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Disaster can lead to stressful crises and life stress among individuals. One of the most vulnerable age groups to post-traumatic stress are older adults. As such, this study explored older Filipino adults’ living experiences pertaining to disaster during Typhoon Haiyan, highlighting the problems they encounter after the disaster and identifying factors that contribute to their disaster resilience. The researchers used a thematic analysis in the study among 11 older adults as participants. Three main themes were unveiled upon the analysis of the data: 1) feelings of powerlessness and selflessness within the self; 2) Individuals with positive and negative outlook, over time, slowly influence a positive outcome; and 3) accepting responsibility for one’s personal decisions and actions. Older adults’ immediate reaction after a disaster is the feeling of powerlessness. However, whether they have positive or negative outlooks about life, over time, these perspectives slowly influence a positive outcome, which leads to these older adults take hold on their responsibility as part of their personal decisions and actions to move forward. Gerontologists may suggest that older adults consider social support activities if they are receptive to them and may benefit from such activities, which can provide social contact, reduce alienation and isolation, and increase a sense of belonging, and life meaning.

The first diagnostic tool for thyroid disease management is ultrasound. Despite its importance, ultrasound is an extremely subjective procedure that requires a high level of performance skill. Few studies have assessed thyroid ultrasound performance and its effectiveness, particularly the variability between observers in the assessment of ultrasound images. This study evaluated the variability in ultrasound assessments and diagnoses of thyroid nodules between 2 radiologists. In this retrospective study, 75 thyroid nodules in 39 patients were reviewed by 2 experienced radiologists. The nodule composition, margin, shape, calcification, and vasculitis were determined using echogenicity. The study evaluation included these 5 assessments and the final diagnosis. Interobserver variation was determined using Cohen kappa statistics. The interobserver agreements in the interpretation of echogenicity, shape, and margin were fair (κ = 0.21-0.40), whereas there were substantial agreements for vascularity and calcification (κ = 0.62-0.78). The agreements between the observers for individual ultrasound features in this study were the highest for vascularity and the presence/absence of calcification. The interobserver reproducibility for thyroid nodule ultrasound reporting was adequate, but the diagnostic evaluation ability of the observers was inconsistent. The variability in the interpretation of sonographic features could influence the level of suspicion of thyroid malignancy. This study emphasizes the need for consistency in the training of sonographic interpretation of thyroid nodules, particularly for echogenicity, shape, and margin.

BACKGROUND: With the steadily increasing size of its elderly population, Saudi Arabia is currently trying to meet the demands for competent care for older people. However, the lack of a valid and reliable measurement instrument in the Arab Peninsula hinders related studies among nursing students in this part of the globe. Given the importance of nursing students' attitudes toward working with older people, a specialized tool that can provide an accurate assessment of students' attitudes toward older adults is necessary. OBJECTIVE: Evaluate the psychometric properties of the Kogan Attitudes towards Older People Arabic version (KAOP-A) among Saudi nursing students. DESIGN: Descriptive, cross-sectional. SETTING: Nursing department of a government university. SUBJECTS AND METHODS: Using total population sampling, Saudi nursing students were surveyed using the KAOP-A. The tool was culturally adapted to the Arabic language using a forward and backward method. Content and construct validity were established accordingly. The internal consistency was established to support the reliability of the tool. MAIN OUTCOME MEASURES: The validity and reliability of the KAOP-A. SAMPLE SIZE: 164 nursing students. RESULTS: The KAOP-A had acceptable content and construct validity. The Exploratory Factor Analysis supported a two-factor solution for the KAOP-A with an explained variance of 60.12%. The computed Cronbach's alpha for the entire scale was 0.89. The mean score of the KAOP-A scale was 121.55 (SD=26.92, range=40–204), indicating a slightly positive attitude toward aging among the students. Nursing students belonging to extended type of family and living in rural community, as well as older students and students who reported higher degree of closeness with their grandparents, exhibited more positive attitudes towards older people. CONCLUSION: The tool can be used to accurately assess student attitudes towards older people, which can inform the creation of educational policies and interventions geared towards creating a more positive outlook on older adult care among nursing students in Saudi Arabia. LIMITATIONS: We did not perform test and re-test reliability analysis. CONFLICT OF INTEREST: None.

Reported natural disasters are steadily increasing, yet there is limited previous research explicitly exploring the predictors of disaster resiliency among older people from typhoon-hit provinces. This study examined the relationships between life satisfaction, attitude, spirituality and locus of control towards resiliency among older adult Typhoon Haiyan survivors. A descriptive correlational design was conducted among these survivors in the Eastern Philippines. Standard multiple linear regression analysis was used in the study. The findings indicated that spirituality and attitude were significant predictors of the survivors' resiliency. The spirituality and positive attitudes of the older adults were associated with disaster resiliency among the typhoon survivors. Thus, the findings suggest the need for nurse gerontologists to promote spirituality and encourage positive attitudes among older adults.

The newly discovered coronavirus (COVID-19) has become a pandemic, infecting thousands of people around the world. This study examines nurses&rsquo, demographic information (age, gender, marital status, area of practice, total years of experience in the current hospital, work region, monthly salary, educational level, workplace, nationality, working hours per day, total nursing experience, and the respondents&rsquo, main source of information on COVID-19), awareness, attitudes, prevention, and perceptions of COVID-19 during the outbreak in Saudi Arabia. A cross-sectional descriptive design of 500 nurses working at government and non-governmental hospitals in five regions in Saudi Arabia were selected using convenience sampling. The Kruskal&ndash, Wallis test was applied and the Mann&ndash, Whitney test was utilized as a post hoc test. The majority of nurses in this study, 96.85%, had excellent knowledge of COVID-19. Some (83.2%) of nurses reported significant prevention knowledge and treatment skills about COVID-19, while 7.6% had little knowledge about prevention. More than half of the nurses (60.4%) had high positive attitudes toward caring for COVID-19 patients. In conclusion, female nurses, married nurses, and bachelor&rsquo, s degree nurses had greater awareness, better attitude, and prevention clinical experience towards COVID-19. Meanwhile, non-Saudi nurses had higher self-reported awareness, positive attitudes, optimal prevention, and positive perceptions compared to Saudi nurses. This study provides baseline information immediately needed to enable health authorities to prioritize training programs that support nurses during the COVID-19 pandemic.

Objectives: The study aimed at assessing the stressors among hemodialysis (HD) patients and finding out whether there is any relation between these stressors and patients' characteristics in the North of the West Bank. Methods: A quantitative, cross-sectional, descriptive–analytical study was carried out. Data collection took place at three governmental hospitals and one private hospital where 120 HD patients responded to the HD stress scale. Results: Hemodialysis patients were mildly to moderately stressed, the greatest perceived sources of stress appeared to be “physiological stressors” (mean = 2.655), but the item with the highest percentage was 'limitation on time and place for vacation' (84.2%) which belong to psychosocial stress subscale, and the item stress with the least percentage was “dependency on nurses and technicians”(45%). Conclusions: There was significant difference between the psychosocial stressors and duration of treatment. The study concluded that HD patients are in need for continuous support, and it is recommended different contributions to improve the quality of their life.

This study investigated the psychometric properties of the Insomnia Severity Index (ISI) in substance-using Ethiopian adults. A simple random sampling of houses and a purposive sampling selection was performed in Mizan city, Ethiopia (

Objective To evaluate the effectiveness of an early mobility protocol for stroke patients in the intensive care unit. Methods Participants were patients with first or recurrent stroke (n=60, age=49.02+/- 6.36 years, body mass index=32.95+/-5.67 kg/m2) admitted to the intensive care stroke unit in general hospitals, Riyadh during October and December 2016. Single group pretest-posttest design involving an early mobility protocol was started within first 24 hours admission. Pre and post measurements of muscle strength, pulmonary function and quality of life were carried out. Results There were significant improvements in muscle strength of upper and lower extremities` muscles after treatment (p less than 0.05), pulmonary functions including Forced Vital Capacity, Forced Expiratory Volume 1 (p less than 0.05) and quality of life, namely, Barthel Index and modified Rankin Scale (p less than 0.01). Conclusion This study demonstrates that initiating an early mobility protocol is safe and effective for intensive care unit stroke patients and supports introducing the current protocol as a standard protocol in neurogenic Intensive Care Units.

الملخص: أهداف البحث: هدفت هذه الدراسة إلى تقييم الإجهاد الناتج عن العمل لدى التمريض وتحديد العلاقة بين الإجهاد المرتبط بالعمل والبيانات الديموغرافية. طرق البحث: استخدمت هذه الدراسة تصميما مستعرضا وصفيا. أجريت هذه الدراسة في مستشفى حكومي ثانوي (عدد المشاركين ١٧٨، سعة المستشفى ٢٢٥ سريرا) في منطقة الرياض، بالمملكة العربية السعودية. يقدم هذا المستشفى العديد من الخدمات الطبية والجراحية المهمة للحصول على رعاية وخدمات للمرضى ذات جودة عالية. وتمت مقابلة ما مجموعه ١٧٨ ممرضا وممرضة. ثم تم استبعاد ١٥ استبانة بسبب نقص البيانات (معدل استجابة ٩٢.٥٢٪). النتائج: كان رأي المشاركين أن بيئة العمل مرهقة إلى حد ما، وارتبطت الجنسية بشكل كبير وكانت مؤشرا كبيرا لمستوى الإجهاد لدى المشاركين. كان لدى الممرضات من الجنسية الهندية مستويات إجهاد أعلى مقارنة مع الجنسيات الأخرى. وكانت ساعات العمل في الأسبوع مؤشرا كبيرا لمستويات الإجهاد لدى التمريض. الاستنتاجات: سلطت هذه الدراسة الضوء على الإجهاد المرتبط بعمل التمريض وتحديد العلاقة بين الإجهاد المرتبط بالعمل والبيانات الديموغرافية. ارتبطت جنسية الممرضين وساعات العمل في الأسبوع مع مستوى الإجهاد لديهم. يمكن استخدام نتائج هذه الدراسة كدليل لوضع سياسات الموارد البشرية نحو تقليل التوتر لتعزيز الرعاية الصحية وتحسين أداء العمل. Abstract: Objectives: This study aimed to assess the perceived work-related-stress of staff nurses and determine the relationship between work-related stress and demographic profile. Methods: This study used a descriptive cross-sectional design and was conducted in a secondary public hospital (staff nurses = 178, bed capacity = 225) in Riyadh, KSA. The hospital provides medical and surgical services that are important to achieve optimum quality patient care and services. In total, 178 staff nurses were interviewed, but 15 responses were excluded because of missing data (response rate: 92.52%). Results: Nurses reported a moderately stressful work environment. Nationality was found to be a significant predictor of nurses' stress levels. Indian nurses had higher stress levels compared with nurses of other nationalities. Working hours per week was another significant predictor of stress. Conclusion: This study highlighted perceived work-related stress of staff nurses and determined the relationship between work-related stress and demographic profile. Most nurses were moderately stressed. Working hours were associated directly with stress level. The study findings can serve as a guide for establishing human resources policies aiming at reducing nurses' stress and, thereby, promoting improved health care and task force work performance. الكلمات المفتاحية: مستشفى الرعاية الحرجة, التمريض, الممرضين, رعاية المرضى, الإجهاد, Keywords: Acute care hospital, Nurses, Nursing profession, Patient care, Stress

Background Daytime sleepiness is highly prevalent across the globe. The Epworth sleepiness scale (ESS) is the most widely used tool for screening daytime sleepiness. The psychometric properties of the ESS have not been comprehensively examined in African populations. Material and methods A cross-sectional design with simple random sampling was used in the present study. The study recruited 600 students from Mizan-Tepi University, Ethiopia, of which 329 (age = 18–28 years and body mass index = 21.19 ± 3.17 kg/m2) completed the study. ESS, a semi-structured socio-demographics questionnaire and a clinical interview to diagnose insomnia according to the International Classification of Sleep Disorders were employed. Results All except one item of the ESS showed a floor effect, while only one item score showed ceiling effect. However, no ceiling/floor effect was observed in the ESS total score. The Cronbach’s alpha (0.75) and composite reliability (0.75), indicated good internal consistency, while a moderate item-total score correlation (r = 0.55–0.67) implied favorable internal homogeneity. The known-group validity was established by significantly higher scores for all the ESS item scores and the ESS total scores among those with symptoms of insomnia than among non-symptomatic students. Fit indices along with the consideration of inter-factor correlation coefficient, measures of item retention favored the unidimensional structure of the ESS. Conclusion The ESS has excellent psychometric validity for screening daytime sleepiness in Ethiopian university students. Electronic supplementary material The online version of this article (10.1186/s12955-019-1098-9) contains supplementary material, which is available to authorized users.

Background Psychometric investigations of tools used in the screening of migraine including the migraine screen questionnaire (MS-Q), using an adequate statistical approach is needed. We assessed the psychometric properties of the migraine screen questionnaire (MS-Q) using categorical data methods. Material and methods A total of 343 students at Mizan-Tepi University, Ethiopia, age range = 18–35 years were selected by a simple random sampling method to participate in a cross-sectional study. The respondents completed the MS-Q, a semi-structured socio-demographic questionnaire, and a visual analog scale for attention (VAS-A). Results The cumulative variance rule (> 40%), the Kaiser’s criteria (Eigenvalue> 1), the Scree test and, the parallel analysis (minimum rank) identified a 1-factor model for the MS-Q with the factor loadings in the range of 0.78 to 0.84. Fit indices favored a 1-factor model of the MS-Q as indicated by comparative fit index (0.993), weighted root mean square residual (0.048), root mean square error of approximation (0.067), the goodness of fit index (1.00), and non-normed fit index (0.987). The values of the Factor Determinacy Index (0.953), marginal reliability (0.909), H-latent (0.909), H-observed (0.727), explained common variance (0.906) and the mean item residual absolute loadings (0.225) further complimented finding of the 1-Factor model. McDonald’s Omega (0.903) suggested adequate internal consistency. Discriminative validity was supported by significantly higher scores for the total and all the MS-Q items except one among those with complaints of attention. Conclusion The categorical methods support the psychometric validity of the MS-Q in the study population.

BACKGROUND: Polysubstance dependence, stress, and sleep disturbances are inter-related by shared physiological pathways. No study has investigated the relationship between sleep and concurrent use of alcohol and khat. OBJECTIVES: The aim of the study was to assess the effect of the concurrent use of alcohol and khat as well as concurrent alcohol, khat, and tobacco smoking on sleep patterns. METHODS: A sample of community-dwelling adults (n = 339, age = 25.5 ± 5.7 years, body mass index = 22.0 ± 2.2 kg/m2) from Mizan-Aman, Ethiopia, participated in a cross-sectional study. Semi-structured tool for sociodemographics, substance use habit, and the Pittsburgh Sleep Quality Index (PSQI) were used. The difference in sleep patterns among substance use groups, i.e., nonusers, alcohol use only, concurrent alcohol and khat use, and concurrent alcohol, khat and tobacco smoking was assessed. RESULTS: The poorest sleep quality was found among concurrent users of alcohol, khat, and tobacco smoking (PSQI global score = 8.2 ± 2.4), followed by concurrent users of alcohol and khat (PSQI global score = 7.3 ± 2.9) (F (3.335) = 23.64, P < 0.001). There were significant differences in the PSQI component score of sleep quality χ2(3) =159.09, P < 0.001, the PSQI component score of sleep latency χ2(3) = 128.09, P < 0.001, and the PSQI component score of sleep disturbances χ2(3) = 37.69, P < 0.001 between substance use groups. CONCLUSION: Concurrent use of alcohol, khat as well as alcohol, khat, and tobacco smoking was associated with poor sleep. Sleep disturbances in this group need management to avoid the prospective development of psychosocial disturbances in polysubstance users.

Background Successful implementation of KMC depends on the attitudes and practices of maternity-ward nurses. This study assessed the attitudes and practices of kangaroo mother care (KMC) by maternity-ward nurses in the Eastern Philippines. Methods A cross-sectional survey design was used in the study. A convenience sample of 138 maternity-ward nurses working in six rural health units (RHUs), two public hospitals and one private hospital. A questionnaire was used to assess the attitudes and practices of KMC by the recruited maternity-ward nurses. Data were collected from June to July 2017 in maternity-ward nurses' workplace. Results Maternity-ward nurses have a positive attitude towards KMC. Age is associated with attitudes towards KMC. Married maternity-ward nurses have exhibit better attitudes and practice than single nurses. The attitudes of maternity-ward nurses with master's degrees towards KMC are more positive than those with BSN degrees. Maternity-ward nurses from Rural Health Units have better attitudes but fewer support to practice the KMC skills than those from public hospitals. Conclusions Maternity-ward nurses who are married, hold master's degrees and are working in RHUs have better KMC attitudes than their counterparts. Maternity-ward nurses have good KMC attitude but poor KMC practices. The KMC information and skills of maternity-ward nurses should be continuously updated to implement KMC effectively and efficiently.

Background Current evidence suggests that the addiction on one substance may underpin or affect addiction on another in polysubstance users. However, there is no tool that has been shown to have psychometric validation for assessment of the severity of khat addiction in polysubstance users. Methods Polysubstance users with khat chewing habit (n = 178, age = 25.8 ± 3.6, BMI = 23.3 ± 2.8 kg/m2) were recruited from randomly selected houses for a cross-sectional study in Mizan, Ethiopia. The survey including severity of dependence scale for khat (SDS-khat), a brief metacognition questionnaire, and a semi-structured socio-demographics tool were administered by trained interviewers. Results There was no ceiling effect or floor effect in the SDS-Khat scores. Internal consistency was moderate (Cronbach’s alpha = 0.58). Internal homogeneity was adequate (Item-total correlations of the SDS-Khat; r ≥ 0.55). Significant negative correlations between the SDS-Khat and the metacognition (r = −.19 to −.34, p

This study aims to describe and explain disaster-related resiliency from the perspective of older adult survivors through the grounded theory approach. A total of 14 older adults who survived Typhoon Haiyan participated in the study. These participants were chosen through purposive sampling, followed by theoretical sampling, to attain conceptual and theoretical saturation. Data were gathered through in-depth interviews, which took place in temporary shelter homes. Grounded disaster-related resiliency theory was generated on the basis of the subcategories and categories that were developed. The post-disaster recovery path can be conceptualized into three categories: (1) participants’ perception of strength, (2) self-regulating behavior, and (3) maintaining a positive attitude. These categories provide coping mechanisms that are important in building resiliency following a natural disaster. The results of this study may provide a theoretical framework for the design and implementation of disaster risk protection strategies and policies for local governments at the international level.

Background: Competency in ECG interpretation is an important skill in nursing practice since it leads to the detection of cardiovascular disorders. Incorrect interpretation of ECG findings can result in adverse patient outcomes. There has been no study done to evaluate the competency in ECG interpretation among registered nurses in Nablus, Palestine. The study aimed to assess the basic skills in interpretation of ECG among registered nurses in private and government hospitals in Nablus, Palestine. The study also evaluated the ability of the registered nurses to recognize lethal and non- lethal ECGs arrhythmias. Method: Cross-sectional design was used. ECG questionnaire contains two parts; the 1st part including demographic data, and the 2nd part including ECG parameters, common ECG’s and lethal ECG. It was distributed to (154) registered nurses in Nablus private hospitals and (146) registered nurse in Nablus governmental hospitals. Result: Registered nurses in government hospitals have much better ability than registered nurses in private hospitals to conclude the type of arrhythmia by the shape of the ECG figure, but their ability to interpret primary ECG parameters were lower than the ability of the registered nurses in private hospitals. In contrast, the registered nurses in private hospitals have a much better ability than registered nurses in interpreting the primary ECG parameters including heart rate and rhythm. Conclusion: There is a gap between what had been practiced in private hospitals and in government hospitals regarding nurses’ competency in ECG interpretation.

Background: Despite the vast number of studies related to the student’s quality of life (QoL), only a few were explicitly conducted in the nursing academe in Saudi Arabia. Aims: This study aimed to determine the profile and QoL of student nurses in a baccalaureate degree program in Saudi Arabia. Settings and Design: This study utilized a descriptive cross-sectional design and was conducted in the Department of Nursing at Majmaah University, Saudi Arabia. Methods and Material: The demographics and adopted Arabic WHOQOL-BREF questionnaires were used to collect the data among the 100 nursing students between October and November 2016. Analysis used: The descriptive statistics and multiple regression analyses were utilized to describe the demographics, and to establish its relationship to the four domains of QoL. Results: Gender, distance from school, and monthly allowance (p >0.05) were found to have no significant association with the physical, psychological, social, and environment domains of QoL. However, marital status (p

Background and Objectives: A basic difficulty underlying many of the serious problems of academic administration is the inability to deal effectively with conflict among faculty members, between faculty members and administrators, between faculty and students, and between representatives of the institution and external stakeholders. When those responsible for institutional policy are able to focus and resolve conflicts arising from different ideologies, values and vested interests, it is possible for decision-making and problem-solving to be governed by commitment to the pursuit of academic excellence. The objectives of the study was to analyze the correlation of emotional intelligence (EI) and conflict management styles (CMS) of faculty members teaching nursing and other allied health programs. Methods: Adopted questionnaires were used to collect data from respondents (n=104) and structural equation modeling (SEM) was used to tabulate and statistically analyze the data. Results: Some EI components of faculty members affect their CMS skills; specifically, on EI awareness and management to CMS collaborating (β=-0.157, p

Background and Purpose: The major purposes of the study are revision of the Nursing Educational Motivation and Barriers Inventory (NEMBI) and translation of it into Arabic. Methods: NEMBI was translated into Arabic, then back-translated to ensure the accuracy of the translation. The translation and back-translation of NEMBI were accurate and identical. A panel of experts provided content validation. Reliability was evaluated in a pilot test. For the larger study, 158 Saudi nurses completed the NEMBI. Results: Exploratory factor analysis yielded 8 factors. NEMBI is a valid and reliable tool for use in Arabic-speaking populations. Conclusion: As nursing education is transformed in Arabic-speaking norms, this tool provides a valid and reliable means for examining motivational factors that influence nurses' decision to return to school to advance their education.Keywords: educational motivation; motivational factors; return to school; RN-to-BSN; Nursing Educational Motivation and Barriers Inventory (NEMBI)The National Advisory Council on Nursing Education and Practice, a major American nursing policy advisor, had recommended that by 2010, at least two-thirds of the practicing nurse population in the United States should hold a baccalaureate or higher degree (American Association of Colleges of Nursing [AACN], 2012c). Unfortunately, nurses failed to meet this recommendation; currently, only 47.2% of nurses hold a bachelor of science in nursing (BSN) degree or above (AACN, 2012c). Moreover, the Institute of Medicine (IOM, 2011) report, The Future of Nursing, recommended that by 2020, 80% of nurses should be prepared at the BSN level.The Ministry of Health (MOH) seeks to elevate the educational qualifications of nurses in Saudi Arabia. Most nurses hold either associate degrees in nursing (ADNs) or diplomas in nursing (96.1%). Of the 3.7% of nurses who hold a BSN, only 40% of them are Saudi Arabian. Only 43 Saudi Arabian nurses hold master of science in nursing (MSN) degrees (less than 1%), and 10 nurses hold a doctor of philosophy (Saudi Commission for Health Specialties, personal communication, January 7, 2013). To achieve success in meeting the goal of increasing the percentage of nurses who hold BSN and higher degrees, it is important to understand the intrinsic and extrinsic motivational factors associated with nursing educational advancement in Saudi Arabia. This has not been studied to date, and appropriate instruments are not available for use in Arabic-speaking populations.The purposes of this study are revision of the Nursing Educational Motivation and Barriers Inventory (NEMBI) and its translation into Arabic. This tool development study was part of a larger study to investigate motivational factors and barriers related to Saudi Arabian nurses' pursuit of a BSN and its relations to demographic characteristics and employment sector of registered nurses (RNs).REVIEW OF THE LITERATURESeveral studies were conducted on nurses' motivation to pursue a higher degree (Adorno, 2010; Cooley, 2008; Corbett, 1997; Warren & Mills, 2009), the major categories of the motivators were changes in health care, personal satisfaction, monetary, employer expectation, social support, and professional growth. Studies also examined motivation to attend continuing education (Johnson & Copnell, 2002; Tame, 2011), nurses' perceptions about continuing education (Bahn, 2007; Hughes, 2005), and the impact of studying on nurses (Ellis & Nolan, 2005; Gould, Drey, & Berridge, 2007). However, the literature review suggested only a few studies that addressed the motivational factors and barriers nurses encountered related to pursuit of a higher degree of nursing. None of them was conducted in a developing country.There are personnel, personal, professional, and practice benefits of continuing nursing education. Personnel benefits to health care organizations include enhancing staff retention and staff recruitment, increasing motivation to provide quality care, and decreasing stress/ burnout. …

Pain is subjective and can differ from one person to another. Pain assessment can be a simple process by assessing location and intensity of pain.1 Failing to assess pain may affect quality of life, and increase the length of stay of hospitalized clients.2 More than 116 million Americans have pain that persists for weeks to years, and pain costs $560-635 billion per year.3 The International Association for the Study of Pain4 defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” It is crucial that health care providers assess pain with accurate methods that reflect the intensity of the client’s pain. Pain assessment is considered a fifth vital sign; many institutions nationally and internationally apply policies to include pain assessment in each patient’s chart, along with vital signs. Pain has several classifications; common categories are: acute pain, chronic pain, and cancer pain. Pain is also classified by mode of origin and transmission to nociceptive pain, somatic and visceral pain, neuropathic pain, dysesthetic pain, and lancinating pain. These classifications help health care providers to choose the appropriate management plan for pain relief.5 There are several validated assessment tools in the literature to assess the intensity of pain; for example, the Numeric Rating Scale (NRS), Visual Analog Scale, Verbal Descriptor Scale, and Wong-Baker Faces Scale.6,7 For critically ill adults who cannot communicate properly, there are several validated tools including the, Behavioral Pain Scale, Critical-Care Pain Observation Tool, and Face, Legs, Activity, Cry, and Consolability (FLACC) pain scale.6 The Association of Critical-Care Nurses6 issued a practice alert recently regarding pain assessment in critically ill adults. This report emphasizes: the need for patients to self-report pain using a validated pain assessment tool; the necessity of using a validated behavioral pain scale for critically ill adult clients who cannot communicate, avoiding referring primarily to vital signs for pain assessment of critically ill adult clients, and, for those unable to communicate, asking someone who knows the client well to identify any behavior that may indicate pain. Furthermore, the implementation of a nonverbal pain scale in critical care units improved clients’ ratings of their pain experience, improved documentation by nurses, and increased nurses’ confidence in assessing pain in nonverbal clients.8,9 From clinical practice in different Ministry of Health hospitals in Almadinah Almunawwarah, Saudi Arabia, we noticed that there are no specific protocols for pain assessment or pain management. Additionally, there is a scarcity of literature addressing this topic in the hospitals of Almadinah Almunawwarah, Saudi Arabia. This study will add to the database of knowledge and attitudes on pain assessment among health care providers in Saudi Arabia. We aim to present data on the assessment of pain, knowledge of pain, and attitudes regarding pain among health care providers in Almadinah Almunawwarah, Saudi Arabia.

Background: Delirium is an acute change in mental status with an unpredictable course of diminished attention and incoherent thinking, which is common among ICU patients. Various evidence implies a correlation between delirium and many fatal outcomes in intensive care unit (ICU) patients, such as higher 6-month mortality rate, longer hospital stays, longer post-ICU hospital stays, a higher occurrence of cognitive impairment, and long-term cognitive impairment after a critical illness. Aim: To identify the risk factors, pathophysiology, and management of ICU delirium among critically ill patients. Method: Using literature review, this study thoroughly examined the results of studies from different journals investigating ICU delirium Findings: The identified risk factors were age, cigarette smoking, alcohol abuse, eroids, sedatives, total number of medications, sodium level, hypoalbuminemia, hypertension, sepsis, chronic renal failure, trauma, immobility, and pain. Moreover, underlying mechanisms in the development of ICU delirium were cholinergic deficiency, neuropathologic lesion, direct brain insults, aberrant stress response and inflammatory process, and alteration of plasma melatonin. Numerous effective non-pharmacologic and pharmacologic treatments are available to manage delirium. Conclusion: Delirium is a form of acute brain dysfunction that is not well-recognized in ICU. The identification of the risk factors and the possible underlying mechanisms for the development of delirium continues to be the first step in its management; then, the next step is often pharmacologic and non-pharmacologic treatments. The choice of these treatments should be understood as part of a greater multicomponent approach in the management of critically ill patients.

Background: In Saudi Arabia, educational demands may become more challenging for students, and expectations may be more competitive than in previous academic experiences. Understanding students’ quality of life (QOL) is important for the success of students and any academic institutions. Aim & Methods: A cross-sectional study with a descriptive-comparative design was utilized to determine the QOL of 100 nursing students at the College of Applied Medical Sciences, Majmaah University. The Arabic version of the World Health Organization Quality of Life (WHOQOL-BREF) instrument was used in data collection. Results: All nursing students had an average level in the four domains of QOL, which include physical health, psychological, social relationships, and environment. Female nursing students had a greater standard of QOL-than their male counterparts, particularly in physical and psychological health, and social relationship domains. However, in the environment domain, both men and women had the same level of QOL. Although female nursing students have a higher QOL score than males, the findings were not significant. Conclusion: This present study shows a relatively good social dimension in the QOL of nursing students in this university. These findings suggest that administrators and faculty should always consider the various dimensions of QOL among nursing students in implementing their institutional policies and procedures. Educators should provide students with several opportunities to nurture their different skills, while considering QOL in setting both extracurricular and academic requirements.