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Background Integrating high fidelity simulation while teaching diabetes ketoacidosis would ensure a controlled therapeutic milieu for nursing students to practice. Purpose To evaluate the effectiveness of simulation teaching intervention for diabetes ketoacidosis in critical care nursing for undergraduate students' in a public university. Methods A simple, two-arm (parallel) randomized controlled trial was conducted in a national public university. A total of 164 nursing students were recruited and randomly assigned to two groups. The simulation group (N = 82) participated in the diabetes ketoacidosis high-fidelity simulation teaching intervention compared to the control group (N = 82) who were exposed to patient assignments on a clinical day on an acute medical unit. The primary outcomes were assessed using the Student Satisfaction and Self Confidence in Learning, Simulation Design Scale, Educational Practice Questionnaire, Critical Thinking Skills Tool and California Critical Thinking Skill Test from 2015 to 2016. Results The students in the randomized control trial have had significantly higher scores on Student Satisfaction, and Self Confidence in Learning, Simulation Design, Educational Practice, Critical thinking skills and Critical Thinking Skill post-test mean scores. Younger age groups who had higher satisfaction had better self-confidence and a positive perception of the simulation design and education practice, which reflected better learning outcomes in the simulation group compared to the control group. Conclusions This study supports the use of high-fidelity simulation scenarios as a teaching-learning strategy that is useful for students to assess, plan, intervene and evaluate in emergencies like diabetes ketoacidosis.

Objective The study determines the relationship between the socio-demographic, clinical factors and quality of life among adults with diabetic nephropathy and undergoing hemodialysis. Methods This was a cross-sectional, descriptive study conducted among adults diagnosed with diabetic nephropathy receiving hemodialysis in a dialysis unit. The kidney specific quality of life and the general quality of life (KDQOL-SF) was used to collect data between January 2015 to July 2016. A hundred and forty participants completed the survey from the selected sample of 185 adults. Results Adults with complex comorbidities, stage 3, 4 and 5 chronic kidney disease, higher body mass index, and uncontrolled glycemic control were significantly associated with lower quality of life, physical and mental component summary scores. Conclusions Poor physical functioning, role-physical, body pain, role-emotional, emotional well-being, general health, mental health scores significantly affected the quality of life in high-risk adults with diabetic nephropathy. The study demonstrated the significance of patient reported outcomes for adults with diabetic nephropathy and planning healthy lifestyle changes to improve the quality of life.

Objective A randomized clinical trial to examine the levels of body mass index, fasting blood glucose, blood pressure and glycemic control using multi-modality strategies among adults with type 2 diabetes. Methods A randomized control trial (RCT), two-arm, prospective, and an interventional was designed with an intervention group (IG) and a control group (CG) using stratified block randomization and triple-blinding. Adults with T2D (N = 200) were randomly assigned to an intervention group (IG, n = 100) and a control group (CG, n = 100) in a single site trial. The adults with T2D in the IG were exposed to multi-modality strategies using an animated digital video, motivational interviewing, telephone counseling and the structured diabetes education by the diabetes nurse educator. Adults in the CG were only exposed to the structured diabetes education. Body mass index (BMI), fasting blood glucose (FBG), blood pressure (BP), and glycosylated hemoglobin (HbA1c) were measured as primary outcomes. Results The adults with T2D in the IG had significant improvements in the HbA1c (2.4%), BMI (2.8 kg/m2), and a FBG (1.8 mmol/L); and they achieved lower HbA1c levels compared to the CG. Conclusion Multi-modality strategies were effective for lowering HbA1c and reducing BMI among adults with T2D. Implications. Integration of cognitive behavioural educational using multi-modality strategies promoted better primary outcomes among adults with T2D.

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross-sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60-s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019-2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well-covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self-report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services.

Objective The objective of this review is to assess the effectiveness and meaningfulness of breast cancer peer survivorship and support group in improving the quality of life of immigrant adults. Introduction Immigrant women use fewer follow-up and peer support services following treatment for breast cancer than people who have not recently immigrated to a new country. Review questions This JBI convergent segregated approach to a mixed methods systematic review will address the following review questions. What is the impact of survivorship and peer support groups on improving the quality of life for immigrant women survivors? What is the impact of acculturated interventions for breast cancer survivors to improve quality of life? Inclusion criteria The inclusion criteria include immigrant women who have completed their initial course of breast cancer treatment. The exclusion criteria include non-immigrant - women and men (above 18 years) who are not diagnosed with breast cancer, or currently undergoing active or advanced treatment, or end of life care. Methods The proposed systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for mixed methods systematic reviews. The search strategy will include qualitative, quantitative, and mixed methods research reports published in academic journals and a grey literature search for unpublished research reports. A mixed method integrated approach to synthesis and integration will be used. Findings of method synthesis will be configured according to JBI methodology convergent segregated mixed methods systematic review. Systematic review registration number Registration of title in PROSPERO 2020: https://www.crd.york.ac.uk/prospero/#loginpage.

Background Type 2 Diabetes Mellitus (T2DM) has an impact on an individuals' health and is influenced by glycemic control. Aim To examine the relationship between glycemic control, demographic and clinical factors on self-efficacy and self-care behaviours among adults with T2DM. Design A correlational, descriptive study was used. One hundred and forty Omani adults with T2DM were recruited from a public hospital. Methods Data on self-efficacy, self-care behaviours and glycemic control were collected between April and July 2016. The study was approved by the College Ethics Committee and Hospital Board. Bivariate and multivariate analyses were conducted. Results Most adults had a fasting blood glucose >7.2mmol/L (90.7%), with the majority demonstrating ‘uncontrolled' or poor HbA1c of >8% (65%). Variance of self-care behaviour (20.6%) and 31.3% of the variance of the self-efficacy was explained by the age, duration of diabetes, medication, HbA1c and prevention of activities of living. Conclusions Adults with T2DM with poor glycemic control were more probable to have poor self-efficacy and self-care behaviours. Glycemic control has an effect on improving diet, exercise, medication, foot care efficacy and behaviours. Clinical relevance The study recommends using these findings to plan self-efficacy and self-care behaviour to improve glycemic control among adults with T2DM.

The aim of this study was to explore predictors of health related quality of life (HRQoL) among men and women with type 2 diabetes. This cross-sectional descriptive study consisted of a random sample of 300 adults with type 2 diabetes in a selected public hospital. Euro-QoL and Revised Summary of Diabetes Self-Care Activities scales were used to collect data between January and June 2010. Schooling and ability to manage positively were highly significant predictors of quality of life (QoL) among women as compared to men. Age, prevention of activities of daily living and knowledge/management of diabetes were significant predictors of Health state among women as compared to men. Findings demonstrate that 30.6% (versus 35.7%) of the variance in the total QoL and 14% (versus 23%) of the variance in health state could be explained by personal and clinical characteristics among women and men, respectively. The study underlines the importance for nurse educators to assess HRQoL among men and women and to develop effective self-care management strategies based on personal and clinical characteristics.

Aim The aim of the study was to determine factors influencing foot care behaviors among adults with type 2 diabetes. Methods A correlational descriptive study was conducted with a random sample of 160 adults with type 2 diabetes from the public hospital between April and July 2014. Results Just over 15% of the sample had a history of foot ulcers and almost 42% had numbness/tingling and pain in their feet. Positive foot care behaviors were correlated with higher income, higher educational attainment, lower body weight, positive attitude and higher awareness of diabetes and its management. Conclusion Targeting type 2 diabetes people with low level of education, low income and overweight may help to enhance their foot care and reduce foot complications in similar populations, Implications. Those most at risk of foot problems should be targeted for education to increase their awareness of ways to prevent and to manage foot problems.

Background: The Arab adult with T2DM is understudied with less known facts about the perception of empowerment and its relationship with self-care and glycemic control. Purpose: The purpose of this study was to determine the extent to which perception of empowerment by Arab adults living with Type 2 Diabetes Mellitus (T2DM) was associated with better glycemic control and self-care management. Methods: A cross-sectional descriptive study was led among 300 Arab adults living in Oman with T2DM in an outpatient diabetes clinic. The Diabetes Empowerment Scale (DES), glycosylated haemaglobin (HbA1c) and Body mass index was assessed. The DES was found to be valid and reliable for the population. ANOVA, Regression analysis, and Structural equation modeling was used for analysis. Results: The composite score and three subscales of DES were a significant and strong predictor of good glycemic control among Omani adults with T2DM (p

Background: Nurse educators’ use blended learning pedagogy to support student centered learning in undergraduate curriculum. E-learning technology has been used to engage students in conceptual and experiential opportunities in higher education. Objective : The objective of the study was to explore the perceptions of use and satisfaction of e-learning (Moodle) among nurse educators in an undergraduate nursing curriculum. Methods : A cross-sectional research design was used among 50 nurse educators in undergraduate nursing in February 2010. Ethical approval was sought from the College ethics committee. A validated and reliable self-administered Faculty Satisfaction Survey was used to collect data. Inferential statistics was used to analyze the data. Results : Nurse educator’s perceptions were divergent, acknowledging the benefits of moodle, while some of them expressed concerns regarding over-time, limited resources, increased workload, and poor technical support. Some of the nurse educators exhibited positive attitudes towards the pedagogical value of moodle in engaging students, while some lacked the confidence to embark on developing courses using moodle. Conclusion : The study showed a rising awareness of the use of e-learning among nurse educators and moderate satisfa- ction as a blending learning approach. Implication: Nurse educators may need to incorporate moodle in the teaching-learning at a self-directed pace, using flexibility and convenience for higher learning approaches.

Summary Background Clinical nursing education provides baccalaureate nursing students an opportunity to combine cognitive, psychomotor, and affective skills in the Middle East. Objective The aim of the paper is to assess the satisfaction with and effectiveness of the clinical learning environment among nursing students in Oman. Design A cross-sectional descriptive design was used. Setting and Participants A convenience sample consisting of 310 undergraduate nursing students was selected in a public school of nursing in Oman. Methods Ethical approval was obtained from the Research and Ethics Committee, College of Nursing in 2011. A standardized, structured, validated and reliable Clinical Learning Environment Supervision Teacher Evaluation instrument was used. Informed consent was obtained from all the students. Data was analyzed with ANOVA and structural equation modeling. Results Satisfaction with the clinical learning environment (CLE) sub-dimensions was highly significant and had a positive relationship with the total clinical learning environment. In the path model 35% of its total variance of satisfaction with CLE is accounted by leadership style, clinical nurse commitment (variance = 28%), and patient relationships (R2 = 27%). Higher age, GPA and completion of a number of clinical courses were significant in the satisfaction with the CLE among these students. Conclusions Nurse educators can improvise clinical learning placements focusing on leadership style, premises of learning and nursing care, nurse teacher, and supervision while integrating student, teacher and environmental factors. Hence the clinical learning environment is integral to students' learning and valuable in providing educational experiences. Relevance to Practice The CLE model provides information to nurse educators regarding best clinical practices for improving the CLE for BSN students.

Background Women facing social and economic disadvantage in stressed communities of developing countries are at greater risk due to health problems. This paper investigates the relationships between structural, health and psychosocial predictors among women in mining and agricultural communities. This paper is a report of a study of the predictors of the health-related quality of life among Indian women in mining and agricultural communities. Methods A descriptive cross-sectional research design was used. The instruments used are SF-36 Health Survey and Coping Strategy Checklist. ANOVA, MANOVA and GLM were used in the analysis. The study was conducted between January-September 2008 with randomly selected women in a mining (145) and an agricultural community (133) in India. Results Women in the agricultural community had significantly increased Physical Health, Mental Health and SF36 scores compared with those in the mining community. Years of stay, education and employment were significant predictors among women in the agricultural community. 39% (33%) and 40% (26%) of the variance in Physical and Mental health respectively among women in agricultural and mining communities are predicted by the structural, health and psychosocial variables. Conclusion Perceived health status should be recognised as an important assessment of Physical and Mental Health among women in rural stressed communities. Cognitive, emotional and behavioural coping strategies are significant predictors of health related quality of life. Implications. Nurses should use the SF-36 as a diagnostic tool for assessing health related quality of life among women and discuss coping strategies, so that these can target women’s adaptive behaviour. This should be an essential part of the nursing process for facilitating adaptive process for improved health related quality of life.

Purpose: The purpose of this study is to assess the determinants of demographic and clinical factors associated with HbA1C levels among adults with type 2 diabetes mellitus (T2DM) in Muscat. Glycosylated Hemoglobin (HbA1C) is used as marker for long term blood glucose control in adults with type 2 diabetes mellitus. Methods: A cross-sectional design was used. Simple random sampling was used to select 300 adults with T2DM in Oman in 2011. Ethical approval and hospital permission was completed from the Institutional Research and Ethics Committee. Informed consent was obtained from the participants. Chi-square and multiple logistic regression models with demographic and clinical characteristics as predictors of glycemic control (HbA1C) were used to analyze the results. Results: Nearly half percentage of the adults with T2DM had better or controlled HbA1C ( 7%). Younger ages, females, higher education, non-tobacco users, short duration of diabetes, compliance with OHA and high waist-hip ratio predicted better control of HbA1C. Conclusions: Socio-demographic and clinical factors were consistently associated with glycemic control. Gender, education, perception of prevention of ADL, doctor-patient relationship, compliance with medications, and non-tobacco users were significant predictors of better glycemic controls among adults with T2DM. Relevance to clinical practice. Assessment of determinants of HbA1C may assist in determining individualized goals and strategies, subsequently improve glycemic control and enhance self-care management.

Aim: The aim of the study was to evaluate the combined efficacy of foot care education and recombinant human platelet-derived growth factor (rhPDGF) on the wound healing in foot ulcers among adults with type 2 diabetes (T2D). Subjects and Methods: A randomized control trial and a factorial design were used in this study in a 500-bedded private teaching hospital with four major surgical units in 2013. A sample size of 50 adults with T2D was selected in each of the three groups; the combined intervention (foot education and rhPDGF), the medication intervention (rhPDGF), and the control group (CG) (Betadine gel). A standard clinical practice guideline was adopted for the three groups at baseline, 15 th day, and 30 th day. A modified Bates-Jensen wound assessment tool was used to assess the wound healing. Results: Combined efficacy of foot care education and rhPDGF resulted in complete closure of wound with a mean time of 15.91 days compared to the medication intervention (rhPDGF) and the CG in foot ulcers. There was better wound healing characteristics among adults with T2D exposed to the foot care education and rhPDGF compared to the use of rhPDGF and Betadine. Conclusion: Combined efficacy of foot care education with PDGF improved the total wound healing and ensured better wound characteristics in lower extremity foot ulcers among adults with T2D.

The aim of this paper is to explore smoking behaviours and habits among students at a public University in Oman. An exploratory cross sectional research design was used. 840 students were randomly selected in clusters drawn across nine colleges in the University. A Modified World Health Organization Smoking Behaviours Self-administered Questionnaire was used in 2012. 10.01% of the students smoked, of which 8.69% of the students lived more than 5 years outside homes and had leisure time (8.33%). 14.2% of the students had history of smoking, of which 10.71% have an intention to smoke. There is significant difference in smoking behaviours among male and female, fathers or a family member. Results provide baseline data to develop pro-interventions for smoking awareness and counseling for university students and encourage policy makers to strengthen the policies to curb tobacco products.

This paper is a qualitative study of women's well-being and reproductive health status among married women in mining communities in India. An exploratory qualitative research design was conducted using purposive sampling among 40 selected married women in a rural Indian mining community. Ethical permission was obtained from Goa University. A semi-structured indepth interview guide was used to gather women's experiences and perceptions regarding well-being and reproductive health in 2010. These interviews were audiotaped, transcribed, verified, coded and then analyzed using qualitative content analysis. Early marriage, increased fertility, less birth intervals, son preference and lack of decision-making regarding reproductive health choices were found to affect women's reproductive health. Domestic violence, gender preference, husbands drinking behaviors, and low spousal communication were common experiences considered by women as factors leading to poor quality of marital relationship. Four main themes in confronting women's well-being are poor literacy and mobility, low employment and income generating opportunities, poor reproductive health choices and preferences and poor quality of martial relationships and communication. These determinants of physical, psychological and cultural well-being should be an essential part of nursing assessment in the primary care settings for informed actions. Nursing interventions should be directed towards participatory approach, informed decision making and empowering women towards better health and well-being in the mining community.