Nurses' perceptions of the obstacles and supportive behaviors of end-of-life care in intensive care units.

PURPOSE: This study examined the Jordanian registered nurses' perceptions of the obstacles and supportive behaviors of End-of-Life Care in Intensive Care Units and examined the differences in the concepts based on the samples' demographics. METHODS: A cross-sectional and comparative study was conducted using a convenience sample of 230 Intensive Care Unit registered nurses in Jordan. Data were analyzed descriptively, and differences were measured using the independent sample t-test, the one-way Analysis of Variance, and Scheffe's post hoc test. RESULTS: The registered nurses' scored moderately on obstacles (74.98 ± 14.54) and supportive behaviors (69.22 ± 4.84). The commonly perceived obstacle and supportive behaviors to End-of-Life Care in Intensive Care Units s were reported. The perceived obstacles differ based on the registered nurses' certification as an Intensive Care Units nurse (3.04 ± 0.58 vs. 2.74 ± 0.49, p = 0.008), type of Intensive Care Unit (3.28 ± 0.34 vs. 2.86 ± 0.62, p < 0.001), type of facility (3.16 ± 0.59 vs. 2.77 ± 0.61, p < 0.001), number of beds in the unit (3.07 ± 0.48 vs. 2.69 ± 0.48, p = 0.020), and the number of hours worked per week (3.06 ± 0.56 vs. 2.81 ± 0.60, p = 0.005). In contrast, supportive behaviors only differ based on the registered nurses' age (3.22 ± 0.69 vs. 2.90 ± 0.64, p = 0.019). CONCLUSIONS: The common End-of-Life Care perceived obstacle in Intensive Care Units was the lack of nursing education and training regarding the studies concept, which warrants immediate intervention such as on-job training. The common End-of-Life Care perceived supportive behavior in Intensive Care Units was when family members accepted that the patient was dying when nurses offered support to family members; motivational interventions are needed to sustain such behavior. Differences in the perceived obstacles and supportive behaviors should be leveraged for the benefit of patients, nurses, and hospitals.

Predictors of Post-Percutaneous Coronary Intervention Chest Pain Among Coronary Heart Disease Patients.

Patients who undergo percutaneous coronary intervention (PCI) procedure frequently suffer post-PCI chest pain (PPCP). This study aims to identify the changes in PPCP level and investigate the predictors of PPCP among patients with coronary heart disease at three measurement times: on admission (T1), 24 hours post-PCI (T2), and 30 days post-PCI (T3). A repeated-measure design was used. Significant differences were observed in PPCP levels between T1 and T2; between T2 and T3; and between T1 and T3. The predictors of PPCP are (1) high-intensity physical activities duration per week, (2) cardiac enzyme level upon admission, (3) increased ejection fraction, and (4) increased heart rate. The results highlight that identifying predictors of PPCP helps in determining high-risk patients, whereby evidence-based interventions can decrease readmission rates and reduce patient exposure to unnecessary investigations and procedures. More research is needed to explain the changes in PPCP level and to confirm these results.

Changes in the Anxiety Levels of Patients Undergoing Percutaneous Coronary Intervention.

BACKGROUND: Anxiety is a predictor of a bad prognosis in patients with coronary heart disease. Patients with coronary heart disease undergoing percutaneous coronary intervention (PCI) reported high levels of anxiety, yet little is known about changes in anxiety levels after this procedure. OBJECTIVE: The aim of this study was to examine changes in anxiety levels of patients undergoing PCI and identify differences in anxiety levels based on patients' demographics and clinical details. METHODS: A convenience sample of patients undergoing first-time elective PCI (N = 165) completed the Generalized Anxiety Disorder Scale at baseline (discharge time) and 6 months later. Paired samples t test was used to assess the changes in anxiety levels. The χ2 test was used to examine the pattern of changes between the 2 time points. Patients did not have access to cardiac rehabilitation. RESULTS: Six months after PCI, the anxiety level scores decreased significantly; mean scores for the baseline versus follow-up were 10.84 ± 5.98 versus 4.29 ± 6.02, respectively (P = .001). Only 18.2% of the patients had normal levels of anxiety at the baseline compared with 71.5% 6 months later. History of hospitalization after PCI, being a smoker, younger age, and low level of education were associated with higher levels of anxiety at follow-up. CONCLUSIONS: Although anxiety levels were reduced 6 months after PCI, assessing patients' anxiety levels and implementing psychoeducational interventions at follow-up should be incorporated to optimize the care of PCI patients, particularly for those who are younger, who are smokers, or with a low educational level.

High levels of risk factors and poor secondary prevention for coronary heart disease patients in public hospitals: A descriptive repeated measures study.

BACKGROUND: Secondary prevention is a priority after coronary revascularization for effective long-term cardiovascular care. Coronary Heart Disease is a major health problem in Jordan, but little is known about the current provision of secondary prevention. AIM: The aim of this study was to evaluate risk factors and explore the current provision of secondary Coronary Heart Disease prevention among patients presenting with first-time Coronary Heart Disease at two time points: during hospitalization (Time 1) and 6 months later (Time 2), in multicentre settings in Jordan. METHODS: A descriptive, repeated measures research study design was applied to a consecutive sample of 180 patients with first-time Coronary Heart Disease. Demographic and clinical details were recorded from medical files. Self-administered questionnaires developed by the researchers were used to measure secondary prevention information related to Coronary Heart Disease, including secondary prevention services, lifestyle advice received and medical advice topics. A short form of the International Physical Activity Questionnaire was used to measure physical activity. Participants were assessed at Times 1 and 2. RESULTS: Unstructured lifestyle advice given to the patients at Times 1 and 2 most frequently related to medications, smoking, diet and blood lipids control advice topics, with no statistically significant improvement in cardiovascular risk factors among patients between Times 1 and 2. CONCLUSION: Despite an extremely high prevalence of risk factors in this population, the provision of secondary prevention is poor in Jordan, which requires urgent improvement, and the contribution of nurses' to secondary prevention should be enhanced.

The Impact of Type of Acute Myocardial Infarction on Cardiac Patient Self-efficacy After Hospitalization.

BACKGROUND: Self-efficacy is an important psychological construct associated with patient adherence with healthy lifestyle choices. Few studies have focused on the impacts of the type of acute myocardial infarction (AMI), non-ST-elevation myocardial infarction (STEMI) and STEMI, and the different treatment modalities of AMI on changes in cardiac self-efficacy after hospitalization. OBJECTIVE: This study examined the changes in cardiac self-efficacy based on the type of AMI and aimed to investigate the impact of different treatment modalities on changes in cardiac self-efficacy among post-AMI patients during hospitalization and at the 3- and 6-month follow-ups subsequent to hospitalization. METHODS: A repeated-measures design was used with a convenient sample of 210 patients diagnosed with first AMI. Patients completed the Cardiac Self-efficacy Questionnaire at the 3 time points. The study was implemented in 3 major hospitals in Jordan. Patients did not have access to cardiac rehabilitation. RESULTS: There was a statistically significant impact of AMI type on changes in cardiac self-efficacy measured between T1 and T2, between T2 and T3, and subsequently between T1 and T3. Nevertheless, there was no statistically significant impact of treatment modalities of AMI on changes in cardiac self-efficacy measured at the 3 time points. CONCLUSIONS: Assessment of self-efficacy for post-AMI patients is recommended. Moreover, post-non-STEMI patients need more attention when implementing an intervention to enhance self-efficacy after hospitalization. Health decision makers have to consider establishing cardiac rehabilitation to improve self-efficacy in Jordan. Further research is needed to confirm the study results and to investigate other contributing factors that could influence self-efficacy after hospitalization.

Relationship between anxiety, post-traumatic stress, insomnia and fibromyalgia among female refugees in jordan: A cross-sectional study.

WHAT IS KNOWN ON THE SUBJECT?: Fibromyalgia (FM) is a syndrome of chronic widespread pain, typically associated with fatigue, sleep, cognitive dysfunction and disordered mood. FM may limit an individual's ability to participate in everyday work and social activities, thereby making it difficult to maintain normal relationships with other individuals. While it has been studied in different populations and settings, the impact of FM and associated psychological factors has not been previously studied among female war refugees. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The study showed the high impact of FM on female refugees in Jordan; approximately three quarters of the participants had a moderate to severe FM impact. Refugees settled in Irbid city, Iraq, showed increased age, anxiety and post-traumatic stress disorder correlated with a higher FM impact. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study recommends evaluation of the impact of FM among all female refugees living in Jordan, along with its neighbouring countries hosting refugees. Healthcare providers, including mental health nurses, should be aware of the role of PTSD and anxiety on the impact of FM. Accordingly, healthcare workers should design appropriate mental health treatment plans to help to decrease the impact of FM. Mental health nurses should evaluate FM impact among all refugees worldwide. Nurses in Jordan are recommended to share their experience with nurses outside of Jordan as this may help with funds being obtained and the implementation of advanced psychological interventions. ABSTRACT: INTRODUCTION: Fibromyalgia (FM) is a syndrome of chronic widespread pain. While it has been studied in different populations and settings, the impact of FM and its associated psychological factors has not been previously studied among female war refugees. AIM: To assess the impact of FM and its associated factors in female refugees. METHODS: A cross-sectional study was conducted. The impact of FM, anxiety, post-traumatic stress (PTSD) and insomnia was investigated. RESULTS: 288 refugees previously diagnosed with FM were recruited. The results showed that 73.62% of the participants had a moderate to severe FM impact. Refugees settled in Irbid city were six times more likely to have a higher FM impact than refugees settled in Zarqa, and Iraqi refugees were more likely to have a higher impact than Syrian. Increased age, anxiety and PTSD were correlated with a greater impact. CONCLUSION: Mental health nursing services should be directed towards female refugees, particularly those with increased age, anxiety and PTSD. IMPLICATIONS FOR PRACTICE: Mental health nurses should evaluate the FM impact among all refugees worldwide. Furthermore, nurses in Jordan are recommended to share their experiences with nurses outside of Jordan, as this may help to raise funds and implement advanced psychological interventions.

Public knowledge, attitudes, and practice about COVID-19 pandemic.

COVID-19 is a newly discovered global pandemic that affected almost all countries, including Jordan. Knowledge, attitude and practices are fundamental to suppress the spread of the virus. This study aimed to examine knowledge, attitude and practices about COVID-19 in Jordan. A cross-sectional design was used to recruit a convenience sample of public from Jordan. An online instrument used to assess knowledge, attitude and practices about COVID-19, and was developed by the research team. The data were collected online through social media networks in Jordan. The data were collected during May 2020. 2470 participants participated and completed the study questionnaire. Results indicated good knowledge, practice, and attitude, about COVID-19 among the public in Jordan. Linear regression showed that female, aged 40 years or more, married, with Bachelor degree or higher, employed, and participants believe that Jordan will control COVID-19 had higher knowledge compared to their counterparts. Besides, linear regression showed that female, living in Amman city, with high knowledge about COVID-19, and believing that Jordan will control COVID-19 had higher practice compared to their counterparts. Knowledge, attitude and practices levels regarding COVID-19 among Jordanian population during the pandemic were high. However, health authorities and government have to implement and maintain educational programs to enhance the Jordanian population's awareness regarding COVID-19 and to prevent its spread specially among male, aged less than 40 years, unmarried, with less than Bachelor degree, unemployed, and for participants believe that Jordan will not control COVID-19.

The association between hope and quality of life in haemodialysis patients.

BACKGROUND: Hope is important for patients with end-stage renal disease receiving haemodialysis (HD) and hope is associated with quality of life (QoL). Studies examining hope among the HD population are limited and, as far as the authors know, have not been undertaken in Jordan. AIMS: To examine levels of hope and QoL and to examine the association between hope and QoL in HD patients in Jordan. METHODS: A cross-sectional design was used. A convenience sample of 202 patients from six different dialysis centres was recruited. The World Health Organization QOL-BREF and the Herth Hope Index were used. FINDINGS: Moderate levels of hope (M=32.3±4.1) were reported. Respondents reported low mean scores for the physical domain of QoL (M=48.3±21.1) but not for the psychological and social relationship domains. Higher hope scores were associated with better QoL. CONCLUSION: The findings suggest a positive relationship between the level of hope and QoL in people receiving HD. Encouraging hope while caring for HD patients in clinical settings may improve their QoL. Understanding the relationship between hope and QoL may help healthcare providers to improve the quality of care for patients and their families.

Changes in illness perception among patients' undergoing percutaneous coronary intervention.

BACKGROUND: Little is known about changes in illness perception (IP) among patients treated with percutaneous coronary intervention (PCI). OBJECTIVES: To examine changes in IP among patients undergoing PCI and examine the effects of demographics and clinical details on IP. METHODS: A descriptive repeated measures design was used. IP was evaluated at pre discharge time and six months' later. RESULTS: Six months' post PCI, patients perceived their illness as chronic, had more control over their condition, and better understanding of it. They experienced less symptoms, lower perceptions of consequences on their life and less emotional representation indicating positive changes. Receiving health education at follow-up time had a significant interaction effects on increased personal and treatment control. Having a family history of coronary heart disease associated with better understanding of illness. CONCLUSION: Assessing patient' IP and providing health education at follow-up time should be incorporated in optimizing the care of PCI patients.

Experiences on Providing Home Care for A Relative with Heart Failure: A Qualitative Study.

PURPOSE: The aim of this study was to explore and describe the lived experiences of persons providing home care for community-dwelling relative with heart failure (HF) in Jordan. Design: It was a phenomenological study. Methods: Data were collected through interviews with 29 participants and analyzed using a thematic analysis approach. Findings: Four core themes have emerged: caregiving as a mandatory responsibility, positive experiences, negative experiences, and factors influencing the quality of the experiences. Conclusion: Although the hallmark of the participants' experience was negative, they showed a strong commitment to caring for their ill relatives. Clinical Evidence: The findings underscore the need for frequent assessment and support of family caregivers.

Social support predicted quality of life in people receiving haemodialysis treatment: A cross-sectional survey.

Aims: To examine levels of social support and quality of life (QOL) and to examine the association between social support and QOL in patients receiving haemodialysis (HD) treatment. Design: A cross-sectional study. Method: social support and QOL were measured using the Multidimensional Scale of Perceived social Support (MSPSS) and the World Health Organization QOL-BREF questionnaires, respectively. A convenience sample of 195 patients receiving HD from different dialysis units across Jordan completed the questionnaires. Results: Respondents scored highest on the social relationships domain of QOL (55.5 SD 21.4) compared with the lowest mean scores of the physical and environmental domains (48.6 SD 20.4; 46.2 SD 17.3, respectively). social support had a positive significant association with quality of life. Multiple linear regression identified age and social support as influencing factors, explaining 24.6% of the total variance in the social domain of quality of life.Understanding the relationship between social support and QOL in patients receiving HD may provide guidance to the healthcare providers, family members and social services about the importance of social support to this group of patients.

Do Illness Perception Predict Perceived Learning Needs Among Patients Treated With Percutaneous Coronary Intervention.

BACKGROUND: The number of coronary heart disease (CHD) patients treated with percutaneous coronary intervention (PCI) has increased. The illness perception (IP) of PCI recipients needs to be evaluated. Yet, little is known whether patients' IP predicts perceived learning needs among patients treated with PCI. OBJECTIVE: The aim of this study was to assess patients' IP and to examine its influence on perceived learning needs post PCI. METHODS: A cross-sectional design was used. A convenience sample of 208 patients who had undergone first-time PCI participated in the study. Data were collected before patients were discharged from the hospital using the Brief Illness Perception Questionnaire and the Percutaneous Coronary Intervention Learning Need Scale. RESULTS: Patients were highly concerned about their illness and perceived high consequences and symptoms related to CHD. They perceived low levels of personal and treatment control over their illness. Patients reported high learning needs. Multiple linear regression showed that low perception of personal control (P < .037), treatment control (P < .041), and high perception of disease symptoms (P < .018) significantly predicted high perceived learning needs. CONCLUSION: Hence, the patients' IP influences perceived learning needs, which may be included in routine clinical assessments. Tailored health education programs are needed for patients treated with PCI; such a program should target patients who perceived low levels of personal and treatment control over illness and have a high perception of symptoms.

Perceived Learning Needs of Patients With Heart Failure in Jordan: Perspectives of Patients, Caregivers, and Nurses: A Cross-Sectional Survey.

BACKGROUND: Identifying learning needs is an important component of care among patients with heart failure (HF). There is a discrepancy in the level of importance of information as perceived by patients, caregivers, and nurses. No studies have been conducted to identify learning needs among patients with HF in Jordan. OBJECTIVE: The aim of this study was to identify the learning needs of patients with HF in Jordan from the perspective of patients, family caregivers, and their nurses. METHODS: A descriptive comparative design using a convenience sample of 67 patients with HF, 67 family caregivers, and 67 nurses was used. The Heart Failure Learning Needs Inventory was used to identify the learning needs. The mean scores were compared among the 3 groups and ranked by importance for each item to determine the most important areas of perceived needs for each group. RESULTS: All groups had high total Heart Failure Learning Needs mean scores: patients, 4.12 ± 0.92; caregivers, 4.14 ± 0.65; and nurses, 4.08 ± 0.54. The top priority learning need for both patients and caregivers was "the recommended daily salt intake," whereas for nurses, it was "why I am taking each medication and its side effects"; nurses significantly perceived it as more important to learn than patients and caregivers did. Younger and employed patients requested more information than other patients. CONCLUSIONS: Although some similarities exist, there are important differences among the 3 groups on perceived importance of information. Understanding these differences may be critical in developing a tailored educational program for patients and caregivers and improving nursing practice.

Spirituality, Anxiety and Depression Among People Receiving Hemodialysis Treatment in Jordan: A Cross-Sectional Study.

Spirituality is an important factor that may mediate the detrimental impacts of hemodialysis on mental health. Lack of research examining spirituality and mental health in the Arab world in general and Jordan in particular encouraged this research. The study examined levels of spirituality, depression and anxiety and explored the association between them among patients receiving hemodialysis treatment in Jordan. A cross-sectional design was used to recruit 202 patients receiving hemodialysis treatment. Self-administered questionnaires including spiritual well-being scale, depression and anxiety and a demographic data sheet were used. The data were analyzed using SPSS and descriptive, inferential statistics and linear multivariate regression. The majority of respondents reported moderate mean levels of spirituality well-being (62.4%), while 60.9% and 80.2% scored low-to-moderate levels of depression, respectively. Only 22.3% reported moderate-to-severe anxiety levels. Increasing anxiety and number of co-morbid conditions were predictors of depression. No significant correlations were found between spirituality neither with the sample characteristics nor with depression and anxiety. It was found that depression and anxiety are common among respondents. Spirituality was of medium importance to them, yet it was not significantly associated with depression and anxiety. The implications of this study for holistic clinical practice are explored.

Hope predicted quality of life in dyads of community-dwelling patients receiving hemodialysis and their family caregivers.

PURPOSE: End-stage renal disease (ESRD) patients on hemodialysis (HD) and their family caregivers (FCGs) reported poor quality of life (QoL). Hope has shown association with QoL at the individual level. However, the association between hope and QoL in dyads has never been examined in particular in dyads of patients and FCGs. The purpose of this study was to examine the associations between hope and QoL in dyads of ESRD patients on HD and their family caregivers (FCGs). METHODS: This was a cross-sectional study in which data were collected from 123 community-dwelling patient-FCG dyads. Hope was measured using the Herth Hope Index and QoL was measured using the World Health Organization Quality of Life BREF. The Actor-Partner Interdependence Model multilevel modeling dyadic analysis approach was used to analyze the data. RESULTS: Each individual's hope scores predicted their own better QoL scores. Patients' hope scores predicted better Environmental domain QoL in FCGs. CONCLUSION: All domains of QoL of patients and their FCGs are related to their own level of hope. Better FCGs' environment domain of QoL was linked to high patients' levels of hope. Improving QoL may be achieved by targeting and improving hope in both members of the dyad.

The prevalence and the predictors of insomnia among refugees.

This study aimed to investigate the prevalence of insomnia and associated sociodemographic factors among refugees in Jordan. A cross-sectional survey was undertaken with a representative sample of 373 refugees. The majority of refugees had moderate to severe insomnia (n = 196, 52.2%). Older age, living in the city of Mafraq, having secondary education or below, unemployed, and lacking easy access to medication were the predictors of higher insomnia. More attention by health care providers including nurses should be given to older refugees and those with a lower level of education, as these groups tend to be more liable to suffer from insomnia.

Development and psychometric testing of the Physical Examination Attitudes and Practices Scale.

AIM: To develop and test a scale that assesses the attitudes and practices of registered nurses toward physical examination (PE) in of (delete) the clinical settings. METHODS: A cross-sectional methodological design with a convenience sample of 277 registered nurses was used. A Likert-type scale was constructed using 55 Likert-type items that were extracted from the relevant literature. Exploratory factor analyses were conducted using varimax rotation. Factor loading, eigenvalues, and screeplots were used to determine the best fit model. RESULTS: The final version of the scale consisted of four factors. The determinant score was (0.001) and the total variance explained was 56.26%. All of those four factors had eigenvalue more than 1. The final version of the scale (the 20-item scale) was tested for reliability and was internally consistent (Cronbach's α = 0.833). The scale was supported for its validity. CONCLUSION: The final version of the scale can be used to determine nurses' perspective and use of PE, and assist in bridging the gap between what is taught and what is practices regarding PE.

A Survey on Sexual Counseling for Patients With Cardiac Disease Among Nurses in Jordan.

BACKGROUND: Recovery among patients with cardiac disease also requires attention to their sexual health. However, cultural, religious, and social factors may make Arab Muslim patients reluctant to disclose their sexual concerns and nurses hesitant to discuss patients' sexuality matters. OBJECTIVE: The aim of this study was to explore sexual counseling (SC) among nurses in Jordan in terms of responsibility, confidence, and practice. METHOD: This was a descriptive, correlational study. Staff nurses were recruited from 10 hospitals in Jordan. Nurses completed the cardiac version of the Survey of Sexuality-Related Nursing Practice and reported their demographics. RESULTS: The sample consisted of 379 nurses (female, 59%; mean age, 28.1 years). A significant proportion of nurses viewed assessment/discussion of patients' sexuality matters as not within their responsibilities (39%), did not feel confident to address sexuality matters (50%), and rated themselves as not at all/not very knowledgeable about sexuality (60%). Few nurses were routinely integrating SC in clinical practice (9%). Sexual counseling was associated with nurses' gender (male, higher confidence and practice) and previous training on sexuality in nursing practice. CONCLUSIONS: Nurses in Jordan, especially female nurses, are neither prepared nor competent to provide SC. Nurses need focused education on sexuality to optimize patients' sexual health.

Anxiety, stress, and quality of life among Iraqi refugees in Jordan: A cross sectional survey.

This study was conducted to identify the predictors, levels, and prevalence of anxiety and stress and to assess the relationship between these factors and quality of life in recently displaced Iraqis. A cross-sectional design was used. A convenience sample of 171 Iraqi refugees was recruited. The results indicated that more than half of the sample suffered from high anxiety levels, while 42.8% reported high stress. The regression model explained 46.3% of the variance in levels of quality of life. Unemployment, fewer than three family members, and high anxiety significantly predicted low-level quality of life. These three predictors need to be taken into consideration when developing health-related interventions to improve the quality of life of Iraqi refugees.