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As Jordan strives to achieve universal health coverage, the mechanism for determining which health technologies to include in the basket of reimbursed services has become increasingly important. This study sought to understand stakeholder perspectives in the Jordanian health system regarding the readiness and need to implement health technology assessment (HTA) to support decision-making quality and transparency, ensure value for money on health system spending, and support the achievement of universal health coverage. This study used a cross-sectional survey methodology, and a quantitative analysis was conducted. A questionnaire based on the HTA implementation scorecard was administered in-person to capture responses regarding fourteen dimensions. Thirty-one responses from representatives across the Ministry of Health, regulatory authority, and other stakeholders in the national health system were collected. Most respondents were familiar with HTA and there was nearly unanimous agreement on the need for HTA implementation in Jordan. While the perspectives on how the implementation would occur were varied, careful consideration may be warranted in the areas of the legal framework for HTA, the quality of available data, financial constraints, and limited human resource capacity, as Jordan progresses towards implementing HTA on the road to universal healthcare.

The critical care environment is stressful with complex clinical cases and high levels of workload [1]. Adequate exposure to various clinical experiences is essential to develop effective clinical reasoning skills [2]. Taking into consideration the risk of clinical practice mistakes and the importance of patient safety, simulation is an effective method to immerse learners in scenarios that mimic clinical situations with focused learning opportunities. Guided reflection through reflective learning conversations following simulation activities is recognized as an effective method to develop clinical reasoning skills [3]. We describe a co-design process to develop a simulation guided reflective learning conversation model to optimize the clinical reasoning skills for critical care nurses attending simulation-based activities. A co-design working group of 10 critical care nurses of varying levels of seniority, experience, nationality, and gender; two critical care doctors; three patient representatives; 2 researchers, and 5–6 critical care educators are working collaboratively to co-design the guided reflective learning conversation model, in which clinical reasoning can be optimized with consideration to a wide range of case complexity, subspecialty, and competence levels. The co-design working group is meeting online for 4–6 workshops of 4 hours. The co-design process is built on valid and reliable clinical reasoning and educational theoretical frameworks and models. The inputs to the process, exercises, and activities are taking place during the workshops and the outputs of the workshops are described to establish the co-design process. The final draft of the model will be validated and tested. The study sample will be grouped into experimental and control cohorts of critical care nurses who attend critical care simulation-based courses (N=300). Data will be collected through surveys, focus groups, and simulation-based objective assessment and observations. The study has received Institutional Review Board approval from the Hamad Medical Corporation Medical Research Centre (MRC-01-22-117) and the University of Hertfordshire (HSK/PGR/UH/04728). The first draft of the co-design model is presented in Simulation-Based Reflective Learning Conversation Model (SBRLCM) under development Clinical reasoning is multidimensional with difficulty to structure and evaluate during debriefing. Developing a guided reflective learning conversation model in which clinical reasoning skills are actively and effectively embedded, would therefore enable critical care nurses developing clinical reasoning skills to meet the special demands of critical care. 1. Vahedian-Azimi A, Hajiesmaeili M, Kangasniemi M, Fornés-Vives J, Hunsucker RL, Rahimibashar F, Pourhoseingholi MA, Farrokhvar L, Miller AC. Effects of stress on critical care nurses: a national cross-sectional study. Journal of intensive care medicine. 2019;34(4):311–22. 2. Kang H, Kang HY. The effects of simulation-based education on the clinical reasoning competence, clinical competence, and educational satisfaction. Journal of the Korea Academia-Industrial cooperation Society. 2020;21(8):107–14. 3. Decker S, Alinier G, Crawford SB, Gordon RM, Jenkins D, Wilson C. Healthcare Simulation Standards of Best Practice

Background: Clinical reasoning is described as a reflective process that enables health care practitioners to collect data, solve problems, and make decisions and judgments to enhance patient outcomes and patient safety 1 . To avoid practice mistakes, healthcare professionals should possess or develop effective clinical reasoning skills. To develop effective clinical reasoning skills, enough exposure to various experiences is required. Practicing and developing clinical reasoning skills can be achieved in both clinical and simulated settings 2 . Using structured clinical reasoning models could enhance effective clinical reasoning development 3 . This review aims to explore the current clinical reasoning models. \ud \ud Methods: A scoping review was undertaken to answer the question; what are the best available clinical reasoning models to enhance clinical reasoning in clinical and simulated settings? The following sources were searched: Medline; Scopus; Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic published in 2000 onwards. The search included [MeSH] topics of; “Clinical reasoning” and “Clinical Reasoning Models”. The inclusion criteria were primary studies that described the use of clinical reasoning models in clinical and simulated settings. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of the Joanne Briggs institute. \ud \ud Results: There are valid clinical reasoning models to be used for clinical and simulated settings which are; TANNER, DML, clinical Reasoning Model (CRM), Outcome-Present State Test (OPT), and Self-Regulated Learning (SRL) model (Table 1). However, the validity of these models needs to be tested considering different health care specialties, the scope of practice, complexity, and seniority levels. \ud \ud Conclusion: Considering the importance of clinical reasoning skills in health care practices, using structured models could enhance the clinical reasoning process, however, despite the availability of clinical reasoning models, additional validation for these models is still required

Clinical reasoning is interconnected with decision-making which is a critical element to ensure patient safety A scoping review was undertaken to answer the questions: What are the best available valid and reliable tools to evaluate clinical reasoning while attending simulation-based activities? Do we have valid and reliable clinical reasoning assessment tools for simulation that measure clinical reasoning considering different seniority and competency levels? We searched Medline, Scopus, Education Research Complete, and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of: ‘Clinical reasoning’, ‘Simulation-based courses’ and ‘Clinical Reasoning tools’. The inclusion criteria were primary studies that described the use of tools measuring clinical reasoning while attending simulation-based courses. Two independent researchers agreed on the inclusion of the identified papers for full-text review. This review followed the review guidelines of Joanne Briggs institute.There are valid and reliable tools to evaluate clinical reasoning while attending simulation which is Clinical Reasoning Evaluation Simulation Tool CREST There is an adequate number of tools to measure clinical reasoning while attending simulation. However, there is a significant basis to test the reliability and validity of these tools against different competence and seniority levels, and applicability to other healthcare professions.

In response to COVID-19, our organization expanded the critical care beds capacity; however, the number of critical care nurses was insufficient to meet expansion demands. Therefore, non-critical care nurses were deployed to COVID-19 critical care units. The deployed nurses lacked experience and training in critical care. To ensure patient safety, the nurses were assigned to assessors who evaluated their fitness to practice after receiving upskilling training through simulation-based education (SBE). However, due to the massive expansion and rapid deployment process, there was a shortage of competency assessors, highlighting an urgent need to use SBE to develop more assessors. We developed additional competency assessors through simulation embedding deliberate practice and rigorous assessment. Deliberate practice in simulation is described as progressive learning, which includes repetitive performance and rigorous assessment The aim of the study was to explore the effectiveness of simulation embedding deliberate practice in developing nurse competency assessors.Eleven assessor candidates were asked to perform competency assessments under simulated conditions. During the simulation, simulated participant (SP) roles were assigned as a bedside nurse and patient relative; the patient was a high-fidelity patient simulator. The assessor candidates were asked to perform a competency assessment of the bedside nurse who should perform the required critical care skills on the patient in the presence of the patient’s relative. The candidates used a valid observation rubric to complete the assessment. Using deliberate practice strategies, after each competency assessment, a debriefing session was conducted in which the SPs provided constructive feedback on the assessor’s performance. The assessor repeated the competency assessment under the same simulation conditions and attended debriefing sessions until they mastered the competency assessment process. Post simulation evaluation collected data to evaluate the candidates’ perception of the training.Eleven nurses completed the simulation developmental programme and were assessed as competent to become assessors. The questionnaire findings revealed that all nurses perceived themselves as competent assessors; however, 90% reported the need for frequent exposure to the competency assessment process over time, in the clinical setting, to enhance their competence and confidence levels.The hybrid simulation modality of SP and patient simulator embedding deliberate practice method was deemed to be an effective fast track method to develop competency assessors. However, practice of competency assessment in real clinical settings is essential to confirm competence.

COVID-19 created pressure on healthcare institutions to quickly prepare for maximum capacities. To meet the critical care capacity challenges, non-critical care nurses and overseas short-term temporary contracted nurses needed to be urgently deployed to the critical care units. That quick deployment and recruitment process raised concern about competence and patient safety; therefore, the deployed nurses were upskilled using fast track simulation-based education (SBE). SBE is an effective method to manage quick, focussed upskilling training, helping to improve patient care and safety The aim of the study was to explore the effectiveness of the COVID-19 SBE upskilling program on perceived satisfaction, confidence and competence of deployed nurses.Upskilling of 1200 non-critical care nurses was conducted using SBE between 14 March and 1 June 2021 during the country’s second wave of COVID-19. Training consisted of completing a mandatory 2-hour online critical care introductory module that included information on COVID-19 (the disease, pathophysiology), the critical care environment, critical care scope of service and infection control strategies. The online module was followed by 4 hours of in-person SBE using a demonstration and return demonstration approach. Considering the urgency of the situation and time constraints, skills were selected and prioritized according to patient safety and included care of the patient receiving mechanical ventilation, invasive line monitoring and care, recognition of deterioration, proning, and assessment of patient response to interventions. Post SBE, a survey was administered to collect data on the perceived satisfaction, confidence and competence of the nurses being deployed.The majority of the nurses reported confidence in their new skills (97%), while 96% perceived themselves as competent after successful completion of SBEs. The nurses were highly satisfied with the training effectiveness (92%), and 99% believed that they were able to successfully achieve the learning objectives. Specifics about perceived competence and confidence per survey item will be reported in the presentation. The SBE upskilling programme was evaluated as an effective way to learn how to manage critically ill patients.Nurses perceived themselves as confident and competent after participating in SBE. However, competence confirmation will be evaluated either in further SBE or through actual competency assessment in the clinical setting by trained competency validators. Nurses could perceive themselves as confident and competent but still perform incorrectly. Fast track SBEs should not be used to confirm full competence due to the inability to provide repetition of skills practice.

This study aimed to describe the process of the institutionalization of health technology assessment (HTA) in Jordan. In particular, this study presents local policy perspectives on capacity building for HTA and the progress made toward its use in pricing and reimbursement decisions.University-based education and professional development training in pharmacoeconomics and pharmaceutical policy have been the starting points to create a receptive environment, necessary expertise, and local tools across many settings in Jordan. International collaboration with HTA supporting bodies helped to build connections and informed policy development on local levels through projects, meetings, and discussions. HTA INSTITUTIONALIZATION AND ITS USE IN PRICING AND REIMBURSEMENT DECISIONS: Institutionalizing HTA in the King Hussein Cancer Center and the Royal Medical Services was the driving factor for HTA implementation and practice advancement; nevertheless, process transparency and experience sharing through reports and publications are still limited. The Jordan Food and Drug Administration's pricing and formulary decisions require pharmacoeconomic consultation in selected cases according to the Jordanian Drug Law. Nevertheless, there is a lack of local methodological guidelines for conducting HTA. In addition, HTA practitioners and the regulatory scope of future HTA activities in Jordan cannot be determined yet.Over the past 2 decades, Jordan has crossed a number of milestones and advanced further to implement HTA as a tool for evaluating health interventions. As a next step, legislation is needed to mandate the use of HTA and to enhance transparency in decision-making processes.

Background To enhance clinical reasoning skills and reflective practices, Hamad Medical Corporation implemented a new educational initiative known as the reflective learning conversations method. The educational method was designed to discuss reflectively post real patient experiences. The reflective conversations aim to improve nurses' practices and ensure patient safety in the critical care and trauma units. Objectives This study investigates the perceived relationship between reflective learning conversations method and clinical reasoning skills amongst critical care and trauma nurses, and explores how clinical reasoning skills can be developed through learning conversation activities. Design A cross sectional parallel mixed methods study was conducted in Hamad Medical Corporation critical care and trauma units. Anonymous self-reported questionnaires were collected from 236 critical care and trauma nurses who attended the reflective learning conversation activities. Focus group interviews were concurrently conducted alongside the questionnaire survey. Results Attending reflective learning conversations educational activities has a significantly positive impact on critical care and trauma nurses' clinical reasoning skills. Reflective practice can be promoted and enhanced through the use of reflective learning conversations method. However, attending group reflection and the fear of feeling threatened are perceived barriers to reflective learning conversations. Conclusions Reflective learning conversations are perceived as an effective clinical education method to enhance the clinical reasoning skills of critical care and trauma nurses. There are barriers to effective learning conversation methods which need further in depth investigations considering gender and seniority factors.

It may be argued that altruism, or the selfless concern for others, was fundamental to the discipline of nursing; however, with the evolution of nursing, there has been debate within the profession and among service users about whether this element has been lost. Nurses deal with increasingly complex and stressful situations, both patient and performance related. Additionally, demands on the service and capacity constraints continue to place a significant burden on nurses and other health professionals. There are concerns that the cost of caring has had an impact at a personal and performance level within the nursing profession, highlighted particularly by the negative experiences described by NHS service users in the Francis report. Debate continues about the definition of ‘compassionate care’ and how we measure its delivery. Resolving these concerns is a high priority for recruitment and retention strategies within both the NHS and private sector healthcare organisations.

BackgroundThe coronavirus disease 2019 (COVID-19) crisis created pressure on healthcare institutions to be prepared with maximum workforce and bed capacity. Clinical education during COVID-19 has high risk of disease transmission to learners due to contamination of equipment, supplies and surfaces, in addition to increased clinical-related stress and fear. Simulation-based education (SBE) has potential to help manage the pandemic by rapidly upskilling nurses’ clinical responsibilities.MethodsUpskilling of 445 non-critical care nurses was conducted using SBE between 14th March and 30 May 2020. Training consisted of completing a mandatory online critical care awareness module, followed by 3 hours of critical care simulation-based scenarios using demonstration and return-demonstration approach.ResultsAll 445 non-critical care nurses completed required modules and simulation experiences. The critical care simulation-based upskilling programme was evaluated as an effective way to learn how to manage critically ill patients. The majority of evaluation items were rated over 95% for effectiveness of the education; four items were less than 95% (88–94%). Lower rated items considered training and practice time, improved competency and commitment to apply learning.ConclusionRapidly developed and implemented upskilling of critical care nurses was effectively accomplished with SBE. However, learners noted the need for longer learning times and increased practice opportunity to improve competency. Lack of intent to apply the patient care techniques requires further study. SBE has potential as an effective educational method for rapid preparedness in future crisis.

Objectives Health technology assessment (HTA) can increase the appropriateness and transparency of pricing and reimbursement decisions. Jordan is still in the early phase of its HTA implementation, although the country has very limited public resources for the coverage of healthcare technologies. The study objective was to explore and validate priorities in the HTA road map for Jordan and propose to facilitate the preferred HTA status. Methods Health policy experts from the public and private sectors were asked to participate in a survey to explore the current and future status of HTA implementation in Jordan. Semistructured interviews with senior policy makers supported by literature review were conducted to validate survey results and make recommendations for specific actions. Results Survey and interview results indicated a need for increased HTA training, including both short courses and academic programs and gradually increasing public funding for technology assessment and appraisal. Multiple HTA bodies with central coordination can be the most feasible format of HTA institutionalization. The weight of cost-effectiveness criterion based on local data with published reports and explicit decision thresholds should be increased in policy decisions of pharmaceutical and nonpharmaceutical technologies. Conclusion Currently, HTA has limited impact on health policy decisions in Jordan, and when it is used to support pharmaceutical reimbursement decisions, it is mainly based on results from other countries without considering transferability of international evidence. Policy makers should facilitate HTA institutionalization and use in policy decisions by increasing the weight of local evidence in HTA recommendations.

Background: A journal club is a forum to debate and review clinical practice using a number of models to gauge the strength of evidence associated with the clinical practice. A large body of evidence supports the importance of journal clubs as a method to improve patient outcome by enhancing the implementation of evidence-based practice and professional development in the clinical setting1–3. Journal club activities have been recommended by the Hamad Medical Corporation (HMC) Critical Care Nursing Network (CCNN), Qatar, and started in the critical care areas of Hamad General Hospital for different critical care specialties such as trauma, surgical, and medical ICUs since 2014. Methods: The journal club is a 1-hour monthly critical care educational activity for HMC critical care nurses. A flyer promoting the article to be discussed is shared with the critical care nurses one week prior to the scheduled date and each session is attended by 15–20 nurses. Participants gain continuing professional development (CPD) credits for each session they attend. The articles discussed cover patient safety and critical care clinical practices. A structured review of the selected articles is facilitated by an expert educator with a research background. The strength of the evidence to change current clinical practice will be evaluated in a group discussion format (Table 1). At the end of each journal club activity, the facilitator summarizes the learning points, recommendations, and the action plan if the group believes changes to current clinical practice are recommended3. Results: Around 50 journal clubs have been conducted in the critical care units of HMC with a total attendance of 1100 nurses. The journal club activity encouraged critical care nurses to establish the first nursing clinical research team in critical care areas of HMC (Table 2). Additionally, it had a positive impact on improving the professional development and competency level of the critical care nurses which were assessed and evaluated by HMC critical care competency assessors through applying the specialty critical care competency checklist. Finally, implementation of the journal club activity and reviewing best available evidence and research literature led to improvements in clinical practice (Table 3). Conclusion: Implementation of the journal club activity helped in developing critical care nurses’ awareness on current research studies and best available evidence, in addition to keeping them up-to-date with new findings, practices, and critical care trends. The journal club with its structured review questions has proven to be an effective way of evaluating the strengths of the evidence presented in the reviewed articles and sometimes led to changing our critical care clinical practice. It also contributes to improving nurses’ ability to critically appraise research articles. Furthermore, it promotes the implementation of new knowledge gained in clinical practice which is expected to improve patient safety and outcomes.

Background: Reflective practice has become an integral element in healthcare and education.1,2 Hamad Medical Corporation (HMC) is the largest healthcare organization in Qatar and it aims to: develop highly competent healthcare practitioners, promote nurses’ critical thinking, enhance the implementation of evidence-based practice, encourage deep learning approaches, create positive learning environments, maintain patient safety, and bridge the gap between theory and practice in the critical care clinical settings.3 To achieve this, in 2015, reflective learning conversations and debriefing educational methods have been introduced by the HMC Nursing Education and Research Department. Methods: The HMC critical care education team introduced a new one-hour Continuing Professional Development (CPD) educational activity under the title of “Reflective learning conversation and debriefing”. This educational activity has been officially added to the critical care monthly and annual education plans and calendars. The reflective and debriefing discussion aims to give the chance for the critical care practitioners to share their real clinical experiences.1,2,4,5 The critical care nurses of HMC attend each session in a group of 5-7 clinicians and they are asked to reflect critically on a real clinical cases in relation to challenges, limitations, pitfalls, and improvement plan.2,5 A facilitator with a clinical and educational background facilitates the discussion and nurses are encouraged to summarize the learning lessons from that experience in addition to the recommendations and action plans which will be decided accordingly. This is then disseminated and shared with other healthcare facilities if it fits their scope of service. The reflective learning conversation and debriefing guidelines and protocol were established by the corporate nursing education team and are available to clinicians and facilitators (Table 1). Results: Reflective learning conversation with a debriefing improves nurses and health care practitioner's critical thinking and competency level which was evident by learners’ feedback and clinical competency assessment (Table 2). Furthermore, that educational activity is an attractive teaching and learning method to create dynamic learning environments in the critical care clinical settings which was evident by learners and facilitators’ feedback (Table 2). Moreover, nurse empowerment and active engagement were enhanced and encouraged by applying that educational method which was evidenced by the clinical experts’ feedback (Table 2). Finally, applying that method was effective to enhance evidence-based practice and patient safety in critical care settings (Table 3). Conclusion: Reflective learning conversations and debriefing has been perceived to be an effective learning method. Healthcare practitioners can learn from errors and previous experiences to avoid future mistakes in clinical practice. Sharing clinical experiences provides a medium to discuss cases from different angles and in depth which helps to promote deep learning, evidence-based practice, active learning, and patient safety. The recommendations of reflective learning conversations and debriefings can be applied and utilized to change current practice toward best practice and are applicable in all clinical domains and specialties. Although currently attended only by nurses, such sessions would be even more beneficial if attended by multiple professions.

Background: Hamad Medical Corporation (HMC), Qatar, aims to be MAGNET accredited (Nurse Excellence Program) by the American Nurse Credentialing Center (ANCC), in addition to be an academic health center. For these accreditations it is required to establish specialty foundation courses1 and one of these courses is the Critical Care Foundation Program (CCFP) which was designed by HMC critical care and educational experts. During the planning and curriculum design stages, the scientific and planning committee had a thematic focus on; learner-centeredness, active learning, and eustress learning strategies2,3. Methods: Stressful learning has negative impact on achieving learning outcomes2,3. For effective implementation of learner-centeredness and eustress learning, the CCFP design embedded different interactive teaching and assessment strategies including but not limited to; case-based teaching, competency-based teaching, interactive group learning conversations, and demonstration workshops1,2,4,5. To get the CCFP certificates learners should attend the whole program. However, there is a clinical attachment (competency assessment) and the CCFP was designed as eight teaching days over 8 weeks (one day per week). The program design was planned purposefully as the critical care nurses are given enough time to go to the critical care clinical fields to do the competency assessment for related CCFP teaching topics. Eight hundred critical care nurses have attended CCFP over the last four years. During the program, learners were given a chance and appropriate time to consolidate their knowledge and skills, in addition to bridge the gap between theory and practice, and to become competent and specialized ICU nurses with normal and tolerable levels of stress (eustress)3–5. As per the Qatar Certified Healthcare Practitioner Continuing Professional Development requirement, all course participants completed an evaluation form, which we administered online and combined with the participants’ ability to download the program completion certificate. The data from the participants’ evaluation forms was reviewed by the course scientific and planning committee which then was used to make further recommendations. Results: The CCFP curriculum design was helpful and effective in controlling critical care nurse's stress level which was evident by learner's self-reporting feedback and assessment tools (Table 1). Moreover, the program design was effective for active learner's engagement which was evident by the learner's feedback, educational experts, and peer review reports (Tables 1 and 2). A total of 800 nurses underwent the critical care specialty competency assessment process, and they were signed off as competent in all the domains assessed. Conclusion: Eustress learning allocates the learner at the center of the learning process and provides better learning outcomes. The design of this teaching curriculum which integrates different modalities of teaching and assessment methods helps learners to be actively involved in the learning and assessment process. Considering flexible and evidence based assessment methods in addition to written exams is recommended to decrease stress among learners. Reflection, and competency clinical attachment are recommended teaching and assessment methods to decrease learning and assessment stress levels, and to promote the effectiveness of the learning and teaching process.

Background Access to healthcare services including innovative treatments is one of the most important objectives of healthcare system in Jordan. This research summarized one of the actual practices pertaining to health priority setting in Jordan with official requirement to use cost-effectiveness analysis. Objectives To address the role of economic evidence to inform the decisions and rationales drawn by health policy experts to optimize resources mobilization for new cancer drugs. Method The research reported a case study of formulary setting priority in Jordan. Documentary collation and analysis of a secondary source (meeting minutes) produced by decision committee were conducted by the research team. The decisions and rationales shaped by panelists for 22 newly registered oncology drugs at Jordan Food and Drug Administration were reviewed and described. Results It was found that the absence of official health economic guidelines in the country and informal use of cost-effectiveness analysis by the panelists appeared to flaw the importance of incremental cost-effectiveness ratio (ICER). Nevertheless, “the lower the ICER, the better the drug” was the primary factor in all committee’s decisions to inform resources mobilization. Despite of the latter, 7 drugs were selected for formulary inclusion for different oncology disease areas in Jordan. Conclusions Priority setting for new cancer drugs is not well-informed in Jordan. Nevertheless, this research revealed different disadvantages that appear to militate against the perspective of the study. Recommendations for implementation and enhancement of health economic evaluation include further investment in capacity building (eg, prepare qualified health economists) and create incentive to improve availability and accessibility of local data.

Anxiety related to the COVID-19 pandemic is prevalent among the nursing workforce and has the potential to affect well-being and performance in the workplace. This paper reports on a joint education/nursing and midwifery workforce quality improvement initiative in the State of Qatar to address an urgent need for COVID-19 preparedness during the second wave of infection. A Simulation-Based Education (SBE) program was developed and delivered over a period of 2 months (February to April 2021) to prepare nurses for deployment to COVID-19 facilities. Perceived anxiety scores related to COVID-19 deployment were collected from 121 nurses before and after SBE attendance. The data demonstrates that SBE is an effective method to reduce deployment-related anxiety among registered nurses.

© 2017 Alinier, Campbell, Labib, Mehta, Hssain, Almomani, Hassan, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. Alinier G, Campbell C, Labib A, Mehta T, Hssain AA, Almomani EAH, Hassan IF. 'Qatar welcomes the Extracorporeal Life Support Organisation of the South and West Asia Chapter 2017 Conference', Qatar Medical Journal, 4th Annual ELSO-SWAC Conference Proceedings 2017:1 http://dx.doi.org/10.5339/qmj.2017.swacelso.1

Background: There is little evidence of research outcome data or studies into self-reported back pain in Middle Eastern or Gulf region countries. Within HMC there is anecdotal evidence that suggests that back pain in nurses working in critical care environments accounts for a significant percentage of all sick cause leave. This has the potential to impact on productivity, patient care and quality of life in nurses working within critical care in environments. Methods: A cross center mixed methodology study looking at back pain in nurses working in critical care environments data collection included demographic, occupational, and health characteristics and a Likert questionnaire. This comprised of 10 questions relating to manual handling education, equipment, staffing levels and ergonomics and was distributed in critical care and emergency departments across five hospital sites responses rate n = 450. Results: Outcome data identified 65% of the respondents reported experiencing back pain over the last year with subsequent negative impact on quality of life. There was statically significant association between gender and quality of life p = 0.001; with more women verbalizing a negative impact on quality of life secondary to back pain. There were also statically significant relationships between age with younger age group reporting negative impact on quality of life p = 0.001 and length of time employed in HMC with respondents who have been employed between 1–5 years experiencing the greatest impact p = 0.001. Conclusions: Back pain is an under reported occupational health concern that impacts on productivity and quality of life. Mandatory training in manual handling should feature in corporate educational agenda. Occupational health initiatives' are essential in the management of chronic health conditions.