Research Title: Parental Child Rearing Practices in Palestine from the Parents and their School aged Children Perspectives

Author: Maha Mohammed Wahbi Atout, Published Year: 2019

14th International Family Nursing Conference (IFNC14), Social Determinants of Family Health: Expanding Family Nursing Capacity, Washington, D.C..United States of America

Faculty: Nursing

Abstract: The objectives of this study were twofold: to describe parental child-rearing perspectives and report practices from the perspectives of Palestinian parents and their children, and to explore the relationships between these perspectives. A descriptive cross-sectional design was used. The Alabama Parenting Questionnaire (APQ) was administered to 120 parents and 120 children drawn from four districts in Palestine. Children had higher scores on involvement, positive parenting, poor monitoring, inconsistent discipline and corporal punishment. Three significant parent–child relationships were obtained: parental involvement (r = 0.276, p = 0.003), positive parenting (r = 0.0301, p = 0.001) and poor parental monitoring (r = -0.241, p = 0.008). Accordingly, parents need empowerment, and their child-rearing practices need improvement. They must acknowledge their role as important to child development and school achievement.

Keywords: Child Development, Child Rearing, Palestine, Parental Perception, Rearing Practices, School-Aged Children.

Research Title: The perceptions of palestinian health professionals toward factors facilitating or impeding the prevention of home injuries among young children: A qualitative study

Author: Maha Mohammed Wahbi Atout, Published Year: 2019

PULSUS, , Abu Dhabi, UAE

Faculty: Nursing

Abstract: Background: Childhood unintentional injury is an important global health problem that causes considerable mortality, morbidity and disability among children. These injuries are most common among under-fives and form a significant burden on healthcare systems, particularly in low- and middle-income countries. Potentially, health professionals, especially doctors and nurses, have a pivotal role in the prevention of home injuries. In Palestine there is a paucity of research in this area. The aim of this study was to explore health professionals’ perceptions regarding the prevention of home injuries among children aged under-five years in Ramallah district in Palestine. Methods: A qualitative approach was adopted; whereby semi-structured interviews were undertaken with twenty-four health professionals (doctors and nurses) who worked with children in a primary health care setting. The derived data were analysed using thematic analysis. Findings: Three types of factors that facilitated or impeded the prevention of home injuries emerged. First, health professional related factors included lack of training, workload and lack of collaborations. Second, parental related factors included low economic status, level of education, lack of awareness and mothers’ employment status. Finally, the environmental factors which included home size and structure, lack of data, low priority for policy makers, lack of funds and the political situation. Conclusion: The continuous education and specialised training for professionals are imperative in activate their pivotal roles in increasing the awareness of parents and children toward prevention of home injuries in the healthcare settings with limited resources such as Palestine. It is also recommended that policy makers activate the role of many parties, including media, health professionals, and other professionals in minimizing the unintentional home injuries among young children.

Keywords: Home injuries, Palestinian, children, healthcare professionals

Research Title: Views and experiences of using advanced technologies in higher education of health care professionals: A mixed method systematic review

Author: Maha Mohammed Wahbi Atout, Published Year: 2019

New Communication Technologies and their Impact on Effective Learning Societies, Philadelphia University

Faculty: Nursing

Abstract: The teaching of healthcare professionals has shifted from conventional teaching methods, and has almost fully embraced the use of technology-based learning instead. It is thought that the use of sophisticated technology in a healthcare training setting has been successful, on account of the value and experience it adds to both the teaching and learning processes, as well as its widespread use within healthcare practice. Since this widespread use of technology is a relatively recent occurrence in the realm of healthcare higher education, there exists a need for the evaluation of how it is experienced, used and viewed. This review synthesises both qualitative and quantitative data regarding user views and experience of technology within healthcare higher education, in an attempt to gather useful insights into how use of such technologies can be improved. Methods: Both quantitative and qualitative data was used for this mixed-method review. The data was combined into a single synthesis, using an integrated approach. The review took note of relevant papers concerning the use of advanced technology among healthcare professionals within higher education, and included the views of both students and lecturers from healthcare related courses such as; nursing, medicine (MBChB), dentistry, medical laboratory science/technology and pharmacy. Eight databases were searched in October 2018, followed by hand searching of related reference lists. The Mixed-Method Appraisal Tool (MMAT – Version 2011) was used to assess the methodological quality of the review. Results: In total, 13 papers were used for the review – ten quantitative, two mixed-method and one qualitative study. Nine of these studied focussed on the experiences of nurses, two on medical doctors, one on pharmacy students, and one on dentistry. The two synthesised findings that were generated are explained below. Facilitators of using advanced technology: It was indicated that technology is an indispensable tool in healthcare education. Many benefits associated with its use were revealed, which included; improved clinical competency, improved overall quality of education, improved patient outcomes, improved research and evidence-based practice skills, improved peer networking, co-working and collaboration, improved learning experience and outputs, and an enhanced understanding of self-directed learning. The results revealed that in order to fully utilise advanced technologies, the provision of adequate resources, as well as access to technical support and mentorship, is required. Challenges of using advanced technology: There were numerous factors which hindered the widespread adoption of advanced technology in healthcare education. These factors included; the high costs involved, a lack of relevant or adequate equipment, a lack of knowledge or understanding in such technology, a dearth of technical support, failure of technology, heavy workloads combined with time constrains, users having a negative attitude towards the use of technology, as well as a more generalised aversion to change. Conclusions: While the use of advanced technology for the training of healthcare professionals is generally embraced, it is not without problems. It is necessary for institutions to offer relevant and accessible support to both students and teachers, in order to improve the use of such technology in teaching and learning practice. Research in future should seek to understand the influence of advanced technology on the education and training of professionals within the healthcare sector.

Keywords: Healthcare professionals, experiences, higher education, systematic review

Research Title: Using Advanced Technology in Nursing Education in Palestine

Author: Maha Mohammed Wahbi Atout, Published Year: 2019

New Communication Technologies and their Impact on Effective Learning Societies, Philadelphia University

Faculty: Nursing

Abstract: Technology has been shown to have a profound effect on education in the 21st century. Using technology in nursing education has become indispensable, due to the need to link theoretical courses with hospital-based practice. Therefore, nursing educators and students must possess high levels of competency in communication and information technology. There has been little research in the Middle East regarding the use of technology in education. Most research on this subject has been carried out in Western countries. Palestine is an example of a developing country with many political issues that can affect its educational environment. However, few studies have been conducted in Palestine that investigate this issue from robust perspectives. Consequently, the present study investigates the experiences of using advanced technology in nursing education from the perspectives of lecturers, students, administrators, and lab technicians at two Palestinian universities. Methodology: This study employed a mixed method of research design. It was conducted in two Palestinian universities and employed several data collection methods: participant observation, semi-structured interviews, and curriculum analysis. A purposeful sampling strategy was adopted to recruit the participants. Maximum variation sampling was employed in order to include participants with different characteristics, which will improve the transferability of the findings to a broader setting. Within-case and cross-case data analysis was undertaken in accordance with Stake’s (2006) recommendations. Findings: Six interviews have been collected to date: assistant professor (n=3) and lecturers (n=3). The initial findings revealed several facilitators and challenges regarding the use of advanced technology in nursing education in Palestine. Although using technology was perceived to be time-consuming initially, lecturers pointed out that technology facilitated their work after they mastered its usage. Technology saved time and effort, for example by providing an accurate grading system for exams. Additionally, some educators reported that they encouraged adopting different technological means by their students who demonstrated advanced technological capabilities. Using technology enabled educators to communicate with students, especially during difficult political circumstances. However, educators reported several challenges pertaining to the use and sustainability of technology in the classroom. The high cost, especially as a part of the university’s budget, was one of the most prominent obstacles to adopting technology. Lack of skills in using technology was another obstacle faced by Palestinian professors. The resistance of some faculty members to the change represented by the adoption of technology was a third obstacle. Finally, educators reported that while it was very important to adopt advanced technology in education, some students could use it negatively, such as to cheat on exams. Conclusion: The study findings reveal several facilitators and challenges faced by Palestinian nursing educators in the use of technology. Continuous training of educators is imperative for increasing the use of communication and technology in nursing education. There is a need for updated policies to avoid advanced technology’s perceived negative consequences and maximize its benefits.

Keywords: Advanced technology, nursing, education, Palestine

Research Title: Exploring communication in the care for children with cancer in Palestine: an ethnographic qualitative case study approach

Author: Maha Mohammed Wahbi Atout, Published Year: 2019

The LANCET, 393

Faculty: Nursing

Abstract: Background There has been little research in the Middle East regarding communication in the care for children with cancer. Findings of studies undertaken in diverse cultural settings show that health-care providers report being poorly prepared to communicate with children with cancer and feel inadequately prepared to support families facing loss. The Arab culture differs in numerous ways from western culture (eg, with regard to disclosing prognosis information to children). Therefore, this study explores the experiences of children, families, and health professionals in communication in the care of children with cancer in Palestine. Methods This study used an ethnographic qualitative case study approach. It was conducted in one oncology unit based in the West Bank. Two data collection methods were employed: participant observation and semi-structured interviews. Ethics approval was obtained from the hospital ethical review board. Informed written consent was obtained from all participants (or legal guardians, in the case of children). Findings 70 hours of observation were undertaken and 35 interviews were conducted, involving five physicians, 11 nurses, six children aged 6–18 years, seven mothers, and six grandmothers. Although a few parents completely hid the diagnosis of leukaemia from their children, others tried to relieve the situation by informing their children of 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. The observational data showed that the children were not involved in discussions relating to their disease, and most communication about their illness was between their parents and physicians. Interpretation The findings reveal the challenges that physicians, nurses, grandmothers, and mothers face in communicating with children with cancer. Each group reported a need to improve their communication skills with children with cancer. Strategies are needed to involve children in communication regarding their disease and their prognosis.

Keywords: Communication; cancer; children; Palestine; Physician

Research Title: ‘We try to transmit pseudo strength to our kids; if we are broken, they will be broken as well’: nature of the dialogue between mothers, grandmothers and children with leukaemia in palestine

Author: Maha Mohammed Wahbi Atout, Published Year: 2019

BMJ Palliative & Supportive Care, 9

Faculty: Nursing

Abstract: Background Mothers of children with life-limiting illnesses describe facing challenges such as sometimes finding it difficult to communicate with their children, for example when their children become irritable due to their illnesses. This study explored the experience of communicating regarding the care of children with cancer, from the perspective of physicians, nurses, mothers, grandmothers and children in Palestine. This paper reports on the perceptions of the mothers and the grandmothers. 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. Results The study generated 70 hours of observation and 35 interviews; physicians (n=5), nurses (n=11), children aged 6–18 (n=6), mothers (n=7) and grandmothers (n=6). Findings: The mothers and grandmothers stated that they pretended to be strong in front of their children to prevent them from feeling distressed by witnessing their mother’s suffering and grieving. Protecting children from seeing their mothers’ distress was thought to be essential to help children face their illness and their own suffering. Mothers talked to their children about their children’s strengths rather than the deprivations caused by their illnesses. Although they did not feel strong, the mothers tried to transfer their own strength to their children to strengthen them and protect them from being broken. Conclusions Being the mother of a child with cancer is clearly distressing and they suffer along with their child. Their maternal role drives them to conceal their own grief and their conversations with their children are strengths-based. There is clearly a role for nurses caring for families of children with cancer to support mothers and give them the opportunity to express and share their grief and distress.

Keywords: Conversation; mothers; children, cancer, Palestine; grandmothers

Research Title: Type, intensity and quality of information given by physicians during the cancer journey of palestinian children with leukaemia: between revelation and concealment

Author: Maha Mohammed Wahbi Atout, Published Year: 2019

BMJ Palliative & Supportive Care, 9

Faculty: Nursing

Abstract: Background Despite the accumulation of evidence that supports the importance of giving parents detailed information, there is less evidence to support the notion that providing ‘negative’ information has a harmful effect on both parents and children. This study explored the communication of information across the cancer journeys taken by children from different perspectives in Palestine. This paper reports on the perceptions of the physicians. Methods This study used an ethnographic qualitative case study approach. It was conducted in one oncology unit in one Palestinian hospital and used two data collection methods: participant observation and semi-structured interviews. Results The study generated 70 hours of observation and 35 interviews; physicians (n=5), nurses (n=11), children aged 6–18 (n=6), mothers (n=7) and grandmothers (n=6). The findings demonstrated that physicians were reasonably open with parents at the diagnosis stage; however, as the child’s condition got worse, they concealed negative information to protect parents from emotional suffering. However, despite their tendency to conceal information, they associated revealing information about the child’s deterioration to parents as an important act to protect themselves legally. Furthermore, they generally concealed negative information from children. There seemed to be a close link between the type, intensity and quality of information revealed and the stage of the cancer journey (diagnosis, treatment and prognosis). Conclusions This study of Arab physicians delivering care to children with cancer and their families are positioned at a point in tension where they are reluctant to reveal information about a child’s deterioration and the knowledge that by concealing this information they place themselves in a difficult position. Although concealing information may be explained by cultural context, it does leave a communication gap for children and their parents at a very sensitive time in the child’s cancer journey.

Keywords: Information; cancer; children; Palestine; Physician

Research Title: A STUDY OF CAPITAL STRUCTURE DECISIONS BY SMES: EMPIRICAL EVIDENCE FROM JORDAN

Author: Mohammad Oqlah Al-Smadi, Published Year: 2019

Academy of Accounting and Financial Studies Journal, 23

Faculty: Business

Abstract: Although of the important role for SMEs in promoting economic growth, as well as in combating poverty and unemployment, the determinants of their capital structure have not been studied sufficiently. Using a panel data of (77) SMEs in Jordan, this study examines factors that affect choices of capital structure. Two models were developed, the long-term debt model and the short-term debt model. The regression results of the long-term model show that assets structure, growth, size, and liquidity have a beneficial impact on the longterm debt ratio, while profitability has a negative effect. The results of the short-term model show that assets structure, size, and profitability have a negative impact, while growth has a positive impact. The results of the study can be used by the management of SMEs and government entities, which develop policies that aim to support and foster the emergence of SMEs in the Jordanian economy.

Keywords: SMEs, Long Term Debt, Short Term Debt, Jordan

Research Title: Corporate governance and risk taking of Jordanian listed corporations: the impact of board of directors

Author: Mohammad Oqlah Al-Smadi, Published Year: 2019

Investment Management and Financial Innovation, 16

Faculty: Business

Abstract: The aim of this study is to evaluate the compliance level of corporate governance rules and examine the impact of this compliance on risk taking of corporations in Jordan. This study used panel data of the listed corporations in Amman Stock Exchange from 2013 to 2017. Corporate governance index was constructed to gauge the compliance level of corporate governance rules. The results show a good level of overall compliance of corporate governance rules. As for the compliance of the categories of corporate governance rules, rules of transparency and disclosure are ranked first, while rules of general meeting assembly are ranked fourth. The regression results report a negative influence of corporate governance and corporate risk taking. In addition, four governance variables concerning the features of the board of directors are used in the study. The results reveal a negative impact of the size of the board of directors, independence of the board, and committees of the board on corporate risk taking. It is expected that the outcomes of the study can be used by management of the corporations in addition to the Jordanian Securities Commission that seek to enhance confidence in the Jordanian capital market.

Keywords: corporate governance, total risk, idiosyncratic risk, Jordanian listed corporations

Research Title: Exploring the communication experience in caring for children with cancer: An ethnographic multiple case study approach from Palestine.

Author: Maha Mohammed Wahbi Atout, Published Year: 2018

The Lancet Palestinian Health Alliance 9th conference, American University of Beirut, Lebanon

Faculty: 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