1
Research Title: Exploring the communication experience in caring for children with cancer: An ethnographic multiple case study approach from Palestine.
Author: Atout, M, Bashayreh, I. Carter, B , Published Year: 2018
The Lancet Palestinian Health Alliance 9th conference, American University of Beirut, Lebanon
Faculty: Faculty of Nursing

Abstract: Background: There has been little research in the Middle East regarding the experience of communicating with children with cancer from the perspectives of physicians, family carers and nurses. A preliminary systematic review of research about health care providers shows that they report being poorly prepared to communicate with children with cancer and their families, feeling inadequately prepared to support families facing loss and lacking confidence to deal with difficult questions and conflict. However, the Arab culture significantly differs from the previously mentioned studies’ culture in numerous respects, specifically Western culture with regard to disclosing prognosis information to children. Consequently, this study explores the experience of communicating regarding the care of children with cancer, from the perspective of physicians, nurses, mothers and children in Palestine. Material and Methods: This study employed an ethnographic collective qualitative case study approach. It was conducted in one oncology unit in a Palestinian hospital. Two data collection methods were employed: participant observation and semi-structured interviews. Findings: The number of interviews collected to date is (10) ten interviews. We conducted interviews with physicians (n=2), nurses (n=2), children aged 6–18 (n=2), mothers (n=2) and grandmothers (n=2) with 30 observational hours. The initial findings reveal that, while a few parents completely hid the diagnoses of leukaemia from their children, others tried to relieve the situation by informing their children of their having different diagnoses, such as a blood infection. The term cancer was avoided in the discussion of the disease by health care providers and parents to ameliorate the negative effect of this term, which is considered taboo in the studied culture. Generally, children were not involved in discussions related to their diseases. Instead, the majority of communications about their illnesses were with their parents and physicians. Although a few physicians and nurses agreed on the importance of involving children in the discussion regarding their prognosis and illness, they reported a lack of skills on the appropriate manner of providing them with sensitive information. Physicians reported facing challenges to communication, such as disclosing the bad news at the time of the initial diagnosis and the bad prognosis having an extreme effect on parents. Additionally, nurses experienced emotional suffering because of their long-term treatment of children with cancer, which affected their personal life. Conclusion: The study findings reveal that physicians, nurses and mothers demonstrated the challenges they face when they communicate with children with cancer. They also reported their need for improving their communication skills with children with cancer. The lack of communication skills education with children with cancer is quite clear and requires specialised communication skills education for both health care providers and parents. Finally, strategies are needed to involve children in the communication regarding their disease and their prognosis on the hospital level.

Keywords: Cancer, communication, ethnography, family carers, children, Palestine

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Research Title: Guideline Model for Nurses to Prevent the Medication Errors and Adverse Drug Events in Pediatric Inpatients
Author: Hanan T., Elbahnasawy, Samia Elnagar, Maha Atout , Published Year: 2012
Journal of American Science, 8(8)
Faculty: Faculty of Nursing

Abstract: Abstract: Medication errors were defined as errors in medication ordering, transcribing, dispensing, administering, or monitoring. Quasi experimental design was conducted for this study, The study aimed to identifying nurses needs of knowledge, practice, and attitude, developing guideline model for prevention of medication errors according to nurses needs and evaluating the effect of guideline model for prevention of medication error on nurses knowledge, practice, and attitude. The study was conducted in the pediatric medical, surgical and neonatal intensive care units in Al – Basher hospital in Amman city Jordan. This is a convenient sample of 85 registered nurses who's worked in the mentioned above setting. For data collection an interview questionnaire (pre/ posttest format) was used to assess nurses knowledge and practices as regard to definition, causes, contributing factorsand complication of medication errors also medication calculations, correct reading order, review patient six rights and double check of medication. The result of the study showed the effectiveness of guideline model on nurses who caring with children for medication administration. The implementation of guideline model showed significant improvement in nurses knowledge regarding all tested items , also concluded that the highest statistical significant improvement in nursing practices were noticed in most of the tested area which lead to prevent of medication errors . According to this study it is recommended that using the guideline model by all pediatric nurses which are dealing with children to prevent the medication errors, encourage continuous education program for pediatric nurses by using the different educational strategies to achieve high level of care for children and develop other standardized guideline model relevant to different aspect in pediatric nursing in order to cover most of the nurses educational needs.

Keywords: Guideline model, Medication error, Pediatric nurses

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Research Title: Exploring the experience of communication in the care of children with palliative care needs:Adopting different stances : mothers' communication experiences
Author: Maha Atout, Published Year: 2018
Faculty: Faculty of Nursing

Abstract: Background: despite having limited access to specialist palliative care, countries can successfully satisfy palliative care needs by ensuring all health professionals are properly trained and educated in their respective roles. To ensure that adequate care is provided for children with palliative needs in all healthcare settings, adequate training and support for care professionals is essential, even in cases where minimal specialist services are offered. Effective communication is a fundamental element in ensuring the quality of care provided to children with palliative care needs and has a considerable effect on the well-being of children as well as their relatives and care professionals. Nonetheless, a broad overview of the existing literature reveals that nurses often feel inadequately trained or prepared in terms of the communication skills needed to deal with the difficult situations. They often lack the confidence to communicate properly with parents or to deal with difficult questions or issues of conflict. Whilst this seems to echo studies previously conducted across a range of countries worldwide, research shows that countries with an Arab culture face slightly different issues in terms of disclosing serious prognoses to families. The current study is the first to examine communication between children, parents, and health professionals, in the care of children with non-malignant life-threatening and life-limiting illnesses in Jordan, and in particular the cultural and spiritual context that affects this communication. Purpose and objectives: The purpose of the current study is to explore the experience of communication in the care of children with palliative care needs, from the perspective of physicians, nurses, and mothers in Jordan. In this paper, the findings concerning mothers’ experiences will be presented. Methods: This study employed a collective qualitative case study approach. It was conducted in three paediatric units in a Jordanian hospital. Each case comprised a child aged 1-12 years, their most involved family carer (mothers), physician(s) and nurse(s). Two data collection methods were employed: participant observation and semi-structured interviews with three categories of participants: mothers, physicians, and the nurses who cared for the children that participated in this study. Within-case and cross-case analysis was undertaken in accordance with Stake’s (2006) recommendations. The within-case analysis focused on establishing the contextual background for every case. This was significant to protect the uniqueness of each case within its context and to be consistent with the case-study approach. The within-case analysis was presented narratively for every case. Then, cross-case analysis was undertaken to systematically extract the themes and subthemes of each case to identify similarities, differences, and contradictions. Findings: the study was based on 15 cases, with a total of 197 observational hours and 60 interviews (conducted with 15 mothers, 12 physicians and 21 nurses). The findings indicate that, in their experiences of communication with their children and healthcare professionals, mothers cited their adoption of different stances based on the specific care circumstances of the child. Thus, the role of the mother was determined by context as they adopted whatever stance they perceived as most appropriate in any given circumstances. For example, mothers were very empathetic and supportive when their child had to undergo invasive or painful procedures. On the other hand, other situations required mothers to convey strength in order to overcome emotional distress and motivate children to maintain strength as well. Furthermore, while some mothers allowed the doctor to determine the best course of action in their child’s treatment, others played a more active role in endorsing the rights of their child to be given the best health care available and safeguarding them from any unnecessary harm. Mothers controlled their style of interaction with both health care professionals and their children based on specific situations at various stages of the care process. Conclusion: These findings have several implications. In the first instance, the parents’ experiences should be taken into consideration when the medical teams establish the children’s treatment plans. Additionally, the continuous education and specialised training for professionals, which provides staff with specialised communication skills and emotional support for children and parents are imperative in improving the clinical practice in the healthcare settings with limited access to specialist palliative care.

Keywords: Children with life-threatening or life- limiting illnesses, End of life, Experience of communication, Healthcare care providers, Paediatric palliative care.

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Research Title: Changing priorities in the care of children with cancer: The experience of Jordanian Parents
Author: Maha Atout, Published Year: 2018
The General Pediatrics, Adolescent Medicine and Neonatology Congress 'Addressing the challenges in the health care of children', Abu Dhabi, UAE
Faculty: Faculty of Nursing

Abstract: Background: when a child has a terminal illness, parents reach a stage of acceptance of their forthcoming bereavement, refocusing their efforts on providing the best end-of-life (EOL) care that is possible. This comes when all treatment options have been explored, and there is no cure found for the illness. Cancer is the most common illness that requires EOL care in Western countries, with life-prolonging treatments explored. It is more and more becoming the norm in Western countries for EOL care to take place out of hospitals and in the patients’ homes which is in response to the wishes of the patients and their families, as well as the medical professionals involved in their care. However, the Arab culture significantly differs in numerous ways from Western culture. There have been no prior studies in Palestine on different issue related to parenting for children with cancer, but is something that requires attention. Purpose: the purpose of the current study is to explore the experience of parenting among parents who care for children with cancer. Methods: a Phenomenological hermeneutic approach was conducted informed by the philosophy of Martin Heidegger. The study was conducted in one oncology unit a Jordanian hospital. Parents of children aged (6-18) years old or with all types of cancer were considered eligible. A purposeful sampling strategy was adopted to recruit the participants. Maximum variation sampling will be employed. Data was collected using semi-structured interviews. Findings: thirty-two interviews were collected involving mothers (n=29), fathers (n=3). The parents changed their focus during the care of their children from an initial emphasis on normalising their children’s lives, to relieving their physical and psychological discomfort. This change of focus accompanied changes in the parents’ understanding of their children’s disease over time. They became more realistic regarding the future of their children, and therefore attempted to make their lives as enjoyable and comfortable as possible. Moreover, they evaluated any activity their children performed according to how much it affected their levels of comfort. When these activities resulted in further physical or psychological effort, the parents prioritised the comfort of their children over the benefits of the activities. Conclusion: the parents’ experiences should be taken into consideration when the medical teams establish the children’s treatment plans. Additionally, the continuous education and specialised training for professionals, which provides staff with specialised communication skills and emotional support for children and parents are imperative in improving the clinical practice in the healthcare settings with limited access to specialist palliative care.

Keywords: Cancer, experience, parents, children, Jordan

5
Research Title: The practice of mutual protection in the care of children with palliative care needs: multiple case study approach from Jordan
Author: Maha Atout, Published Year: 2018
Journal of Pediatric Nursing (Elsevier) ,
Faculty: Faculty of Nursing

Abstract: Abstract Purpose This study explores the experience of disclosing critical information in the care of children with palliative care needs, from the perspective of physicians, nurses, and mothers in Jordan. Design and methods This study employed a qualitative case study approach. It was conducted in three paediatric units in a Jordanian hospital. Each case comprised a child aged 1–12 years with a condition eligible for palliative care who received health care in one of these units, and their most involved carers (e.g. mother, physician and nurse). Two data collection methods were employed: participant observation and semi-structured interviews with three categories of participants: mothers, physicians, and nurses. Ethical approval was obtained from the hospital ethical review board. Written consent was obtained from all participants. Results Qualitative case studies were developed around 15 children (aged 1–12 years, nine were boys and six were girls, with varying diagnoses: renal disease, neurological conditions, and congenital heart defects). A total of 197 observational hours and 60 interviews were completed (15 mothers, 12 physicians and 21 nurses). The findings demonstrate that the practice of ‘mutual protection’ dominated communication between children, parents and clinical staff. Parents protected their children by disclosing only partial information about their disease, and by avoiding any information they thought would cause the child distress or loss of hope. Similarly, children avoided expression to their parents of their anxieties or fears, in order to protect them. In turn, nurses attempted to ensure observance of professional boundaries with children and mothers to avoid a sense of loss when a child died. Conclusion The findings of the current study indicate that while open and honest communication between parents and children is generally recommended by literature, not all mothers agree with adopting open communication with their children concerning their illnesses. Therefore, any future intervention planned for them should respect parents' autonomy and decisions in addition to their cultural backgrounds. Practical implications The provision of ongoing education and specialised training for professionals to provide them with culturally sensitive skills in communication and provision of emotional support for children and parents is needed to improve clinical practice in healthcare settings with limited access to specialist palliative care such as Jordan.

Keywords: Child, Life- limiting, Communication, Mutual protection, Palliative care, Jordan, Qualitative

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Research Title: Elastic Neural Network Method for Load Prediction in Cloud Computing Grid
Author: Nameer N. EL-Emam, Published Year: 2018
International Journal of Electrical and Computer Engineering (IJECE), 9
Faculty: Faculty of Information Technology

Abstract: Cloud computing still has no standard definition, yet it is concerned with Internet or network on-demand delivery of resources and services. It has gained much popularity in last few years due to rapid growth in technology and the Internet. Many issues yet to be tackled within cloud computing technical challenges, such as Virtual Machine migration, server association, fault tolerance, scalability, and availability. The most we are concerned with in this research is balancing servers load; the way of spreading the load between various nodes exists in any distributed systems that help to utilize resource and job response time, enhance scalability, and user satisfaction. Load rebalancing algorithm with dynamic resource allocation is presented to adapt with changing needs of a cloud environment. This research presents a modified elastic adaptive neural network (EANN) with modified adaptive smoothing errors, to build an evolving system to predict Virtual Machine load. To evaluate the proposed balancing method, we conducted a series of simulation studies using cloud simulator and made comparisons with previously suggested approaches in the previous work. The experimental results show that suggested method betters present approaches significantly and all these approaches.

Keywords: Cloud computing, Load balancing, Neural networks, Virtual machine migration

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Research Title: Modified Multi-Level Steganography to Enhance Data Security
Author: Nameer N. EL-Emam, Published Year: 2018
International Journal of Communication Networks and Information Security (IJCNIS), 10
Faculty: Faculty of Information Technology

Abstract: Data-hiding using steganography algorithm becomes an important technique to prevent unauthorized users to have access to a secret data. In this paper, steganography algorithm has been constructed to hide a secret data in a gray and a color images, this algorithm is named deep hiding/extraction algorithm (DHEA) to modify multi-level steganography (MLS). The suggested hiding algorithm is based on modified least significant bit (MDLSB) to scatter data in a cover-image and it utilizes a number of levels; where each level perform hiding data on a gray image except the last level that applies a color image to keep secret data. Furthermore, proper randomization approach with two layers is implemented; the first layer uses random pixels selection for hiding a secret data at each level, while the second layer implements at the last level to move randomly from segment to the others. In addition, the proposed hiding algorithm implements an effective lossless image compression using DEFLATE algorithm to make it possible to hide data into a next level. Dynamic encryption algorithm based on Advanced Encryption Standard (AES) is applied at each level by changing cipher keys (Ck) from level to the next, this approach has been applied to increase the security and working against attackers. Soft computing using a meta-heuristic approach based on artificial bee colony (ABC) algorithm has been introduced to achieve smoothing on pixels of stego-image, this approach is effective to reduce the noise caused by a hidden large amount of data and to increase a stego-image quality on the last level. The experimental result demonstrates the effectiveness of the proposed algorithm with bee colony DHA-ABC to show high-performing to hide a large amount of data up to four bits per pixel (bpp) with high security in terms of hard extraction of a secret message and noise reduction of the stego-image. Moreover, using deep hiding with unlimited levels is promising to confuse attackers and to compress a deep sequence of images into one image.

Keywords: Steganography, Multi-level steganography, Bee Colony Algorithm, least Significant Bit, Image Smoothing, Segmentation Image

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Research Title: Effects of fabrication parameters and operating temperature on CdS thin film electronic properties
Author: Wagah F. Alazzawi, Published Year: 2018
International Conference on Electrical and Electronics Engineering, Istanbul - Turky
Faculty: Faculty of Engineering

Abstract: This paper is a study of the effects of fabrication parameters and operating temperature on CdS thin film electronic properties. In this research work only three fabrication parameters will be considered and they are annealing temperature, deposition rate and doping level, while on the other hand the electronic properties, which will be under investigation are surface and bulk resistances, I-V characteristics, carrier concentration and Hall mobility. In our previously published paper it was found that the best substrate temperature is 180oC and thickness 1.2µm. A number of samples of CdS thin film were fabricated with these parameters using vacuum thermal evaporation technique. The study and analysis of these samples show that and from I-V characteristic the current is directly proportional to the biasing voltage and annealing temperature while it is inversely proportional to deposition rate. The carrier concentration and Hall mobility are generally influenced by the annealing temperature. Carrier concentration decreases gradually with the increase of deposition rate and similarly the Hall mobility decreases with the increase of deposition rate and up to deposition rate of 6oA/sec where beyond this value it starts to increase. The resistance of the thin film on the whole decreases with the increase of the operation temperature and annealing temperature.

Keywords: cadmium sulfide thin film, annealing temperature, deposition rate, surface and bulk resistance, carrier concentration, Hall mobility, operating temperature, doping level.

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Research Title: Critical Care Nurses’ Knowledge, Attitudes, and Perceived Barriers towards Pressure Injuries Prevention
Author: Abdul-Monim Batiha, Published Year: 2018
International Journal of Advanced Nursing Studies, 7(2)
Faculty: Faculty of Nursing

Abstract: Background: Pressure injuries are a considerable problem for hospitalized critically ill and elderly patients, as such injuries produce pain, and reduce total wellbeing, resulting in increased morbidity and mortality, as well as often extending those patients’ hospital stays Purpose: The purpose of this study was to determine critical care nurses knowledge, attitudes, and perceived barriers toward pressure injuries prevention. Design: A descriptive cross-sectional survey was performed, using a questionnaire method to critical care nurses’. The study took place between August and October 2017 and involved ten hospitals: two university hospital, six public hospitals, and two private hospitals. Methods: Data were collected by means of a questionnaire using two valid and reliable instruments: i) the Pressure Ulcer Knowledge Assessment Tool 2⋅0, and ii) Attitude Toward Pressure Ulcer Prevention and two newly developed instruments sociodemographic and perceived barriers toward pressure injury prevention. Results: The entire mean knowledge score for the participants was 54.9%, and overall high attitude scores were 76.7%. Level of education, years employed in a critical care unit, training received on pressure injury prevention, and the number of papers read on pressure injury prevention was all identified as having a significant and independent effect on participants’ knowledge concerning prevention of pressure injuries. To evaluate the effect of demographic characteristics on nurses’ attitudes, the only significant variable was "years of employment in critical care units". Shortage of staff was the most commonly cited barrier faced by critical care nurses’ during practice.

Keywords: Attitudes, Barriers, Critical care nurses’, Jordan, Knowledge, Pressure injuries

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Research Title: Measurement and Nonpharmacologic Management of Sleep Disturbance in the Intensive Care Units
Author: Abdul-Monim Batiha, Published Year: 2018
Crit Care Nurs Q, 42(1)
Faculty: Faculty of Nursing

Abstract: The general goal of this review is to summarize, clarify, and evaluate what is known about patients’ sleep in the intensive care units (ICUs) in terms of sleep measurement and management. In addition, this review focuses on the gap in knowledge in this field. A review of online databases for relevant articles in the period between 2000 and 2017 was conducted. The results of this study indicate that there are several methods to measure patients’ quality of sleep. Polysomnography and actigraphy are the most common standard objective and valid methods used to measure sleep disorders in the ICU. On the contrary, several subjective instruments are used such as the Richards- Campbell Sleep Scale, Verran Snyder Harper Sleep Scale, Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Sleep Efficiency Index. To improve patients’ sleep in the ICU, various strategies are used internationally. These strategies include reducing the noise and light levels; using relaxation technique, meditation, hypnosis, earplugs, eye masks, relaxation music; and modifying the time of delivering nursing care.

Keywords: ICU patients, nonpharmacologic interventions, sleep quality