARE

Objectives: the UK's National Institute for Health and Clinical Excellence (NICE) and the Jordan office of the Medicines Transparency Alliance embarked on a pilot project to design an evidence-based guideline for cost-effective pharmacological treatment of essential hypertension in Jordan. The project's objectives were to directly address a major health problem for Jordan by producing a guideline; and to delineate the strengths and weaknesses of Jordan's healthcare process to allow similar future efforts to be planned more efficiently. Methods: the pilot spanned a period of approximately 8 months. Activities were overseen by local technical and guideline development teams, as well as experts from NICE. NICE's hypertension guidelines and economic model were used as a starting point. Parameters in the economic model were adjusted according to input and feedback from local experts with regards to Jordanian physician and patient practices, resource costs, and quality of life estimates. The results of the economic model were integrated with the updated available clinical trial literature. Results: the outputs of the economic model were used to inform recommendations, in the form of a clinical algorithm. A report of the process and the strengths and weaknesses observed was developed, and recommendations for improvements were made. Conclusions: the pilot represented the start of what is intended to be a healthcare process change for the country of Jordan. Issues emerged which can inform strategies to ensure a more cohesive and comprehensive approach to the cost-effective use of appropriate drugs in managing chronic disease in Jordan and countries operating in a similarly resource-constrained environment. Furthermore, our pilot highlights how richer countries with relevant experience in evidence-informed healthcare policy making can assist others in strengthening their decision-making methods and processes.

Benefit-incidence analysis of government spending on Ministry of Health outpatient services in Jordan

A benefit-incidence analysis was conducted for the year 2000 using various data sources including the Jordan healthcare utilization and expenditure survey 2000. The results illustrate that the poorest segment of the Jordanian population were the most likely to report sickness and seek treatment and were the main users of the Ministry of Health outpatient services. The poorest uninsured individuals were the main source of revenues generated through user fees. The targeting efficiency (i.e. total percentage of benefits received) for the poorest quintile was 33.8% compared with 4.0% in the richest quintile. The analysis demonstrates that the Jordanian government in-kind subsidy is reaching the poor.

Smoking Behavior among Coronary Heart Disease Patients in Jordan: A Model from a Developing Country

The purpose of this study was to compare the frequency of cigarette smoking before and after diagnosis of Coronary Heart Disease (CHD), detect the reasons that discourage quitting smoking and resources of advice about quitting, and investigate the relationship between smoking behaviors and demographic variables. A convenient sample of 300 CHD patients from cardiac outpatient clinics participated. Before disease occurrence, nonsmokers composed 40% of all participants, former smokers 11.7%, and current smokers 48.3%. Surprisingly, after disease occurrence only 29.7% of the patients quit smoking, while 60.7% continued smoking, and 9.6% relapsed. The most frequent reasons given by smokers for not quitting smoking were “do not incline to stop smoking” (25.6%) and “craving for a cigarette” (25%). Doctors were cited most frequently as the reason individuals quit smoking (19.0%). The Jordanian health care system needs to implement systematic intensive smoking cessation programs to maintain and promote CHD patients’ motivation to quit smoking.

Jordanian health care providers' perceptions of post‐partum health care

This qualitative descriptive study explored Jordanian health care providers' perceptions of the health care that they provide for post-partum mothers. Thirty Jordanian health care providers (physicians, nurses and midwives) participated in three focus group discussions. A content analysis approach was used to analyse the data as appropriate for descriptive qualitative inquiry. Health care providers indicated that the care they deliver includes breastfeeding, family planning, childcare and laboratory tests. Health care providers reflected confidence in the care given but indicated the need for continuing education, more resources and expressions of appreciation. Findings provide insights into Jordanian health care providers' perspectives on post-partum health care and emphasized the importance of enhancing utilization of such care in Jordan. It is suggested that the Jordanian Ministry of Health develop a comprehensive plan of educational offerings for providers, with a standardized educational programme for post-partum women. It is essential that all health care facilities provide high-quality post-partum health care that meets the needs of the maternal/infant dyad. Like all qualitative descriptive studies, generalizability of the results may be limited to similar situations and cultures.

Occupational Exposure to Sharp Injuries Among Jordanian Health Care Workers

Objectives: (a) Determine the effects of the following variables (sex, age, experience years, hospital sector, occupation group, education level, working area, shift, timing of occurrence of injuries, hospital location) on the number of exposure to sharp injuries (SIs) among Jordanian health care workers (HCWs), (b) determine the number of exposure cases to SIs among subgroups within each selected variable, (c) identify the percentages of HCWs who were exposed to SIs in the last 12 months, and (d) identify the types of devices involved in SIs based on the responses of different occupational groups. Method: Cross-sectional design was used. Data were collected using a survey that was developed by the Centers for Disease Control and Prevention. Participants: One thousand sixty-eight HCWs who work in private and public Jordanian hospitals participated in the survey. Results: The HCWs whose sex; age; experience years; hospital sector, occupation group; education level; working area; shift; timing of occurrence of injuries; hospital location were female, younger than 30years old, more than 2 years, public, nurses, a bachelor degree, intensive care unit, between 3 pm and 11 pm, their injuries were during use of devises/instruments, the location of the hospital they work in was in the central of Jordan, respectively, exposed more to SIs comparing the subgroups within each other. Eighty-eight (8.2%) of HCWs were not exposed to SIs in the last 12 months, 427 (39.9%) were exposed to only 1sharp injury, 164 (15.4%) were exposed to 2 SIs, 169 (15.8%) were exposed to 3 SIs, 83 (7.8%) were exposed to 4 SIs, 95 (8.9%) were exposed to 5 SIs, and 42 of HCWs (3.9%) did not designate. Nurses (n=745, 81%) were the most occupational group involved in SIs, whereas midwives were the least (n = 5, 1%). In addition, used needles for injections were the instruments most involved in SIs (58.7%), whereas surgical dressing set was the least (8.5%). Conclusions: Occupational exposure to SIs is a significant problem facing Jordanian HCWs, which put them at serious risk of infection from blood-borne pathogens.

Hepatitis needs assessment among Jordanian healthcare workers

Hepatitis infections caused by hepatitis A, B and C virus are considered to be an important health problem worldwide. Based on the available data from the Jordanian Ministry of Health, the incidence rates of hepatitis A and B in the Jordanian population in 2003 were 10.2 and 0.8 per 100,000 per year, respectively; however, data on the incidence of hepatitis C are not currently available. To assess Jordanian healthcare workers' hepatitis training needs. A total of 339 healthcare workers from private and public Jordanian healthcare settings participated in this descriptive study. The Minnesota Primary Care Practitioners Viral Hepatitis Survey was utilized for data collection. Two-thirds of the participants expressed that they did not have adequate and current training in issues related to hepatitis infections. Healthcare workers indicated an interest in receiving information and training about hepatitis A, B and C (83%, 71% and 80%, respectively). The results of this study showed that the majority of Jordanian healthcare workers reported a need for hepatitis training. IMPLICATION TO PRACTICE: Standardized training should be provided to healthcare workers who are working in high-risk settings.

An e‐health trend plan for the Jordanian health care system: a review

The purpose of this research is to examine the potential of e-health by focusing explicitly on the delivery of health care products and services. The examination of e-health activity is guided by one broad research question, "What is the potential for constructing e-health strategy as an innovative health technology?". A great amount of attention has been given to e-health activity in the present day. However important this form of e-health is, this type of service simply does not face the same constraints that must be addressed by those actually delivering health care services. The researchers employed a qualitative data collection technique to formulate more examples and cases to derive lessons for Jordan. Phone interviews in a random sample were conducted with corporate officers in Jordan in order to reveal the internal organizational structure and business trends, interface issues, marketing strategies, as well as comparing and contrasting the online health world to the traditional health care realm. Internet-related projects is a top priority for health care information technology executives in the present day, with a cautious approach toward "e-health", as many products have yet to mature, and that the "click and mortar" model may perhaps be the optimal strategy for e-health in Jordan. This paper reviews the e-health trends to demonstrate the tremendous potential for health-related commercial activity on the internet. However, the researcher examining the barriers facing e-health to the Jordanian health system also pointed out almost insurmountable challenges. Despite the apparent promise of e-health, its instability is measured by its failure so far to systematically penetrate the organization of health care. Beyond the pragmatic negotiation of e-health in the immediate context of clinical practice, there are wider issues about how the development/implementation of e-health is funded, about its organization and management at the policy level; and about its potential medico-legal risks. It is hoped that the handful of ventures into cyber medicine appears to be coming from a few enterprising physicians who have set up medical practices on the Web.

Jordan Palliative Care Initiative: A WHO Demonstration Project

A model for pain relief and palliative care for the Middle East has been established in Jordan. King Hussein Cancer Centre (KHCC) in Amman is now a truly comprehensive cancer center as it includes palliative care for inpatients, outpatients, and patients at home. This is especially important in a country and a region where over 75% of the cancer patients are incurable when diagnosed. To support effective palliative care delivery, there have been many significant changes in Jordan between 2001 and 2006. Regulations governing opioid prescribing have been changed to facilitate effective pain management. The national opioid quota has been increased. Cost-effective, generic, immediate-release morphine tablets are being produced in Jordan. Intensive, interactive bedside training courses for doctors, nurses, and clinical pharmacologists have started to overcome opiophobia and motivate health care professionals to take up palliative care as a profession. “Champions” for palliative care have emerged who are leading the development of palliative care in Jordan's health care systems and starting to support neighboring countries to develop pain relief and palliative care. While before 2003, fewer than 250 patients per year received palliative care, by 2006 more than 800 patients per year were receiving pain relief and palliative care through the KHCC and Al Basheer Hospital. The achieved changes and the unusually rapid and effective institutionalization of palliative care serve as a model for other countries in the Middle East region as to what should be done and how.