Nurses' Self-Care Educational Programme (NSSCEP)
Phase: NA
Conditions: Paediatric Oncology, Nurses, Burnout, Occupational Stress, Self Care
Sponsor: Universiti Putra Malaysia

1 
 
 
 
 
 
 
 
Nurses Stress Self-Care Educational Program 
(NSSCEP) 
 
Teaching Quid 
22/8/2025 
 
 
 
 
 
 
 

2 
 
 
NURSES’ STRESS SELF CARE EDUCATIONAL PROGRAM 
DAY ONE / 2 HOURS 
 
 
 
 
 
Session 1:   Self-Care for Nurses: Managing Occupational Stress and Preventing Burnout 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Define burnout and stress, list 
three sources, explain two 
effects on performance. 
Welcome note and program 
overview.  
 
1. Introduction to occupational 
stress and burnout 
2. Workshop Objectives 
3. Key Definitions of 
Occupational Stress and 
Burnout 
4. Effects of Stress on the Body 
and Mind 
5. The Importance of Self 
Stress Management 
Programme 
Laptop, digital 
projector, flip 
charts, 
reflection 
journal. 
 
PowerPoint lecture, 
class discussion, 
guided mindfulness 
activity, concept 
explanation, case 
studies, open 
dialogue, value 
mapping activity, 
team reflection 
activity. 
Session2: Strengthening Your Inner Resources: A Resilience and Coping Workshop 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Promote emotional and social 
support 
to 
reduce 
burnout 
through 
improved 
communication and trust among 
colleagues, which has been 
shown to enhance nurse well-
being 
1. Stress Management Techniques 
 
Deep breathing exercises 
 
Progressive muscle 
relaxation 
 
Time management skills 
 
Grounding techniques 
2. Resilience Training 
 
Developing an optimistic 
outlook 
 
Problem-solving skills 
 
Building a support 
network 
 
Finding Meaning and 
Purpose: 
3. Self-Compassion Practices  
4. Cognitive Restructuring  
Flip charts, 
communicatio
n skill 
checklist, 
reflection 
worksheets. 
 
Interactive lecture, 
paired listening 
practice, empathy 
role-play, group 
discussion, 
mentorship planning. 

3 
 
 
NURSES’ STRESS SELF CARE EDUCATIONAL PROGRAM 
DAY TOW / 2 HOURS 
 
 
 
 
Session 3:  Reframing Stressful Thoughts with Positive Thinking 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Improve 
psychological 
resilience by recognizing and 
reframing negative thoughts and 
fostering optimistic thinking 
habits 
1. Develop an attitude of 
positivity. 
2. Daily gratitude habits (3 Good 
Things Journal). 
3. Practice of resilience (self-
awareness, social support, 
meaning, optimism). 
4. Activities to build resilience 
(Small Wins Journal, Self-Talk 
Assessment, Brief Resilience 
Scale). 
5. Role-playing to reframe 
negative thoughts (e.g., handling 
family complaints). 
6. Progressive muscle relaxation 
(5-10 min) paired with gratitude 
journaling. 
Flip charts, 
positivity 
checklist, 
gratitude 
journal 
worksheets. 
Thought reframing 
exercise, group 
brainstorm, gratitude 
journaling, resilience 
sharing, mood 
tracking tools. 
 
 
Session 4 :   Teamwork and Well-being in Paediatric Oncology Nursing 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Recognize individual roles in 
patient outcomes, build team 
unity through trust and respect, 
and advocate for systemic stress 
reduction. 
1. The Strength of Teamwork 
2. Building Trust and Respect 
within Teams: 
 
3. Problem Solving in Nursing 
Teams 
4. Setting Boundaries to Protect 
Personal Time 
5. Developing a Personal Follow-
up Plan 
6. Effective Communication 
Skills: Connecting with Empathy: 
  - Active listening and empathy. 
  - Non-verbal communication. 
  - Strategic questioning. 
Teamwork 
reflection 
sheets, trust-
building 
activity 
instructions, 
conflict 
resolution 
guide. 
Thought Reframing 
Exercise, Group 
Brainstorm, Gratitude 
Journaling, Resilience 
Sharing, Mood 
Tracking Tools. 
Problem-solving 
exercise, team 
reflection activity, 
barrier brainstorming 
 
 

4 
 
 
Session1: Self-Care for Nurses: Managing Occupational Stress and Preventing Burnout 
 
1 
Introduction (10 minutes) 
This teaching guide provides detailed instructions for facilitating Session 1 of the Nurses’ Stress 
Self-Care Educational Program, designed for paediatric oncology nurses in selected Jordanian 
hospitals. The session introduces the study, its purpose, risks, benefits, and activities, 
emphasizing a culturally relevant initiative for professional and personal growth. The 
programme aims to assist nurses in managing burnout and occupational stress, with a structure 
spanning three days over two weeks, including two two-hour sessions and a one-hour follow-
up session. A one-month booster session and a peer support WhatsApp group will sustain 
engagement. 
 
1.1 Facilitation Steps 
1. Study Overview (5 minutes): Introduce the study, explaining its purpose to improve 
nurses’ self-care management of burnout and occupational stress. Highlight that it is 
part of a doctoral degree requirement, with no known risks based on prior studies. 
Emphasize voluntary participation, confidentiality (using three-digit codes, e.g., I-A-1 
for intervention group, hospital A, participant 1), and no penalties for non-participation. 
Mention certificates of participation upon completion. 
2. Consent and Questionnaires (3 minutes): Guide participants to sign the Informed Con- 
sent Form. Explain the questionnaires, ensuring clarity on each item, and address any 
questions. Outline the data collection process (pre-workshop, post-workshop, and one- 
month follow-up) to ensure accuracy. 
3. Programme Structure (2 minutes): Describe the workshop structure: three days over 
two weeks, with two two-hour sessions and a one-hour follow-up session arranged with 
the nursing manager. Introduce the one-month booster session and WhatsApp group for 
peer support. 
 
 
 
 
 
 
 
 
 
 
 
 
 

5 
 
 
2 
Workshop Objectives (10 minutes) 
2.1 Overview 
This segment outlines the objectives of the workshop, focusing on equipping nurses with 
practical skills to differentiate stress from burnout, identify workplace stressors, develop self-
care strategies, create a burnout prevention plan, and advocate for systemic changes in 
Jordanian hospitals. 
 
2.2 Facilitation Steps 
1. Interactive Lecture (5 minutes): Present the objectives using a flip chart: 
• Differentiate between healthy stress and burnout. 
• Identify sources of stress in the nursing work environment. 
• Learn practical skills for psychological self-care and daily stress management. 
• Develop a personal and realistic burnout prevention plan. 
• Advocate for systemic changes to reduce workplace stress in Jordanian hospitals. 
2. Group Discussion (5 minutes): Facilitate a brief discussion asking participants to share 
one personal goal for the workshop related to stress management. Record key points on 
the flip chart to build engagement. 
 
 
 
3 
Key Definitions of Occupational Stress and Burnout (15 minutes) 
3.1 Overview 
This segment defines occupational stress and burnout, highlighting common sources and 
symptoms relevant to paediatric oncology nurses, supported by WHO and Maslach’s 
frameworks. 
 
3.2 Facilitation Steps 
1. Definitions and Sources (7 minutes): Use an interactive lecture to define occupational 
stress (WHO, 2021: a psychological and physiological response when job demands ex- 
ceed capacity) and burnout (Maslach & Leiter, 2016: chronic stress with emotional 
exhaustion, depersonalization, and reduced personal accomplishment). List common 
sources on a flip chart: limited resources, high workload, job insecurity, conflicts, 
violence, staff shortages, difficult relationships, verbal/physical abuse, equipment 
shortages, night shifts, and lack of support. 
2. Symptoms Table (5 minutes): Display Table 1 (Occupational Stress Common 
Symptoms) using a handout or flip chart: 
3. Reﬂection (3 minutes): Ask participants to identify one symptom they’ve experienced 
and write it on their reflection worksheets, discussing its impact briefly in pairs. 

6 
 
 
 
Table (1): Occupational stress common symptoms 
Physical signs 
Mental signs 
 
Fast heartbeat 
 
Breathing Difficulties 
 
Headache 
 
Stomach discomfort 
 
Sweating 
 
Feeling hot in the face or neck 
 
Trembling 
 
Difficulty concentrating 
 
Obsessing on the situation 
 
Revenge thoughts 
 
Negative thinking 
Emotional signs 
Behavioural signs 
 
Sadness 
 
Irritability 
 
Guilt 
 
Resentment 
 
Urge to harm others 
 
Need for isolation 
 
Numbness 
 
Clenched fists 
 
Pounding of fist on any surface 
 
Pacing 
 
Raising one’s voice 
 
Aggressive or passive-aggressive actions 
 
 
 
 
 
4 
Effects of Stress on the Body and Mind (15 minutes) 
4.1 Overview 
This segment explores the short-term and long-term effects of stress on nurses physical and 
mental health, emphasizing the progression from early symptoms to chronic conditions if 
stressors persist. 
 
4.2 Facilitation Steps 
1. Lecture on Stress Effects (7 minutes): Explain short-term stress (immediate physical 
responses) versus long-term stress (chronic health issues). Present Table 2 (Occupational 
Stress Related Problems) on a flip chart or handout: 
2. Group Activity (5 minutes): Facilitate a group brainstorm on one short-term and one 
long-term effect they have noticed in their work environment. Write responses on the 
flip chart. 
3. Reﬂection (3 minutes): Ask participants to write one stress effect they have 
experienced and a potential coping strategy on their reflection worksheets. 
 
 
 

7 
 
 
Table (2): Occupational stress related problems 
 
Early Physical Symptoms 
Early Mental signs 
Short Term 
 Headaches 
 Digestive issues 
 Eating disturbances 
 Sleep disturbances 
 Fatigue 
 Muscle aches & pains 
 Frequent minor illnesses 
 Anxiety 
 Irritability or mood swings 
 Low morale 
 Depression 
 Alcohol & drug use 
 Feeling powerless 
 Isolation from co- workers. 
 
Chronic Physical Conditions* 
Psychological & Behavioral Problems* 
Long Term 
  High Blood Pressure 
 Heart disease 
 Stroke 
 Spastic colon 
 Immune system dysfunction 
 Diabetes 
 Asthma 
 Musculoskeletal disorders. 
 Serious depression 
 Suicidal behavior 
 Domestic violence 
 Alcohol abuse 
 Substance abuse 
 Burnout. 
* If exposure to stressors continues for a longer period of time, chronic health problems can develop 
 
5 
The Importance of Self Stress Management Programme (10 minutes) 
5.1 Overview 
This segment emphasizes the benefits of effective stress management for nurses health, job 
satisfaction, and patient care quality, introducing problem-focused and emotion-focused coping 
strategies. 
 
5.2 Facilitation Steps 
1. Interactive Lecture (5 minutes): Discuss how stress management improves nurse 
health, care quality, and institutional outcomes. Introduce coping strategies (Figure 1): 
• Problem-focused coping: Aims to change/remove stress causes (e.g., seeking 
solutions, setting boundaries, planning). 
• Emotion-focused coping: Manages uncomfortable feelings (e.g., talking and rest) 
2. Paired Discussion (3 minutes): Pair participants to share one example of a coping 
strategy they have used (problem- or emotion-focused). Distribute communication 
skill checklists to guide interactions. 
3. Reﬂection (2 minutes): Ask participants to write one coping strategy they will try this 
week on their reflection worksheets. 
 
 

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Figure (1): Coping Strategies Types 
 
 
6 
Notes for Facilitators 
• Create a safe, non-judgmental environment to encourage open sharing, critical for 
effective discussions. 
• Monitor time closely to cover all segments within the 1-hour session. 
• Use examples relevant to paediatric oncology nursing (e.g., high workload, emotional 
patient interactions) to make activities relatable. 
• Ensure all participants have access to reflection worksheets and communication 
skill checklists. 
• Adapt discussions to group dynamics, offering alternative scenarios if needed. 
 
 
 
 

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Session 2: Nurture Interpersonal Connections – Building Your Support Network 
1 
Detailed Content and Facilitation 
1.1 Stress Management Techniques (20 minutes) 
1.1.1 Overview 
This segment introduces evidence-based tools to manage stress, including deep breathing, 
progressive muscle relaxation, time management, and grounding techniques, which reduce 
physiological and psychological stress in healthcare professionals. 
 
1.1.2 Facilitation Steps 
1. Introduction (3 minutes): Explain the importance of stress management for nurses, 
noting its impact on reducing cortisol levels and improving well-being. Use the flip chart 
to write key terms: “Deep Breathing,” “Progressive Muscle Relaxation,” “Time 
Management,” and “Grounding Techniques.” 
2. Deep Breathing Exercise (5 minutes): 
• Guide participants through a 4-7-8 breathing exercise: Inhale for 4 seconds, hold 
for 7 seconds, exhale for 8 seconds, as supported by research on diaphragmatic 
breathing for stress reduction. 
• Demonstrate first, then lead the group through 3 rounds. 
• Encourage participants to note how they feel in their reflection worksheets. 
3. Progressive Muscle Relaxation (5 minutes): 
• Instruct participants to tense and relax muscle groups (e.g., hands, shoulders, legs) 
for 5 seconds each, following established protocols. 
• Lead a 5-minute session, focusing on major muscle groups. 
• Ask participants to record observations in their reflection worksheets. 
4. Time Management Skills (4 minutes): 
• Discuss prioritization and delegation using the Eisenhower Matrix, a proven time 
management tool. 
• Encourage paired discussion: Share one-time management challenge and a potential 
solution. 
5. Grounding Techniques (3 minutes): 
• Introduce the 5-4-3-2-1 technique: Identify 5 things you see, 4 you can touch, 3 
you hear, 2 you smell, 1 you taste, effective for anxiety reduction. 
• Lead a brief practice and discuss its application during stressful shifts. 
 
 
 
 
 

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1.2 Resilience Training (20 minutes) 
1.2.1 Overview 
This segment focuses on building long-term resilience through optimism, problem-solving, 
support networks, and finding meaning and purpose, which are critical for mitigating burnout 
in nurses. 
 
1.2.2 Facilitation Steps 
1. Developing an Optimistic Outlook (5 minutes): 
• Use an interactive lecture to discuss optimism as a resilience factor, which can 
reduce burnout symptoms. 
• Example: Share a short story of a nurse who reframed a challenging shift positively. 
• Ask participants to write one optimistic thought about their work on their reflection 
worksheets. 
2. Problem-Solving Skills (5 minutes): 
• Introduce a simple problem-solving framework (e.g., Identify, Analyse, Plan, Act), 
supported by research on structured problem-solving in clinical settings. 
• Use a flip chart to outline a nursing scenario (e.g., managing a heavy patient load). 
• Facilitate a group discussion to brainstorm solutions. 
3. Building a Support Network (5 minutes): 
• Discuss the value of peer support in nursing, which significantly reduces stress and 
enhances coping. 
• Pair participants for a 2-minute listening exercise: One shares a workplace 
challenge, the other listens actively without interrupting. 
• Distribute communication skill checklists to guide future interactions. 
4. Finding Meaning and Purpose (5 minutes): 
• Discuss the spiritual rewards of nursing, such as impacting lives, which enhances 
resilience and job satisfaction. 
• Introduce “purpose mapping.” Participants write one daily task and connect it to a 
core value (e.g., compassion, service) on their reflection worksheets. 
• Encourage sharing in small groups to reinforce purpose-driven work. 
 
 
 
 
 
 

11 
 
 
 
 
1.3 Self-Compassion Practices (10 minutes) 
1.3.1 Overview 
This segment teaches participants to practice self-compassion, which reduces burnout by 
fostering kindness toward oneself and recognizing shared human experiences. 
 
1.3.2 Facilitation Steps 
1. Introduction (2 minutes): Explain self-compassion using the three elements: self- 
kindness, common humanity, and mindfulness, as outlined by Neff. 
2. Empathy Role-Play (6 minutes): 
• Have participants role-play a scenario where one nurse feels overwhelmed and the 
other offers self-compassionate responses (e.g., “It’s okay to feel this way, you’re 
not alone”). 
• Use the communication skill checklist to guide responses. 
3. Reﬂection (3 minutes): Ask participants to write a self-compassionate message to them- 
selves on their reflection worksheets, addressing a recent challenge. 
 
1.4 Cognitive Restructuring (10 minutes) 
1.4.1 Overview 
This segment introduces Cognitive Behavioural Therapy (CBT)-based techniques to identify 
and challenge negative thought patterns, replacing them with positive ones to manage stress 
effectively. 
 
1.4.2 Facilitation Steps 
1. Introduction (3 minutes): Explain cognitive restructuring using a flip chart to illustrate 
the process: Identify negative thought → Challenge it → Replace with a positive thought, 
as described in CBT literature. 
2. Group Activity (5 minutes): 
• Provide a common negative thought (e.g., “I’m not good enough for this job”). 
• Facilitate a group brainstorm to challenge and reframe it (e.g., “I’m learning and 
improving every day”). 
• Write responses on the flip chart. 
3. Reﬂection (2 minutes): Ask participants to identify one negative thought from their 
workweek and write a reframed version on their reflection worksheets. 
 
 
 
 

12 
 
 
2 
Wrap-Up and Mentorship Planning (10 minutes) 
1. Group Discussion (5 minutes): Facilitate a discussion on key takeaways from the 
session. Ask: “What’s one technique you’ll try this week?” 
2. Mentorship Planning (5 minutes): 
• Encourage participants to form mentorship pairs for ongoing support, as peer sup- 
port enhances resilience and reduces burnout. 
• Distribute reflection worksheets with a section for planning weekly check-ins with 
a mentor or peer. 
• Emphasize using communication skills (from the checklist) in mentorship. 
 
3 
Notes for Facilitators 
• Create a safe, non-judgmental environment to encourage open sharing, which is critical 
for effective group discussions. 
• Monitor time closely to cover all segments within the 1-hour session. 
• Be prepared to offer examples relevant to nursing (e.g., patient care challenges) to make 
activities relatable. 
• Ensure all participants have access to reflection worksheets and communication skill 
checklists. 
• Adapt role-plays to the group’s dynamics, offering alternative scenarios if needed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

13 
 
Session 3: Reframing Stressful Thoughts with Positive Thinking 
 
1 
Develop an Attitude of Positivity Cultivating Hope and Resilience (20 minutes) 
1.1 Overview 
This segment introduces positive thinking as a tool to enhance resilience and problem-solving 
under stress, particularly for paediatric oncology nurses in Jordanian hospitals. It focuses 
on identifying and counteracting negative thinking patterns (catastrophizing, overgeneralizing, 
personalizing, filtering) and implementing six steps to foster positive self-talk, which can 
improve energy, control, and purposeful action. 
 
1.2 Facilitation Steps 
1. Interactive Lecture (5 minutes): Explain how positive thinking helps nurses feel better, 
stay resilient, and solve problems effectively. Define negative thinking patterns 
(catastrophizing, overgeneralizing, personalizing, filtering) using a flip chart. Highlight 
the importance of positive self-talk for managing stress and enhancing growth. 
2. Eliminate Internal Negative Chatter (3 minutes): Discuss the need for awareness of 
negative thoughts. Lead a brief exercise where participants identify one negative thought 
they have had recently (e.g., I can’t handle this shift). Ask them to write it on their 
reflection worksheets and note its impact on their mood. 
3. Positive Affirmations (3 minutes): Introduce affirmations as short, believable 
statements repeated daily to rewire thinking. Provide examples (e.g., I am capable of 
managing challenges). Guide participants to write one affirmation on their reflection 
worksheets and practice saying it aloud. 
4. Positive Scripts (4 minutes): Present positive mental scripts (e.g., Calm down first, and 
think this through, I am capable of managing this situation). Display the list on a flip 
chart. Facilitate a paired discussion where participants share one script they could use 
during a stressful shift. 
5. Replace Negative Inﬂuences with Positive Ones (3 minutes): Discuss identifying 
external negative influences (e.g., unsupportive colleagues). Encourage participants to 
brainstorm one positive influence (e.g., a supportive mentor) and write it on their re- 
flection worksheets. 
6. Confront Fears and Focus on Enjoyable Moments (2 minutes): Explain how con- 
fronting fears and focusing on positive moments builds resilience. Lead a brief group 
discussion on one enjoyable moment from their workweek to shift focus to positivity. 

14 
 
2 
Daily Gratitude Habit (3 Good Things Journal) (10 minutes) 
2.1 Overview 
This segment teaches the practice of gratitude to shift focus from deficits to positive aspects 
of life, reducing stress and enhancing well-being among nurses. Writing three things they are 
thankful for daily fosters positive emotions. 
 
2.2 Facilitation Steps 
1. Introduction (3 minutes): Explain the benefits of gratitude for mental health and stress 
reduction, supported by research. Use a flip chart to write 3 Good Things Journal and 
describe the practice of noting three daily things to be thankful for. 
2. Group Activity (4 minutes): Guide participants to write three things they are grateful 
for from the past week on their reflection worksheets (e.g., a kind patient interaction, a 
supportive colleague). Facilitate a brief sharing in small groups to reinforce positivity. 
3. Reﬂection (3 minutes): Ask participants to commit to practicing the 3 Good Things 
Journal daily for a week and write a plan for integrating it into their routine on their 
reflection worksheets. 
 
3 
Practice of Resilience (15 minutes) 
3.1 Overview 
This segment focuses on building resilience among paediatric oncology nurses through self- 
awareness, social support, meaning and purpose, and realistic optimism, which enhance job 
satisfaction and patient outcomes. 
 
3.2 Facilitation Steps 
1. Lecture on Resilience Components (5 minutes): Present Table 5 (Core Components of 
Resilience) on a flip chart or handout: 
 
Table (5): Core Components of Resilience 
Resilience Components 
Descriptions 
1. Self-awareness 
Know how you react to stress 
Example: Notice when you're emotionally triggered and why 
2. Social support 
Trusted relationships reduce pressure 
Example: Regular debriefing with a fellow nurse 
3. Meaning and purpose 
Connect daily tasks to personal values 
Example: “I’m doing this because I believe every child 
deserves dignity” 
4. Realistic optimism 
 
Focus on what you can control 
Example: “I can’t fix staffing, but I can ask for help” 
 
 

15 
 
2. Group Discussion (5 minutes): Facilitate a discussion on one resilience component 
participants find most relevant. Ask them to share an example from their work (e.g., a 
moment of self-awareness or seeking support). 
3. Reﬂection (5 minutes): Ask participants to select one component and write a plan to 
strengthen it (e.g., scheduling a debrief with a colleague) on their reflection worksheets. 
 
 
4 
Activities to Build Resilience (15 minutes) 
4.1 Overview 
This segment provides practical activities to reinforce resilience through journaling, self-talk 
assessment, a resilience scale, and role-playing, tailored to the challenges faced by paediatric 
oncology nurses. 
 
4.2 Facilitation Steps 
1. Small Wins Journal (3 minutes): Introduce the Small Wins Journal, where participants 
write three things they did well each week. Guide them to start with one example on 
their reflection worksheets to build self-efficacy. 
2. Self-Talk Assessment (4 minutes): Distribute a handout with the Self-Talk Assessment 
checklist: 
• I notice that I criticize myself a lot. 
• I say to myself phrases like I can’t or I always fail. 
• I try to change these phrases to more encouraging ones. 
• I use positive phrases when I face a difficult situation. 
• I talk to myself like I would talk to a friend going through a difficult situation. 
Ask participants to check applicable statements and discuss one in pairs. 
3. Brief Resilience Scale (BRS) (3 minutes): Explain the 6-item BRS as a tool to assess 
resilience. Guide participants to complete it on their reflection worksheets and reflect on 
one area for growth, not as a label. 
4. Role-Playing (5 minutes): Facilitate a role-play scenario (e.g., handling family com- 
plaints in a Jordanian hospital). One nurse expresses a negative thought, and the other 
reframes it positively. Follow with a brief point-based quiz to reinforce learning, using 
the communication skill checklist. 
 
 
 
 
 
 
 

16 
 
5 
Notes for Facilitators 
• Create a safe, non-judgmental environment to encourage open sharing, critical for 
effective discussions. 
• Monitor time closely to cover all segments within the 1-hour session. 
• Use examples relevant to paediatric oncology nursing (e.g., emotional patient 
interactions, family complaints) to make activities relatable. 
• Ensure all participants have access to reflection worksheets and communication skill 
checklists. 
• Adapt role-plays to group dynamics, offering alternative scenarios if needed. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

17 
 
Session 4: Teamwork and Well-being in Paediatric Oncology Nursing 
 
1 
The Strength of Teamwork (10 minutes) 
1.1 Overview 
This segment highlights the importance of effective teamwork in paediatric oncology nursing 
for delivering high-quality care and reducing occupational stress and burnout. It emphasizes 
the multidisciplinary nature of teams and the critical role of each nurses skills, knowledge, and 
compassion in improving patient outcomes and fostering team resilience. 
 
1.2 Facilitation Steps 
1. Interactive Lecture (5 minutes): Explain the role of multidisciplinary teams 
(oncologists, nurses, sociologists, dietitians) in paediatric oncology, focusing on shared 
goals, face-to-face interactions, and improved patient welfare. Use a flip chart to list key 
points: shared identity, nurse contributions, and impact on stress reduction. 
2. Group Discussion (3 minutes): Facilitate a discussion asking participants to share one 
example of how their contribution (e.g., compassion, attention to detail) impacted a 
patient or family. Record key points on the flip chart to reinforce pride and responsibility. 
3. Reﬂection (2 minutes): Ask participants to write one strength they bring to their team 
on their reflection worksheets, emphasizing its role in patient care and team resilience. 
 
2 
Building Trust and Respect within Teams (15 minutes) 
2.1 Overview 
This segment focuses on fostering a supportive environment through respect and conflict 
resolution, critical for teamwork in high-pressure paediatric oncology units. It introduces 
techniques like active listening, open communication, mutual respect, reliability, and empathy 
to enhance team cohesion. 
 
2.2 Facilitation Steps 
1. Lecture on Trust and Respect (5 minutes): Present the importance of respect and 
conflict resolution in teams. Use a flip chart to list techniques: active listening, open 
communication, mutual respect, reliability, and empathy. Explain their role in reducing 
stress and improving care quality. 
2. Paired Activity (5 minutes): Pair participants for a 2-minute active listening exercise: 
one shares a workplace challenge, the other practices active listening (nodding, eye 
contact, no interrupting). Distribute communication skill checklists to guide interactions. 
3. Group Discussion (5 minutes): Facilitate a discussion on one technique (e.g., empathy) 
participants find valuable. Ask them to share an example of applying it in their team. 
Write responses on the flip chart. 
 
 
 

18 
 
3 
Problem Solving in Nursing Teams (15 minutes) 
3.1 Overview 
This segment introduces team-based problem-solving as a core skill in nursing, using a 
structured six-step process to address barriers (e.g., delayed medication delivery) while 
fostering trust and safe care. 
 
3.2 Facilitation Steps 
1. Lecture on Problem-Solving Steps (5 minutes): Present Table 6 (Problem Solving 
Steps) on a flip chart or handout: 
 
 
Table (6): Problem Solving Steps 
Step 
Actions 
1. Identify the Problem 
 
Describe it clearly, involve others: 
 
Ask: What exactly is wrong? 
 
Is it a one-time issue or does it happen often? 
 
Involve others to describe the problem clearly 
 
Tip: Don’t rush. A wrong diagnosis of the problem wastes time 
2. Understand the Problem 
 
Gather facts, see full impact: 
 
Collect facts, not opinions 
 
Observe how the issue affects workflow or patient care 
 
Include all voices: nurses, physicians, support staff 
 
Goal: See the full picture before jumping to solutions 
3. Suggest Solutions 
 
Brainstorm as a team: 
 
Avoid judging ideas too early 
 
Encourage everyone to speak 
 
Good example: Create a new handover checklist if critical information 
is missed 
4. Decide on a Solution 
Choose what works, consider risks: 
 
Evaluate the options 
 
Which is doable with your resources? 
 
What will cause the least disruption?  
 
Important: Always consider “What happens if we do nothing?” 
5. Act 
 
Assign tasks, stay flexible 
 
Assign clear roles 
 
Communicate the plan 
 
Document what you’re doing 
 
Tip: Stay flexible. Be ready to adjust if new problems appear 
6. Follow Up 
 
Evaluate, adjust, and share learning 
 
Did the solution work? 
 
Get feedback from team members and patients 
 
Track whether the issue repeats 
 
Share results so everyone learns 
 

19 
 
2. Group Activity (7 minutes): Present a scenario (e.g., delayed chemotherapy 
medication). Facilitate a group brainstorm to apply the six steps, writing solutions on the 
flip chart. Emphasize including all voices and avoiding blame. 
3. Reﬂection (3 minutes): Ask participants to write one problem-solving step they will 
apply in their next team challenge on their reflection worksheets. 
 
4 
Setting Boundaries to Protect Personal Time (10 minutes) 
4.1 Overview 
This segment teaches strategies to set boundaries in the demanding paediatric oncology field to 
prevent burnout and preserve personal well-being, tailored to Jordanian nurses work 
environment. 
 
4.2 Facilitation Steps 
1. Introduction (3 minutes): Explain the importance of boundaries to protect personal 
time. Use a flip chart to list strategies: know your limits, prioritize needs, communicate 
assertively, practice saying no, establish no work zones, seek support. 
2. Paired Discussion (4 minutes): Pair participants to share one boundary-setting 
challenge (e.g., work calls on days off) and a potential strategy. Use communication skill 
checklists to guide assertive communication. 
3. Reﬂection (3 minutes): Ask participants to write one boundary they will set this week 
(e.g., no work emails after 7 PM) on their reflection worksheets. 
 
5 
Developing a Personal Follow-up Plan (10 minutes) 
5.1 Overview 
This segment guides nurses in creating a personal follow-up plan to sustain stress management 
and resilience, using self-assessment, skill practice, peer check-ins, progress logging, and re- 
evaluation. 
 
5.2 Facilitation Steps 
1. Lecture on Follow-up Plan (4 minutes): Present the follow-up plan components using 
a flip chart: weekly self-assessment, skill practice, peer check-ins, logging progress, two-
month re-evaluation. Display the Sample Follow-up Plan Template: 
Sample Follow-up Plan Template 
How to Track Progress 
Time 
Description 
Activity 
Use a digital or paper log 
Friday 
Rate stress and resilience levels 
Weekly Check – in 
Mark on a calendar 
Morning  
5 Minute daily exercise 
Deep Breathing 
Short bullet notes after talk 
Thursday 
10 Minutes weekly conversation 
Partner Reflection 
Compare with initial scores 
After 8 weeks 
Fill burnout / resilience scale 
2 Month Evaluation 

20 
 
  
 
2. Group Activity (4 minutes): Guide participants to draft one part of their follow-up plan 
(e.g., choosing a weekly skill like positive affirmations) on their reflection worksheets. 
Facilitate brief sharing in small groups. 
3. Reﬂection (2 minutes): Ask participants to commit to one follow-up action (e.g., weekly 
stress rating) and write it on their reflection worksheets. 
 
 
6 
Effective Communication Skills: Connecting with Empathy (10 minutes) 
6.1 Overview 
This segment emphasizes empathy and active listening to prevent burnout and enhance team 
cohesion in paediatric oncology nursing, aligning with Jordanian cultural values of strong 
interpersonal relationships. 
 
6.2 Facilitation Steps 
1. Lecture on Communication Skills (3 minutes): Explain how empathy and active 
listening reduce stress and build trust. List skills on a flip chart: active listening, empathy, 
nonverbal cues, clarity, and feedback. Note the cultural relevance in Jordanian settings 
[2]. 
2. Video and Discussion (5 minutes): Show a 2-minute video on assertiveness in nursing 
(https://www.youtube.com/watch?v=hEKrJj_0DU4). Facilitate a brief discussion on how 
empathy applies to patient and team interactions. Use communication skill checklists to 
guide responses. 
3. Reﬂection (2 minutes): Ask participants to write one communication skill they will 
practice (e.g., summarizing a colleagues concern) on their reflection worksheets. 
 
7 
Active Listening and Empathy (10 minutes) 
7.1 Overview 
This segment explores active listening and empathetic listening as tools to enhance 
communication, using dimensions of listening and Coveys empathetic listening tasks to foster 
under- standing in high-stress settings. 
 
 
 
 
 
 
 
 
 
 

21 
 
7.2 Facilitation Steps 
1. Lecture on Listening Dimensions (4 minutes): Present Table 7 (Active Listening 
Dimension) on a flip chart or handout: 
 
Table 7: Active Listening Dimension 
Dimension 
Description 
The occasion for the message 
What is the reason why the person is communicating with me now? 
The length of the message 
What can the length of the message tell me about its importance? 
The words chosen 
Is the message being made formally? Is it with aloofness or slang? 
The volume and pace 
What clues do the loudness and speed give me? 
The Pauses and Hesitations 
How do these enhance or detract from the message? 
Non-verbal clues 
What does eye contact, posture, or facial expressions tell me about the message? 
 
Explain Coveys five empathetic listening tasks: repeat verbatim, rephrase content, reflect 
feelings, combine content and feelings, discern when empathy is not needed. 
 
2. Paired Role-Play (4 minutes): Pair participants to practice empathetic listening: one 
shares a patient interaction challenge, the other applies one listening task (e.g., reflecting 
feelings). Use communication skill checklists 
 
8 
The Power of Non-Verbal Communication (5 minutes) 
8.1 Overview 
This segment highlights the impact of non-verbal communication (body language, gestures) 
on effective interactions, noting its significant role in conveying emotions in nursing. 
 
8.2 Facilitation Steps 
(a) Introduction (3 minutes): Explain non-verbal communications role (93 
(b) Group Activity (2 minutes): Facilitate a quick exercise where participants practice 
positive body language (e.g., open posture, eye contact) in pairs, noting its effect 
on communication. 
 
 
 
 
 
 
 
 

22 
 
9 
Strategic Questioning as a Tool in Active Listening (5 minutes) 
9.1 Overview 
This segment teaches active questioning techniques (open-ended, clarifying, closed, 
reflective) to enhance communication and understanding in nursing interactions. 
9.2 Facilitation Steps 
(a) Lecture on Questioning Types (3 minutes): Present Table 8 (Active Questioning) 
on a flip chart or handout: 
(b) Reﬂection (2 minutes): Ask participants to write one questioning type they will 
use in their next patient or colleague interaction on their reflection worksheets 
Table (8): Active Questioning 
Question type 
Description 
Open ended  Questions 
Open questions stimulate thinking and discussion or responses including 
opinions or feelings. They pass control of the conversation to the respondent. 
Leading words in open questions include: Why, what, or how, as in the 
following examples: 
Could you tell me more about the pain you've been experiencing? 
How have you been feeling since your last medication change? 
How did that make you feel? 
Clarifying Questions 
A clarifying question helps to remove ambiguity, elicits additional detail, and 
guides the answer to a question. When you ask a clarifying question, you ask 
for expansion or detail, while withholding your judgment and own opinions. 
When asking for clarification, you will have to listen carefully to what the other 
person says. Frame your question as someone trying to understand in more 
detail. Often asking for a specific example is useful. This also helps the speaker 
evaluate his or her own opinions and perspective. Below are some examples: 
Example (1): Can you explain more about that moment? 
Example (2): 
Patient says: "I've just been feeling really off lately."  
Nurse asks: "Could you tell me more about what you mean by 'off'? For 
example, have you noticed any changes in your energy levels, appetite, or 
sleep?"  
Example (3): 
Patient says: "This medication isn't working."  
Nurse asks: "Can you describe what you've noticed that makes you say it isn't 
working? Are your symptoms staying the same, getting worse, or are you 
experiencing new side effects?" 
Closed Questions 
Closed questions usually require a one-word answer, and effectively shut off 
discussion. Closed questions provide facts, allow the questioner to maintain 
control of the conversation, and are easy to answer. Typical leading words are: 
Is, can, how many, or does. While closed questions are not the optimum choice 
for active listening, at times they may be necessary to elicit facts. Below are 
several examples of closed questions: 
 
Are you experiencing any pain right now? 
Have you taken your medication this morning? 
Reflective 
You seem worried—did I understand right? 
 
 

23 
 
10 
Notes for Facilitators 
• Create a safe, non-judgmental environment to encourage open sharing, critical 
for effective discussions. 
• Monitor time closely to cover all segments within the 1-hour session. 
• Use examples relevant to paediatric oncology nursing (e.g., patient family in- 
teractions, medication delays) to make activities relatable. 
• Ensure all participants have access to reflection worksheets and 
communication skill checklists. 
• Adapt role-plays and discussions to group dynamics, offering alternative 
scenarios if needed. 

24 
 
Conclusion: Sustaining Your Compassion Journey 
Dear Paediatric Oncology Nurse, 
This manual has provided a framework to recognise and control burnout through focusing on 
finding meaning, nurturing your inner resources, building strong connections, cultivating 
positivity, and prioritising your overall well-being. Remember that burnout prevention and 
self-care are ongoing processes, not destinations.  
We encourage you to revisit these concepts and practices regularly. Integrate the strategies that 
resonate most with you into your daily life, both personally and professionally. When you need 
support, seek it out, and remember the profound impact on the lives of your patients and their 
families.  
Your work is invaluable and there are instances of good. By prioritising your own care, you 
protect not only yourself but also enhance your ability to provide good and sustainable care for 
the children who need you the most. You can find constant strength, purpose, and joy in your 
extraordinary 
vocation. 
 
Thank you for your unwavering dedication, your compassionate hearts, and your tireless efforts 
in the field of paediatric oncology nursing. Your work makes a world of difference. 
 
 
 
 
 
 
 
 

25 
 
 
 
References and reading Materials  
Ano, G. G., & Vasconcelles, E. B. (2005). Religious coping and psychological adjustment to 
stress: 
A 
meta-analysis. 
Journal 
of 
Clinical 
Psychology, 
61(4), 
461–480. 
https://doi.org/10.1002/jclp.20049  
Folkman, S., & Moskowitz, J. T. (2004). Coping: Pitfalls and promise. Annual Review of 
Psychology, 55, 745–774. https://doi.org/10.1146/annurev.psych.55.090902.141456  
Maslach, C., & Leiter, M. P. (2016). Understanding the burnout experience: Recent research 
and 
its 
implications 
for 
psychiatry. 
World 
Psychiatry, 
15(2), 
103–111. 
https://doi.org/10.1002/wps.20311  
Mealer, M., Jones, J., & Moss, M. (2012). A qualitative study of resilience and posttraumatic 
stress disorder in United States ICU nurses. Intensive Care Medicine, 38(9), 1445–1451. 
https://doi.org/10.1007/s00134-012-2600-6  
Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude 
toward oneself. Self and Identity, 2(2), 85–101. https://doi.org/10.1080/15298860309032  
Nopa, I., Kurniawidjaja, L. M., Erwandi, D. J. C. S. P. J. o. P. H., & Health, C. (2023). 
Religious Coping Strategies For Nurses’ Work Related Stress: A Scoping Review. 5(2), 435-
450. https://doi.org/10.30829/contagion.v5i2.15197  
O’Daniel, M., & Rosenstein, A. H. (2008). Professional communication and team 
collaboration. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook 
for nurses (pp. 2–271–2–284). Agency for Healthcare Research and Quality. 
https://www.ncbi.nlm.nih.gov/books/NBK2637/ 
Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning 
making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 
257–301. https://doi.org/10.1037/a0018301  
Parks, L. (2021). Unifying Vision: Strategies that Influence Nurse Self-Care Practices in 
Intensive Care Unit Nurses. https://digitalcommons.jsu.edu/etds_nursing/44/  
Pargament, K. I. (1997). The psychology of religion and coping: Theory, research, practice. 
Guilford Press. 
Salas, E., Sims, D. E., & Burke, C. S. (2005). Is there a “Big Five” in teamwork? Small Group 
Research, 36(5), 555–599. https://doi.org/10.1177/1046496405277134  

26 
 
Shanafelt, T. D., & Noseworthy, J. H. (2017). Executive leadership and physician well-being: 
Nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic 
Proceedings, 92(1), 129–146. https://doi.org/10.1016/j.mayocp.2016.10.004  
Smith, B. W., Dalen, J., Wiggins, K., Tooley, E., Christopher, P., & Bernard, J. (2008). The 
brief resilience scale: Assessing the ability to bounce back. International Journal of Behavioral 
Medicine, 15(3), 194–200. https://doi.org/10.1080/10705500802222972  
Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to 
bounce back from negative emotional experiences. Journal of Personality and Social 
Psychology, 86(2), 320–333. https://doi.org/10.1037/0022-3514.86.2.320  
Zwarenstein, M., Goldman, J., & Reeves, S. (2009). Interprofessional collaboration: Effects of 
practice-based interventions on professional practice and healthcare outcomes. Cochrane 
Database of Systematic Reviews, Issue 3. https://doi.org/10.1002/14651858.CD000072.pub2  
Wei, H., Hardin, S. R., & Watson, J. J. I. j. o. n. s. (2021). A unitary caring science resilience-
building model: Unifying the human caring theory and research-informed psychology and 
neuroscience evidence. 8(1), 130-135. https://doi.org/10.1016/j.ijnss.2020.11.003 
 
Collins, S. (2005). Stress management interventions for nurses: A systematic review. 
Journal of Nursing Research, 10(3), 45–60. 
Lazarus, R. S., & Folkman, S. (1987). Stress, appraisal, and coping. Springer Pub- 
lishing Company. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

27 
 
 
 
 
 
 
APPENDIX (1): 
Boucher of  
Nurses Stress Self-Care Educational Program 
(NSSCEP) 
 
 
 
 
 
 
 
 
 
 

28 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

29 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

30 
 
 
 
 
 
APPENDIX (2): 
Daily Logbook of  
Nurses Stress Self-Care Educational Program 
(NSSCEP) 
 
 
 
 
 
 
 
 
 
 

31 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

32 
 
 
 
 
 
 
General Safety Programme for Control Group 
Teaching Quid 
22/8/2025 
 
 
 
 
 
 
 
 
 

33 
 
 
 
CONTROL GROUP PROGRAM 
DAY ONE / 2 HOURS 
 
 
 
 
Session 1: Infection Prevention and Hand Hygiene 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Reinforce 
awareness 
and 
adherence to infection control 
and hand hygiene standards in 
pediatric oncology settings. 
1. Hospital-acquired infections: 
types and consequences 
2. WHO’s Five Moments for 
Hand Hygiene 
3. Correct handwashing 
techniques (soap and 
alcohol-based rub) 
4. Use of gloves and personal 
protective equipment (PPE) 
5. Preventing infection in 
immunocompromised 
children 
Laptop and 
projector  
WHO 
guidelines 
Video Show 
Handout 
summarizing 
infection 
control 
procedures 
 
1. Short lecture and 
Video 
demonstration 
2. Live hand hygiene 
practice 
3. Group discussion 
on local hospital 
practices 
4. Simulation 
exercise, 
debriefing 
discussion. 
 
Session 2:  Hospital Safety and Emergency Protocols 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Improve nurse preparedness in 
responding to safety hazards and 
emergency situations. 
1. Fire safety: PASS and RACE 
principles 
2. Emergency codes (e.g., Code 
Blue, Code Red) 
3. Evacuation routes and 
procedures 
4. Electrical, chemical, and 
radiation safety 
5. Safe patient handling and fall 
prevention 
Laptop and 
projector  
Safety code 
chart 
Scenario-based 
worksheet 
Emergency 
response 
flowcharts 
 
1. Interactive lecture 
2. Quiz game on 
safety codes 
3. Facility map 
discussion 

34 
 
 
 
CONTROL GROUP PROGRAM 
DAY TWO / 2 HOURS 
 
 
 
 
 
 
 
 
Session 3:   Optimizing Workflow Documentation and Quality Control Medication Administration 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Enhance efficiency in daily 
nursing responsibilities through 
better 
documentation 
and 
medication 
practices 
in 
Jordanian settings, focusing on 
technical accuracy. 
1. Optimizing documentation: 
Best practices for electronic 
health records 
2. Strategies for efficient 
charting software use 
3. The Five Rights of 
medication administration 
4. Paediatric dosing principles 
and calculations 
5. Common causes of 
medication errors 
6. Reporting errors and near 
misses 
7. Safe storage and labelling. 
Medication 
error report 
form (sample), 
video show, 
flip chart, case 
scenarios for 
prioritization 
practice, 
worksheet, 
whiteboard or 
flip chart, 
projector. 
1. Group planning 
activity. Case-
based simulation. 
2. Group debriefing.  
3. Quiz game on 
documentation. 
Session 4: Professional Ethics in Paediatric Oncology Nursing 
Objective 
Content (Topics) 
Materials/Aids Teaching strategy 
Refresh understanding of core 
ethical principles in clinical 
decision-making 
and 
care 
delivery. 
1. Confidentiality and patient 
rights 
2. Informed consent in 
paediatrics 
3. Boundaries in nurse–child–
parent relationships 
4. Advocacy and best interest 
of the child 
5. Ethical dilemmas in 
paediatric oncology care 
Laptop and 
projector  
ANA Code of 
Ethics 
summary 
Discussion 
prompts 
1. Short lecture 
2. Small group 
discussion of 
ethical cases 
3. Role-play (nurse-
parent-child 
scenarios) 
4. Debriefing and 
summary 

35 
 
 
 
 
Control Group Programme: Professional Skills Enhancement Programme 
Overview 
The Professional Skills Enhancement Programme is designed to refresh and strengthen 
essential technical skills for Jordanian paediatric oncology nurses, ensuring high-quality care 
delivery while serving as a placebo intervention. The programme consists of four 2-hour 
sessions over two days, delivered by a trained facilitator using a detailed script to maintain a 
neutral, didactic tone, with session fidelity monitored via recorded samples and a fidelity 
checklist to ensure no stress-related content is introduced. It is coordinated with nursing 
managers to align with shift schedules and avoid peak stress periods (e.g., holidays). Sessions 
are offered in flexible formats (in-person or recorded virtual access), with personalised 
WhatsApp reminders and verbal endorsements from nurse leaders to prevent dropout.  
 
Participants receive printed handouts, a certificate of appreciation with specific skill 
endorsements (e.g., “Certified in Paediatric Oncology Safety”) and potential continuing 
education credits (CECs), subject to hospital approval, to enhance perceived value. A peer 
support WhatsApp group facilitates skill sharing without discussing stress or emotions, and a 
3-month booster session (1 hour, virtual or in-person) reinforces skills. The programme is 
culturally relevant, addressing Jordanian hospital realities (e.g., resource constraints, family 
dynamics), and matches the experimental group’s contact time and engagement level. 
 
 
 
 
 
 
 
 
 

36 
 
 
 
Session 1: Infection Prevention and Hand Hygiene (1 Hours) 
1. Hospital-Acquired Infections (HAIs): Define HAIs (e.g., catheter-associated bloodstream 
infections, ventilator-associated pneumonia) and their impact in paediatric oncology, 
including increased morbidity and hospital costs. Highlight prevalence in developing 
countries like Jordan, where resource constraints exacerbate risks (Allegranzi et al., 2011). 
Discuss the roles of nurses in prevention. 
 
2. WHO’s Five Moments for Hand Hygiene: Explain the five critical moments: before 
touching a patient, before clean/aseptic procedures, after body fluid exposure risk, after 
touching a patient, and after touching patient surroundings. Provide examples from 
Jordanian hospitals (e.g., central line dressing changes) to illustrate application (World 
Health Organization, 2009).  
 
3. Correct Handwashing Techniques: Demonstrate soap-and-water washing (20–40 
seconds) and alcohol-based hand rub (15–20 seconds), covering all hand surfaces (palms, 
fingers, thumbs, wrists). Address common errors and barriers (e.g., limited water supply in 
some facilities).  
 
4. Use of Gloves and Personal Protective Equipment (PPE): Detail protocols for selecting, 
donning, and doffing gloves, masks, gowns, and eye protection in oncology wards. Discuss 
safe disposal and reuse challenges in Jordanian settings. Include chemotherapy-specific PPE 
requirements.  
 
5. Preventing Infection in Immunocompromised Children: Outline strategies like 
environmental cleaning, sterile technique for invasive procedures, and visitor restrictions. 
Emphasise nurse advocacy for infection control policies in resource-limited settings.  
 
6. Hand Hygiene Simulation with UV Gel: Practical exercise using UV gel under blacklight 
to visualise missed areas, followed by group discussion on improving technique. 
Participants create a personal hand hygiene checklist for daily use.  
 

37 
 
7. Case Study Analysis: Review a Jordanian hospital case (e.g., HAI outbreak due to poor 
hand hygiene) to identify prevention strategies, reinforcing practical application. 
Notes for Facilitators 
 
Maintain a neutral tone, framing content as technical skill enhancement (e.g., “improving 
patient safety” rather than “reducing infection-related stress”). 
 
Use Jordanian hospital examples (e.g., King Hussein Cancer Center protocols) to ensure 
relevance. 
 
Encourage participation in simulations but avoid probing personal experiences or emotions. 
 
Monitor group dynamics to ensure quieter participants engage during case study 
discussions; assign roles (e.g., note-taker) if needed. 
 
Reinforce the value of CECs and certificates to motivate completion. 
 
Discussion Points 
 
What are common barriers to hand hygiene in your Jordanian hospital (e.g., time constraints, 
PPE shortages)? How can nurses address these within existing resources? 
 
How do visitor policies in Jordanian oncology wards impact infection control? Share 
practical enforcement strategies. 
 
Based on the case study, what specific actions could nurses take to prevent similar HAIs in 
your workplace? 
 
 
 
 
 
 

38 
 
 
Session 2: Hospital Safety and Emergency Protocols (1 Hours) 
 
1. Fire Safety (PASS and RACE Principles): Explain PASS (Pull, Aim, Squeeze, Sweep) 
for fire extinguisher use and RACE (Rescue, Alarm, Confine, Extinguish/Evacuate) for fire 
response. Highlight fire risks in oncology wards (e.g., oxygen tanks, chemotherapy storage) 
and Jordanian hospital compliance requirements (Joint Commission International, 2020). 
 
2. Emergency Codes: Detail hospital-specific codes (e.g., Code Blue for cardiac arrest, Code 
Red for fire, Code Pink for infant abduction). Clarify nurse roles, communication protocols, 
and documentation during emergencies in Jordanian settings. 
 
3. Evacuation Routes and Procedures: Review hospital evacuation plans, prioritising 
immunocompromised patients and using safe routes. Discuss challenges such as crowded 
corridors or limited lifts in Jordanian facilities. 
 
4. Electrical, Chemical, and Radiation Safety: Outline protocols for managing electrical 
faults, chemical spills (e.g., chemotherapy drugs), and radiation exposure risks. Emphasise 
proper labelling, storage, and spill kits in oncology units. 
 
5. Safe Patient Handling and Fall Prevention: Teach techniques for transferring paediatric 
patients and preventing falls (e.g., bed rails, non-slip flooring). Address risks for weak or 
sedated children in oncology care. 
 
6. Mock Emergency Drill Using Jordanian Facility Maps: Group activity to simulate a 
Code Red response, using hospital-specific maps to plan evacuation routes, assign roles, and 
identify bottlenecks. 
 
7. Safety Audit Checklist Development: Participants create a ward-specific safety checklist 
(e.g., checking fire exits, equipment storage) for daily use. 
 
 

39 
 
 
 
Notes for Facilitators 
 
Focus on procedural knowledge (e.g., “follow RACE steps”) rather than emotional 
preparedness. 
 
Use hospital-specific maps to ground activities in local context, enhancing relevance. 
 
Ensure drills remain technical; avoid discussing fear or stress during emergencies. 
 
Encourage equal participation in group activities by assigning roles (e.g., leader, scribe). 
 
Highlight practical benefits of checklists for daily ward routines to motivate adoption. 
Discussion Points 
 
What safety hazards are most common in your Jordanian oncology ward (e.g., cluttered 
corridors, faulty equipment)? How can nurses address these? 
 
How do emergency codes function in your hospital? Share examples of effective code 
responses. 
 
Based on the mock drill, what improvements could be made to your ward’s evacuation plan? 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

40 
 
 
 
Session 3: Optimising Workflow Documentation and Medication  
Administration (1 Hours) 
 
1. Optimising Electronic Health Records (EHRs): Review best practices for accurate, 
timely EHR entries using structured templates and mandatory fields. Discuss Jordanian 
systems like Hakeem, common errors (e.g., incomplete fields), and their impact on care 
continuity (Kalra, 2011). 
 
2. Actionable Shift Reports: Teach SBAR (Situation, Background, Assessment, 
Recommendation) for concise handovers. Provide examples tailored to paediatric oncology 
(e.g., reporting chemotherapy side effects). 
 
3. Efficient Charting Software Use: Share tips for navigating EHR interfaces, using 
shortcuts, and resolving technical issues (e.g., system downtime). Address challenges in 
Jordanian hospitals, such as slow connectivity. 
 
4. Five Rights of Medication Administration: Ensure the right patient, drug, dose, route, and 
time through verification (e.g., barcode scanning, double-checking). Discuss oncology-
specific risks (e.g., chemotherapy errors). 
 
5. Paediatric Dosing Principles and Calculations: Review weight-based dosing for 
chemotherapy and supportive drugs, using Jordanian formularies. Practice calculations with 
real-world examples (Cohen, 2015). 
 
6. Common Causes of Medication Errors: Identify risks (e.g., look-alike drugs, illegible 
orders) and prevention strategies (e.g., standardised protocols, clear labelling).  
 
7. Reporting Errors and Near Misses: Outline non-punitive reporting protocols in Jordanian 
hospitals, encouraging transparency to improve safety.  
 

41 
 
8. Safe Storage and Labelling: Discuss storage of high-risk medications (e.g., chemotherapy 
agents) and tamper-evident labelling to prevent misuse.  
 
9. Group Prioritisation Simulation with Jordanian Sample Shift Schedules: Activity to 
prioritise tasks (e.g., charting vs. medication rounds) using realistic Jordanian shift 
scenarios, followed by debriefing.  
 
10. Documentation Workflow Mapping: Participants map their current documentation 
process, identify inefficiencies, and propose improvements for their ward.  
 
 
Notes for Facilitators 
 
Frame activities as procedural optimisation (e.g., “streamline charting” not “reduce 
workload stress”). 
 
Use familiar Jordanian systems (e.g., Hakeem) to ensure applicability. 
 
Provide clear instructions for calculations to avoid confusion, offering examples first. 
 
Ensure simulations focus on task prioritisation, not emotional responses to workload. 
 
Encourage participants to share workflow tips but redirect if discussions veer into stress 
complaints. 
 
Discussion Points 
 
How does your hospital’s EHR system (e.g., Hakeem) support or hinder efficient 
documentation? Share practical tips for improvement. 
 
What strategies ensure the Five Rights during busy shifts in Jordanian oncology wards? 
 
Based on the prioritisation simulation, how can your team better organise tasks during peak 
hours? 
  
 
 
 

42 
 
 
 
 
Session 4: Professional Ethics in Paediatric Oncology Nursing (1 Hours) 
 
1. Confidentiality and Patient Rights: Review Jordanian legal and hospital policies on 
privacy, including handling sensitive data (e.g., cancer diagnoses) and communicating 
with families. Discuss cultural expectations around family involvement (Fry & Johnstone, 
2008).  
 
2. Informed Consent in Paediatrics: Outline the consent process for parents/guardians, 
including explaining risks and benefits in culturally sensitive ways. Address assent from 
older children and legal considerations in Jordan.  
 
3. Boundaries in Nurse-Child-Parent Relationships: Provide guidelines for maintaining 
professional boundaries while showing compassion, avoiding over-involvement or 
favouritism. Discuss cultural norms in Jordanian family dynamics.  
 
4. Advocacy for the Child’s Best Interest: Explore nurse roles in advocating for patient 
needs (e.g., pain management, psychosocial support) within teams and family contexts. 
Highlight advocacy within resource constraints.  
 
5. Ethical Dilemmas in Jordanian Paediatric Oncology: Discuss common dilemmas (e.g., 
parental refusal of treatment due to cost, withholding care due to resource shortages) and 
apply decision-making frameworks (e.g., autonomy, beneficence).  
 
6. Role-Play for Ethical Scenarios with Jordanian Families: Simulate ethical challenges 
(e.g., discussing treatment refusal, managing family conflicts), using culturally relevant 
scenarios with props (e.g., mock charts).  
 
7. Ethical Decision-Making Framework Development: Participants create a personal 
decision-making guide based on ethical principles, tailored to their ward’s challenges. 
 

43 
 
 
 
 
 
Notes for Facilitators 
 
Keep discussions focused on ethical principles and procedures, not emotional responses to 
dilemmas. 
 
Use culturally sensitive scenarios (e.g., family-driven decision-making in Jordan) to 
enhance relevance. 
 
Ensure role-plays remain professional; redirect if participants discuss personal distress. 
 
Assign roles in group activities to ensure inclusivity, especially for less vocal participants. 
 
Emphasise the practical utility of decision-making guides for daily practice. 
 
Discussion Points 
 
How do Jordanian cultural norms (e.g., family involvement) shape informed consent 
processes in your ward? 
 
What ethical dilemmas have you observed in Jordanian oncology care? How were they 
resolved? 
 
Based on the role-play, what strategies can nurses use to navigate family conflicts while 
maintaining professionalism? 
  
 
 
 
 
 
 
 
 
 

44 
 
 
 
 
References 
Allegranzi, B., Nejad, S. B., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & 
Pittet, D. (2011). Burden of endemic health-care-associated infection in developing countries: 
Systematic review and meta-analysis. The Lancet, 377(9761), 228–241. 
https://doi.org/10.1016/S0140-6736(10)61458-4  
Cohen, M. R. (2015). Medication errors (2nd ed.). American Pharmacists Association. ISBN: 
978-1582120928 
Fry, S. T., & Johnstone, M.-J. (2008). Ethics in nursing practice: A guide to ethical decision 
making (3rd ed.). Wiley-Blackwell. ISBN: 978-1405160520 
Institute for Safe Medication Practices. (2020). ISMP list of high-alert medications in acute 
care settings. https://www.ismp.org/recommendations/high-alert-medications-acute-list  
Joint Commission International. (2020). International patient safety goals. 
https://www.jointcommissioninternational.org/standards/international-patient-safety-goals/  
Kalra, J. (2011). Medical errors and patient safety: Strategies to reduce and disclose medical 
errors and improve patient safety. De Gruyter. ISBN: 978-3110249491 
Situation, Background, Assessment, Recommendation (SBAR) Toolkit. (2018). Institute for 
Healthcare Improvement. http://www.ihi.org/resources/Pages/Tools/SBARToolkit.aspx  
World Health Organization. (2009). WHO guidelines on hand hygiene in health care. 
https://www.who.int/publications/i/item/9789241597906