Differences in Depression, Anxiety, and Stress in Relation to Changes in Living Conditions, Work Conditions, and Daily Life During the COVID-19 Pandemic in Jordan.

Introduction: The COVID-19 pandemic was associated with numerous changes in daily life conditions that could affect the psychological response of individuals worldwide. Objective: The study aimed to describe and examine differences in depression, anxiety, and stress in relation to living conditions during the COVID-19 pandemic. Methods: A cross-sectional design was used. Purposive snowball sampling was employed to include 642 participants. Arabic versions of the Depression, Anxiety, and Stress Scales were used to collect data. Descriptive statistics, t-test, ANOVA, and Pearson's correlation were used to analyze the data. Results: The total mean scores of depression, anxiety, and stress were 12.26 (SD = 10.53), 9.04 (SD = 9.34), and 13.49 (SD = 10.72), respectively. Of the study sample, 122 (19.5%), 139 (22.2%), and 99 (15.9%) had severe to extremely severe levels of depression, anxiety, and stress, respectively. Significant differences were found in depression, anxiety, and stress in relation to age, chronic diseases, and house size. Conclusion: The findings showed an increased prevalence of depression and anxiety during the COVID-19 pandemic. Mental health practitioners need to recognize the impact of pandemics on youth, females, low-income populations, and individuals with chronic diseases. Preventive mental health services among these populations, such as screening and counseling, would help reduce the health risks.

The emotional and social concerns of mothers of children with cleft palate: A cross-sectional study.

PROBLEM: Among birth defects, a cleft palate is one of the most common defects globally, with a prevalence rate of 1 in 700 live-born children per annum. Caring for a child with cleft palate is considered a challenge for mothers who provide around clock care for these children. Despite this, there is limited knowledge of their experiences and needs particularly in low resource settings. BACKGROUND: Previous literature emphasized that mothers of children with cleft palate face many challenges involving emotional distress, social isolation, and financial burden. QUESTION: To investigate the emotional and social concerns of mothers of children with Cleft Palate compared to mothers of children without cleft palate. METHODS: A comparative study design was conducted at the Jordanian Royal Medical Services using convenience sample of 312 mothers of children with and without cleft palate in Jordan. FINDINGS: There was a significant difference in the presence of anxious feelings between mothers of children with cleft palate and those mothers without cleft palate children. Within group comparison for mothers of children with cleft palate has shown a significant difference in their social concerns with regards to social support and child's future. DISCUSSION: Mothers of children with cleft palate reported significantly higher levels of sadness feelings. These emotions could be attributed to several factors, including the financial burden associated with medical treatment and interventions, the burden of caring for a child with special needs, the social stigma related to the child's appearance, the lack of public awareness, and the insufficient social support services. CONCLUSION: Mothers of children with Cleft Palate experience a considerable amount of emotional and social concerns which require urgent interventions.

Patient satisfaction with primary health care services and primary health care providers.

AIM: To evaluate patients' satisfaction levels with primary healthcare services and providers in Jordan and assess differences in patients' satisfaction in relation to sociodemographic factors and accessibility to primary healthcare. DESIGN: A descriptive cross-sectional design was used in this study. SAMPLING: A convenient sampling technique was utilized. MEASURES: A 34-item survey instrument was adopted and distributed to patients in nine primary healthcare centers in Amman in the period between October and December 2022. RESULTS: A total of 225 patients completed the survey. The mean total score for patient satisfaction with primary healthcare services was 25.22 (SD = 4.13). There were significant differences in satisfaction with services in terms of educational level, visitation reason, mode of transportation, availability of parking, and suitably designed for patients with disabilities. Furthermore, the mean total score for patient satisfaction with primary healthcare providers was 22.85 (SD = 5.86). There were significant differences in relation to visitation reason, mode of transportation, and parking space availability. CONCLUSION: It is important to improve patient satisfaction in primary healthcare facilities, and the Ministry of Health should implement policies for improving the quality of services provided by primary healthcare.

Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan.

BACKGROUND: There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study's purpose was to examine nurses' knowledge and attitudes toward palliative care. METHODS: A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data. RESULTS: We measured nurses' knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type. CONCLUSIONS: ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.

Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses.

Background: The importance and efficacy of Preemptive analgesia in reducing pain for patients undergoing painful procedures still debatable and seldom investigated. The aim of this study was to describe intensive care nurses' perception of the importance of pain assessment and Preemptive analgesia prior painful procedures in critical care settings in Jordan. Method: A cross-sectional descriptive design was used. The sample consisted of 300 registered nurses recruited from 22 intensive care units in Jordan. The data was gathered using a self-administered questionnaire. Results: The results showed that nurses considered pain assessment moderately and extremely important for surgical (n = 263, 87.7%), burn (n = 261, 87%), and trauma patients (n = 256, 85.3%). The majority of nurses rated pain assessment as moderately to extremely important for invasive line placement 80.3%, wound care 78.3%, and drain removal 69%. Nurses assessed the need for Preemptive analgesia more frequently before wound care 70.7%, and before invasive line placement 69.7%. Nurses perceived pain assessment for Preemptive analgesia as less priority for unconscious patients. Conclusion: Effective assessment and management of pain for critically ill patients is mandatory. Thus, it is important to improve nurses' knowledge regarding the Preemptive analgesia and its effects in relieving post-procedural pain in critically ill patient. It is recommended to ensure proper clinical training on how to assess critically ill patients and auditing system.

Girl child marriage and the social context of displacement: a qualitative comparative exploration of Syrian refugees in Jordan and Rohingya refugees in Bangladesh.

BACKGROUND: There is growing global evidence that girl child marriage (CM) increases during humanitarian crises. Norms, attitudes, and policies that sustain CM are deeply entrenched within families and communities, and may be further exacerbated by conflict and displacement. The purpose of this study is to understand how the social and normative environment influences attitudes and practices related to CM in two diverse humanitarian settings. METHODS: We held a total of eight focus group discussions, four in each country, with Syrian refugees in Jordan and Rohingya Refugees in Bangladesh. FGDs were conducted with fathers, mothers, and adolescent boys and girls. RESULTS: Similar themes emerged from both settings. Participants discussed a desire to hold onto tradition in displacement and how norms are reinforced across generations. Social influence emerged in positive and negative ways, including peer pressure and conformity and the positive influence of host communities. In both settings, girls themselves described having little agency. Participants described resistance to change, which was exacerbated by conflict and displacement, though they discussed how social influence could be an effective way to challenge existing norms that drive the practice of girl child marriage. CONCLUSIONS: Our findings represent a more robust understanding of how norms operate within the social ecological system, and how they are reinforced across social relationships, offering an opportunity to more effectively challenge norms that sustain the practice of girl child marriage.

The Willingness of the Healthcare Professionals Working in Healthcare Institutions to Accept the First Dose of COVID-19 Vaccine in Jordan: A National Survey.

Health workers play an important part as role models, advocates for vaccination, vaccinators and educators in a community. Furthermore, they are at high risk of being infected with COVID-19 as they are on the frontlines. Thus, this study purposed to determine the willingness of the healthcare professionals working in healthcare institutions to accept the first dose of COVID-19 vaccine in Jordan. A cross-sectional design and a convenience-sampling method were used to recruit the study population from different healthcare sectors. A web-based survey was used to collect data. Findings showed that 1594 healthcare professionals responded and 74% of them were aged less than 45 years. Almost 65% of the respondents were registered nurses and 68.4% of them were married. A total of 94.9% of the participants heard about the COVID-19 vaccine, but only 56.5% of them had had the opportunity to attend lectures/discussions about COVID-19 vaccine. Official government websites were the primary source of obtaining information about COVID-19 (36.3%). The willingness of acceptance rate of COVID-19 vaccine was 63%. There were positive correlations between vaccine acceptance and compliance toward COVID-19 infection control precautions (r = 0.119, p < 0.01), knowledge about COVID-19 (r = 0.256, p < 0.01), age (r = 0.170, p < 0.01), and years of experience (r = 0.105, p < 0.01). Furthermore, age, knowledge, and compliance were significant predictors of the acceptance of the COVID-19 vaccine. Thus, it is necessary to develop specific interventions for healthcare professionals with low acceptance rates and take into consideration the predictors of COVID-19 vaccine acceptance. Further research is needed to explore the factors influencing the refusal of the COVID-19 vaccine by healthcare professionals.

Nurses' perceptions of hourly rounding in Jordanian hospitals: A national survey.

AIM: This study aims to explore nurses' perceptions of hourly rounding in Jordanian hospitals. BACKGROUND: Hourly rounding is a standardized and systematic process conducted by nurses to anticipate and address needs in hospitalized patients. The evidence on hourly rounding is mixed, and research is needed to affirm the benefits of implementing hourly rounding across different contexts. METHOD: A cross-sectional correlational design was used. A convenient sample of 1378 nurses was recruited from one military hospital, two university-affiliated hospitals, four governmental hospitals and four private hospitals in Jordan. The Hourly Rounding Questionnaire was used to collect data. Descriptive statistics, t test, one-way ANOVA and Kruskal-Wallis H test were used to analyse the data. RESULTS: The highest agreements between nurses were on the items related to the implementation of hourly rounding in terms of 'preventing patient falls' 1211 (87.9%), 'preventing hospital-acquired pressure ulcers' 1201 (87.2%) and 'addressing patients' position' 1199 (87%). The lowest agreements between nurses were on the items related to the involvement of nurses in the decision-making process and sense of ownership 268 (19.4%) and the availability of continued support and resources 239 (17.3%). Female nurses, nurses who often work on a shift rotation, nurses working in private hospitals and respiratory units had a positive perception of hourly rounding. IMPLICATIONS FOR NURSING MANAGEMENT: Findings will inform nursing leaders and policy developers about the implementation of hourly rounding from nurses' perspectives. A protocol should accompany hourly rounding for robust evaluation to measure the impact of this process change with the involvement of nurses in the decision-making process.

Child Marriage in Relation to the Syrian Conflict: Jordanian and Syrian Adolescents' Perspectives.

PURPOSE: Although the average age of marriage has increased in many countries in the Middle East in recent years, child marriage is thought to become more common among certain populations in Jordan, notably the refugees. This study explores the perspectives of Jordanian and Syrian adolescents on child marriage in relation to the Syrian conflict as members of refugee populations and host communities. METHODS: This study used data from in-depth interviews with 64 Jordanian and Syrian adolescents between the ages of 15 and 19 years. Interviews consisted of a narrative, flexible dialog in which participants discussed their life histories using the creation of a visual timeline as a tool. Data analysis was iterative, inductive, and based on the grounded theory approach. Themes were identified through ongoing interaction with the data. RESULTS: Three major themes emerged from the data relating to child marriage: (1) the influence of intermingling between Syrian and Jordanian communities, (2) vulnerability and control interact to fuel increases in child marriage in displacement, and (3) finding agency by rejecting child marriage. CONCLUSIONS: The Syrian conflict has changed practices relating to child marriage, fostering a renewed reliance on child marriage in light of increasing instability, leaving both Jordanian and Syrian adolescents increasingly vulnerable. Many adolescents reject the practice, thus offering an opportunity for social change.

Measuring health service providers' attitudes towards the provision of youth-friendly sexual and reproductive health services: a psychometric study to develop and validate a scale in Jordan.

OBJECTIVES: The aim of this study is to develop and validate a scale to measure provider attitudes towards provision of youth-friendly sexual and reproductive health (SRH) services in a conservative setting in the Middle East. DESIGN: Cross-sectional, psychometric validation study. SETTING: Public health facilities in Amman, Irbid, Mafraq and Zarqa in Jordan. PARTICIPANTS: 552 healthcare providers were recruited by convenience. Providers were eligible if they were a practising midwife, nurse or physician in one of the selected health facilities. METHODS: An initial pool of 52 items was generated using theory and local expert input. We evaluated the psychometric properties of the scale using factor analysis. We assessed internal consistency reliability by calculating Cronbach's alpha and convergent construct validity using linear regression to assess the association between a provider's score on the scale and whether they had ever received training on SRH issues. RESULTS: Our final scale consisted of 3 dimensions and 29 items corresponding to the constructs of: (1) Attitudes towards Information and Services Offered to Youth (11 items) (2) norms and personal beliefs (10 items) and (3) attitudes towards the service delivery environment (8 items). Cronbach's alpha was estimated at 0.72 for the full scale, and between 0.70 and 0.73 for each subscale. The scale demonstrated high construct validity. The results of the linear regression analysis suggest that respondents who had received SRH training had a mean score that was 16% higher (0.64 points; 95% CI 0.2 to 11.2; p<0.01) on the full attitudes scale compared with those who did not. CONCLUSIONS: This paper describes a study to formally develop and validate a scale to measure healthcare provider attitudes in support of youth-friendly SRH services, thus providing an important tool to identify areas for improvement of youth SRH programmes in the Middle East and globally.

Prevalence and Correlates of Sleep Quality Among Jordanian University Students: A Cross-Sectional National Study.

Poor sleep quality affects university students' life and increases their risk of long-term health consequences. This study aimed to describe the quality of sleep among Jordanian university students, examine differences in sleep quality according to selected variables, and identify predictors of sleep quality. A cross-sectional correlational design and a multi-strategic sampling technique were used to select a sample of 1,308 university students. The Pittsburgh Sleep Quality Index, the Perceived Stress Scale, and the Sleep Hygiene Instrument were administered to the subjects. T-test, ANOVA, and multiple regressions were used to analyze the data. The results showed that most students were classified as poor sleepers (87.1%), and only (12.8%) reported having a good sleep quality. Among the components of sleep quality, subjective sleep quality (m = 1.90, SD = 0.89) and daytime dysfunction (m = 1.72, SD = 0.67) had the highest mean scores, while sleep efficiency (m = 0.50, SD = 0.91) and the use of sleep medications (m = 0.23, SD = 0.73) had the lowest mean scores. There were statistically significant differences in sleep quality in relation to residency, academic level, academic achievement, and family income. Significant predictors of sleep quality were gender, marital status, employment status, sleep hygiene, and stress.

Barriers and enablers of intensive care unit nurses' assessment and management of patients' pain.

BACKGROUND: Inadequate pain assessment and management is a problem in hospitalized patients that impairs their well-being. Intensive care unit nurses' pain practices are affected by several barriers and enablers. AIMS AND OBJECTIVES: To explore intensive care unit nurses' pain education, perceived barriers, and enablers of pain assessment and management practices among critically ill patients. DESIGN: A cross-sectional descriptive design was used in the study. METHODS: Convenience sampling technique was used, including 300 nurses recruited from 22 intensive care units in Jordan. The Pain Assessment and Management for Critically Ill Adults Survey was used to collect data. Descriptive statistics, spearman correlation, and chi-square tests were used to analyse the data. RESULTS: Only 127 (42.3%) of the nurses reported moderate to extreme satisfaction about receiving professional development education related to pain among critically ill patients. Nurse workload (65.3%), patient instability (54.4%), patient inability to communicate (53.3%), and sedation interfering with pain assessment (50%) were reported by nurses as the most frequent barriers impacting pain assessment and management. Enablers of pain assessment and management reported most frequently were "pain assessment and management is a unit priority" (63.7%), "enthusiastic and motivated staff" (61.3%), "protocols and guidelines are in use" (57.4%), and "standardized assessment tools are in use" (57%). Some barriers and enablers to pain assessment and management and pain education differed significantly according to nurses' experience and hospital type. CONCLUSION: This study identified a range of enablers and barriers to pain assessment and management practices perceived by intensive care unit nurses. Nurse workload was an important barrier while making pain assessments, and management a unit priority was an important enabler for pain assessment and management. Frequent assessment of barriers and enablers of pain assessment and management is needed in critical care units to improve nurses' practices. Pain education should be included in the hospitals' continuous educational program.

Nursing students' attitudes towards death and caring for dying patients.

AIM: To examine the attitudes of undergraduate Jordanian nursing students towards death and caring for dying patients. DESIGN: A cross-sectional correlational design. METHODS: The Frommelt Attitude Toward Care of the Dying and Death Attitude Profile-Revised scales were used in this study with a convenience sample of 555 students from nursing schools in Jordan. RESULTS: Nursing students had positive attitudes towards death (M = 153.7, SD = 21.5) and a positive attitude towards caring for dying patients (M = 98.1, SD = 9.2). Fear of death, escape acceptance and death avoidance were significant negative predictors, while neutral acceptance, higher academic level and female gender were significant positive predictors of caring for dying patients (F = 4.5). CONCLUSION: Nursing students had positive attitudes towards caring for dying patients that was influenced by university type, academic level and gender. Nursing education must further focus on death, dying and end-of-life care across the core courses of nursing curricula, theory and practicum.

Beliefs About Illness and Treatment Decision Modelling During Ill-Health in Arabic Families.

BACKGROUND: The use of self-prescribed antibiotics and other unproven herbal remedies is common in the Arab world. Understanding how family members decide to manage illness is an important priority for health care providers. PURPOSE: This paper presents a new model that can be viewed as an extension to the Health Belief Model and help clarifies the cognitive processes families use to manage illness in an Arab family in Jordan. It aims to generate an understanding of family beliefs about the causes of illness and appraisal of how best to manage illness in an Arab family. METHODS: A qualitative approach using a family interview method was used to collect data. Twenty-five families participated in semi-structured interviews designed to elicit representational models of illness and treatment-decisions. RESULTS: Thematic analysis revealed two forms of intertwined beliefs: core beliefs (fatalistic) and secondary beliefs (biomedical, supernatural and situational beliefs). Four key elements were identified as underpinning the involvement of family in treatment decision: perceived threat of illness, efficacy of treatment option, cost or availability and family prior experience. CONCLUSION: An understanding of the health belief model and related cognitive appraisal processes used by families may assist health care providers to engage with and overcome some of the social, cultural, and structural variables that could influence how family members decide to manage illness in Jordan.

Health care professionals' attitudes towards youth-friendly sexual and reproductive health services in Jordan: a cross-sectional study of physicians, midwives and nurses.

BACKGROUND: Youth-friendly sexual and reproductive health (SRH) services are thought to make such services for adolescents more accessible and acceptable; however, provider attitudes may still present an important barrier. Improving youth SRH service utilization has been recognized as a national priority in Jordan; however, existing services remain underutilized. Previous studies found that youth perceive SRH services to be inadequate and that providers are not supportive of their needs. The purpose of this study is measure provider attitudes towards youth-friendly SRH services and explore their variation according to individual characteristics among health care professionals in Jordan. METHODS: We measured provider attitudes towards youth-friendly SRH services using a scale that was developed and validated in Jordan. The scale consists of three subscales: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Physicians, midwives and nurses working at either primary health centers, comprehensive care centers, or women's and children's health centers where services to adolescents are or should be offered were recruited from four governorates in Jordan using a two-stage, cluster sampling scheme. Differences in attitudes were assessed using simple and multivariable linear regression analysis. RESULTS: The sample consisted of 510 providers from four governorates in Jordan. The mean provider score on the full scale was 2.7, with a range of 2.0 to 3.8. On Subscales 1 and 2, physicians exhibited significantly more youth-friendly attitudes than nurses by scoring 0.17 points higher than nurses on Subscale 1 (95% CI: 0.02-0.32; p < 0.05) in adjusted analyses. Providers who had been previously trained in SRH issues scored 0.10 points higher (95% CI: 0.00-0.20; p < 0.05) than those who had not on Subscale 3. No differences were found according to provider characteristics on Subscale 2. Providers exhibited the lowest scores related to items referencing youth sexual behavior. CONCLUSIONS: Provider attitudes towards youth-friendly SRH service delivery highlight context-specific, cultural concerns. The limited variation in attitudes related to norms and personal beliefs may be a reflection that such beliefs are deeply held across Jordanian society. Last, as past training on SRH was significantly associated with higher scores, our results suggest opportunity for intervention to improve providers' confidence and knowledge.

Making sexual and reproductive (SRH) services easier for youth to access, organizing service delivery in a way that meets youth's needs, and supporting health care professionals to interact with youth in a friendly manner can make SRH services more youth-friendly. If SRH services are more youth-friendly, more youth may use them. In Jordan, steps have been taken to make SRH services more youth-friendly, but youth still do not believe that providers are supportive of their needs. This study aims to measure physician's, nurse's, and midwives' attitudes towards youth-friendly SRH services in Jordan. We also look at whether certain individual characteristics, such as age, type of service provider, etc. are related to provider attitudes We used a scale that tested in Jordan to measure provider attitudes. The scale focuses on three domains: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Our sample includes 510 health care providers from four regions in Jordan. We used descriptive statistics and regression analysis to conduct our analysis. Our results show that physicians had more supportive attitudes than nurses or midwives on Subscales 1 and 3. Providers who reported having been trained in SRH issues in the past had higher scores on Subscale 3. No individual characteristics were related to Subscale 2. We find that in Jordan, provider attitudes may reflect deeply rooted cultural norms.

Sleep quality, sleep latency, and sleep duration: a national comparative study of university students in Jordan.

BACKGROUND: Sleep problems have significant negative health consequences on university students. STUDY AIM: To assess subjective sleep quality, sleep latency, and sleep duration in a national sample of university students and investigate differences in these components with selected variables. METHODS: A cross-sectional analysis and multi-stage sampling were conducted to select a sample of 1308 students from three major areas in Jordan. Sleep quality, sleep latency, and sleep duration were measured by an Arabic version of the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using measures of frequency and central tendency and Kruskal-Wallis tests. RESULTS: Two-thirds of university students described their sleep quality as fairly bad and very bad and 20 reported sleep latency of more than 30 min during the past month. There was a significant difference in subjective sleep quality according to the student's place of residence. Sleep latency differed according to students' income, physical activity, use of media devices before sleep, smoking status, and academic achievement. Significant differences were also found in sleep duration with students' academic achievement, academic level, and body mass index. CONCLUSIONS: University students suffer from poor sleep quality, delayed sleep phase, and sleep deprivation. Lower-income, smoking, physical inactivity, and using media devices before sleep contributed to students' sleeping problems. IMPLICATIONS: Interventional programs that focus on improving physical activity, controlling tobacco use, healthy sleep education, and reducing screen time are essential public health interventions to reduce sleep problems among youth.

Predictors of job satisfaction of registered nurses providing care for older adults.

BACKGROUND: The population worldwide is ageing. This has required the nursing profession to respond to the growing demands of providing nursing care to this population. PURPOSE: To identify predictors of job satisfaction among registered nurses providing care for older adults. METHODS: A cross-sectional correlational design was used with a convenience sample of nurses. The Quality Work Competence Questionnaire, Job Satisfaction Scale and Nurses' Occupational Stress Scale were used to measure study variables. Descriptive statistics and multiple regressions were used to analyse the data. RESULTS: The study included 500 nurses; and 68% dissatisfied with their job. Nurses were mostly dissatisfied with the physical conditions in which they work (55.2%) and the rate of payment (50.2%). Physical strain demonstrated the highest positive correlation with nurses' satisfaction (r = .36). More years of experience, skills and employee development, high nurses' competence, and more physical strain predicted high job satisfaction. CONCLUSION: Job dissatisfaction among nurses providing care for older adults is high and is influenced by nurses' experience, professional development, competency and physical strain. IMPLICATIONS: Health care organisations should apply strategies that enhance the development of the professional competency of their nursing staff.

Prevalence and differences in habitual sleep efficiency, sleep disturbances, and using sleep medication: a national study of university students in Jordan.

BACKGROUND: Sleep quality has a significant impact on the physical and mental health of the young population. STUDY AIM: To evaluate sleep efficiency, sleep disturbances, and use of sleep medication among university students in Jordan and to examine differences in these problems in relation to selected demographic and health-risk behaviors. METHODS: The study used a cross-sectional design and a multi-stage sampling technique. Three public universities were randomly selected from three major governorates in Jordan. The Arabic version of the Pittsburgh Sleep Quality Index was used to measure sleep efficiency, sleep disturbances, and the use of sleep medication. Descriptive statistics and Kruskal-Wallis tests were used to analyze the data. RESULTS: Of 1308 students who participated in the study, 27% reported sleep efficiency less than 85%, 45% of the students reported nocturnal awakening, 30% reported getting up to use the bathroom, and 9% reported using medication to help sleep. Differences in sleep efficiency, sleep disturbances, and use of sleep medication were found in relation to students' gender, income, marital status, smoking status, and academic achievement. CONCLUSIONS: Poor sleep efficiency, sleep disturbances, and the use of sleep medications are significant problems affecting sleep quality among university students. Students' gender, marital status, income, smoking status, and academic achievement are important factors associated with sleep quality. IMPLICATIONS: Sleep screening among university students is required to identify and provide treatment for sleep problems. Furthermore, educating university students about the effects of smoking on health in general and on sleep in particular should be mandated.

Perceived barriers to healthcare utilization among Jordanian families: A family centered approach.

AIM: This study aimed to understand the barriers to health services utilization by Jordanian families. BACKGROUND: Access to quality healthcare services is a significant issue facing healthcare systems. Healthcare systems must identify and apply measures to overcome barriers that face utilizing health services and thus increase clients' satisfaction. METHODS: A cross-sectional qualitative research design was used in this study. Semi-structured interviews were conducted with twenty-five families to elicit the model of health services barriers. RESULTS: The analysis of the family interviews led to four main themes related to health services barriers: service system, structural/physical barriers, equipment and medication, and staff competency. This study would increase awareness about underserved populations that avoid seeking medical care. CONCLUSION: Public health efforts are required to increase awareness about the importance of contacting the healthcare system as early as possible. However, public health policy may require developing new initiatives that reduce these perceived barriers, such as enhancing communication skills among healthcare workers, increasing supervision and inspection of healthcare quality, and enhancing patient engagement by using phone calls and messages as appointment reminders and careful follow-up.

Parent-child communication about sexual and reproductive health: perspectives of Jordanian and Syrian parents.

Young people throughout the world face considerable challenges related to their sexual and reproductive health (SRH). The parent-child relationship is fundamental to shaping children's trajectories through adolescence and suggests considerable potential to improve youth SRH knowledge. Lack of parent-child sexual communication (PCSC) may cause youth to turn instead to questionable information sources, such as peers, the internet and social media. The limited research in this area, and specifically in the Middle East, led us to explore how parents discuss SRH issues with their children and pinpointed the potential role for parents in supporting their children's SRH needs. A qualitative research approach was used, with 20 focus groups stratified by nationality and sex of participants from four major communities in Jordan. Thematic coding and analysis was used. Parents described their willingness to "break the culture of shame." Three primary strategies emerged: (1) the gender match, (2) mothers as a safe space and (3) seeking help from others, which included two sub-themes: incorporating others, and relying on the delivery of SRH information in schools. Strengths and challenges were inherent within each strategy, and discussion topics varied according to the strategy used. Evidence from this study provides an opportunity for future research and programming to improve adolescent health outcomes within conservative milieus to break the intergenerational cycle of shame. Interventions are suggested to target parents' knowledge and self-confidence to help youth achieve their sexual development. Using gender-matched PCSC strategies, school-based platforms and religious institutions are ways to destigmatise such topics.