A multi-country mixed-method study identifying the association between perceived ethical work climate and problems among critical care nurses.

BACKGROUND: Given the grave ethical tension and dilemmas posed continuously which are aggravated in the intensive care unit context and its related caregiving provision, combined with their impact on critical care nurses' job satisfaction and work-related risks, exploring and analyzing these tensions and conflicts is crucial. This study was conducted to examine the relationship between perceived ethical work climate and problems among critical care nurses in addition to exploring their perspectives on the ethical work climates while caring for patients with infectious diseases. DESIGN AND METHOD: A mixed-method research design was used to conduct this study among 635 participants, comprising 170 from Egypt, 144 from Jordan, 161 from Saudi Arabia, and 160 from the United Arab Emirates. Online or paper-based survey forms were distributed to all eligible critical care nurses who agreed to take part in the study. The survey contained both quantitative and qualitative data that were analyzed separately and integrated during the discussion. The study was reported following the STROBE guidelines. FINDINGS: The overall ethical work climate was fairly good and was significantly associated with ICU nurses' personal and professional characteristics. The findings also identified three main themes: (1) an ethical sense of failure, (2) environmental condemnation, and (3) an instant action plan for resolving ethical conflicts. CONCLUSIONS: ICU nurses perceived that ICU ethical climate was fairly good. The results indicated that ICU nurses generally had a relatively fair perception of the ethical work climate, with implications for addressing ethical issues and conflicts in various settings. IMPACT: Mentorship and/or close supervision concerning ethical resilience, consultation, and decision-making is crucial in the ICU milieu. Metacognitive strategies to reinforce problem-solving and decision-making ICU nurses' skills could help them overcome the different ethical challenges. Adequate resources, teamwork, and organizational support are promising tactics to improve ICU nurses' ethical skills. TRIAL REGISTRATION: Not applicable.

Depressive symptoms, perceived control and quality of life among patients undergoing coronary artery bypass graft: a prospective cohort study.

BACKGROUND: Coronary artery bypass graft surgery (CABG) is an intervention directed toward improving the Quality of Life (QoL) for patients with coronary artery disease. Depression can affect QoL negatively among this population. Perceived control (PC) decreased the effect of anxiety on QoL, however, this effect has not been well-studies regarding depression. Therefore, the purpose of this study was to check the effect of depression on QoL among CABG patients and to determine if preoperative PC moderates this effect. METHODS: This was a prospective observational cohort study conducted on a consecutive sample of 200 patients from three hospitals in Amman, Jordan. Depression Anxiety and Stress Scale, Short-Form Health Survey-36, and Arabic version of the Control Attitude Scale-Revised were used to measure depressive symptoms, QoL and PC respectively. Data were analyzed using t test and step wise multiple regression followed by simple slope analysis. RESULTS: Postoperative Physical Component Summary (PCS) was better than preoperative PCS (mean ± SD: 38.2 ± 9.4 vs. 36.6 ± 9.5, P < 0.001). Postoperative Mental Component Summary (MCS) was better than preoperative MCS (mean ± SD: 44.3 ± 11.5 vs. 41.4 ± 11.4, P < 0.001). Preoperative depression was higher than postoperative depression; (mean ± SD: 12.8 ± 6.8 vs.11.1 ± 6.7, P < 0.01). Simple slope analysis was significant (simple slope = 0.41, t = 6.1, P < 0.001), indicating the moderating effect of PC. CONCLUSION: Patients undergoing CABG surgery had poor QoL and high levels of depression. Perceived control moderated this relationship and improve QoL. Assessing depression levels and implantation of interventions to enhance perceived control levels prior to operation might improve QoL.

The effect of persistent anxiety and depressive symptoms on quality of life among patients with heart failure.

BACKGROUND: Anxiety and depressive symptoms interfere with physical and psychological status, worsening symptoms and quality of life (QoL) among patients with heart failure (HF). This study assesses the impact of persistent anxiety and depressive symptoms on QoL among patients with HF in Jordan. METHODS: This was a prospective observational study of a consecutive sample with a confirmed diagnosis of HF, recruited from four hospitals in Jordan during the period 1-31 March 2020. QoL was measured using the Arabic version of the Short Form 36 Health Survey, while anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Data were analyzed using descriptive statistics and stepwise multiple regression. RESULTS: Of 127 patients who participated in the study, 72 (56.7%) were persistently anxious and 60 (47.3%) were persistently depressed. In multiple regression models, persistent anxiety, persistent depression, and higher levels of New York Heart Association functional class were independent predictors for both Physical Component Summary (of which history of DM was another predictor) and Mental Component Summary. The model explained 78.4% of the variance for PCS, P < 0.05. These predictors reduced QoL/(PCS) by 0.261, 0.398, 0.09, and 0.325 units respectively. Mental Component Summary (MCS) regression model explained 76.1% of the variance, P < 0.001. These predictors reduced QoL/(MCS) by 0.286, 0.346, and 0.359 units respectively. CONCLUSIONS: Persistent anxiety and depressive symptoms were associated with poor QoL among patients with HF. It is highly recommended to assess psychological health for the patients with HF, especially anxiety and depression, and to include this dimension in treatment protocols.

A cross-cultural translation and adaptation of the Arabic Cardiac Self-Efficacy Questionnaire for patients with coronary heart disease.

AIM: The aim of this study is to cross-culturally translate and adapt the Cardiac Self-Efficacy Questionnaire into Arabic and subsequently evaluate the psychometric properties of that translation in a population of Arabic patients. METHOD: The original English version of the Cardiac Self-Efficacy Questionnaire was translated into Arabic following a process recommended by the World Health Organization. A convenience sample consisting of 268 Jordanian patients with coronary heart disease was recruited from a university-affiliated hospital in Amman, Jordan. Data were collected from October 2018 to March 2019. The factor structure, face and content validities, and internal consistency of the Arabic Cardiac Self-Efficacy Questionnaire (A-CSEQ) were evaluated. RESULTS: The factor structure analysis supported a three-factor high-order structure of the A-CSEQ. Face validity showed that the language used, style, and format were clear. The content validity demonstrated a very good content validity index. The reliability was good with ranging from 0.89 to 0.93 for all questionnaire subscales. CONCLUSION: The A-CSEQ is a valid and reliable instrument to assess the cardiac self-efficacy of Arabic patients diagnosed with coronary heart disease. Further assessment of the psychometric properties of the A-CSEQ with different cardiac problems is now recommended.

Depressive symptoms are associated with in-hospital complications following acute myocardial infarction.

AIM: To examine the effect of depressive symptoms on in-hospital complication rates after Acute Myocardial Infarction (AMI). BACKGROUND: Coronary Heart Disease (CHD) is the primary cause of death worldwide. AMI is the most common consequence of CHD. Depressive symptoms are an important risk factor for CHD and increased risk of AMI. Understanding the relationship between depressive symptoms and short term complications for patients with AMI is important for determining their needs, developing interventions, and evaluating the outcomes of interventions. METHODS: A prospective observational study was conducted with 175 patients who were admitted to the Intensive Care Units (ICUs) of four large hospitals in Jordan. During the interview, within 72h (mean, 38±16h) of admission to the hospital, participants completed the sociodemographic and clinical questionnaire and the Beck Depression Inventory Scale. RESULTS: The mean age was 66.9±11.0years. The number of patients with mild, moderate, and severe depressive symptoms who developed complications was significantly higher than those with minimal depressive symptoms, p˂0.001. Patients with mild, moderate, and severe depressive symptoms had longer lengths of stay in the ICU and in hospital than patients with minimal depressive symptoms. Patients with mild, moderate and severe depressive symptoms were at 1.22 times higher risk for developing complications than patients with minimal depressive symptoms. Moreover, previous AMI history increased the risk for developing complication by 150%. CONCLUSIONS: Depressive symptoms were an independent predictor of complications and increased length of stay after AMI. Interventions to control depressive symptoms early after AMI are necessary.

The Effect of Listening to Holy Quran Recital on Pain and Length of Stay Post-CABG: A Randomized Control Trial.

Background: Nearly, 75% of patients post-CABG complain of moderate to severe pain during their hospital stay. Nonpharmacological interventions have been investigated; however, the effect of Holy Quran recital post-CABG is still not well studied, especially in developing Islamic countries. Objective: To investigate the effect of listening to the Holy Quran recital on pain and length of stay post-CABG. Methods: This was a randomized control trial on 132 patients recruited from four hospitals in Amman, Jordan. The intervention group listened to the Holy Quran recited for 10 minutes twice daily while the control group received the usual care. Data were analyzed using paired and independent samples t-tests. Results: Paired t-test testing showed that there was a significant reduction in the pain level, (M [SD], 6.82 [2.27] vs. 4.65 [2.18], t = 23.65, p < 0.001) for the intervention group. In addition, the intervention group had shorter LoS in the ICU and in the hospital compared to the control group, (M [SD], 5.0 [4.02] vs. 6.58 [4.18], t = -2.1, p < 0.05), (M [SD], 10.15 [9.21] vs. 15.01 [13.14], t = -2.6, p < 0.05), respectively. Conclusions: Listening to the Quran was significantly effective in improving pain intensity among post-CABG patients and shortening their hospital/ICU stay. This trial is registered with NCT05419554.

The Effect of Patients' Acuity Level on Nurses Shift Assignment in Jordan: A Qualitative Approach.

BACKGROUND: Matching nursing shift assignment to patients' acuity scores may promote a more equitable and effective workload balance, increasing nurses' satisfaction, and improving quality of care (QoC). PURPOSE: This article explores nurses' perspectives about the nursing assignment process after implementing a project to promote an improved nursing assignment process in medical/surgical wards by using Perroca patient acuity tool (PAT). DESIGN: Qualitative approach was used with two focus group discussions including a total of 13 participants, selected by purposive sampling. RESULTS: Four main themes were generated from the data. The main study themes were: assignment based on acuity score, challenges and limitation, change journey and participants' suggestions, and recommendations for improving the assignment process. CONCLUSIONS: Implementing the tool will yield better nursing assignments; better nursing and patient outcomes and improve QoC.

Validation of the Arabic Version of the Brief Symptom Inventory to Measure Anxiety in Patients With Acute Myocardial Infarction.

BACKGROUND AND PURPOSE: Anxiety after acute myocardial infarction is well-known phenomenon. This study aimed to examine the psychometric properties of the Arabic version of the Brief Symptom Inventory to measure anxiety in this population. METHODS: This was a prospective observational study among 460 patients. Patients answered the Brief Symptom Inventory and the Hospital Anxiety and Depression Scale to measure anxiety. Complications and other clinical variables abstracted from medical records. RESULTS: Cronbach's α was .86, indicating adequate internal consistency. The item-total correlations and all interitem correlations were all acceptable. Anxiety was independent predictor for complication after acute myocardial infarction and higher in females supporting the construct validity. CONCLUSION: Arabic version of the Brief Symptom Inventory is a valid and reliable instrument to measure anxiety after acute myocardial infarction.

Matching Nursing Assignment to Patients' Acuity Level: The Road to Nurses' Satisfaction.

BACKGROUND AND PURPOSE: Nurses face many healthcare challenges, such as high turnover, workload, and unfair assignments, that lead to nurses' dissatisfaction. Linking nursing shift assignment to patients' acuity scores may increase the workload balance, achieving equitable nursing assignment and nurses' satisfaction. This article aimed to (a) describe the effectiveness of the Perroca patient acuity tool (PAT) by measuring nurses' satisfaction with workload and standard of care pre and post the acuity tool application, and (b) measure nurses' satisfaction about the implemented patients' acuity tool. METHODS: Quasi-experimental (one group pre- and postdesign) was used. Donabedian's structure-process-outcome (SPO) model was followed as a conceptual model to guide the implementation process of this study. A convenience sample of 64 nurses participated in the study. Two scales were used to measure nurses' satisfaction with workload and with standard of care. Perroca's scale was used to measure nurses' satisfaction about patient acuity level. RESULTS: Significant differences were found on nurse's total satisfaction level, satisfaction with workload, and satisfaction with standard of care between the two times, pre- and post-Perroca PAT application. The majority of nurses had positive impressions of the tool. CONCLUSION: This study concludes that linking PAT to nursing shift assignment has several positive outcomes. It increases nurses' satisfaction and serves as managers' voice for important staffing decisions like recruitment, assignment distribution, employing new staff, and improving quality of care.

Checking the moderating effect of perceived control on the relationship between anxiety and postoperative hospital length of stay among coronary artery bypass graft patients.

BACKGROUND: Coronary artery disease (CAD) is the most common cardiovascular disease (CVD). Coronary artery bypass graft (CABG) surgery is the most common treatment used for CAD. Patients undergoing this surgery are always anxious, which might increase complications in the postoperative period, especially prolongation of postoperative length of stay (LOS). It has been shown that perceived control (PC) moderated the relationship between anxiety and complications in a cardiac population, but its effect has not been studied in post-CABG. AIM: The aim of this study was to check if there is a moderating effect for the PC on the relationship between anxiety and LOS post-CABG. PATIENTS AND METHODS: A non-experimental, prospective, observational study was conducted with a consecutive sample of 250 patients who underwent elective CABG from four hospitals in Amman, Jordan. PC was measured by the Arabic version of the Control Attitude Scale-Revised (CAS-R), and anxiety was measured by the Arabic version of the anxiety subscale of Hospital Anxiety and Depression Scale. LOS and other needed information were obtained from patients' medical records. RESULTS: Preoperative anxiety was significantly higher than postoperative anxiety (mean [SD]: 12.80 [6.70] vs 11.01 [6.74], P<0.001). Female patients were more anxious and had longer LOS compared to male patients. In stepwise regression, anxiety and PC scores were independent predictors for LOS. Every unit increase in preoperative anxiety increased LOS by 0.381 days, and every unit increase in PC decreased the postoperative LOS by 0.210 days. Moderating effect was checked by simple slope analysis for high (+1 SD) and low (-1 SD) levels of PC. Patients with high anxiety and low PC had the longest LOS, and patients with low anxiety and high PC had the shortest LOS, indicating the moderating effect of PC on the relationship between anxiety and LOS. CONCLUSION: High levels of anxiety were associated with longer LOS after CABG. PC moderates this relationship. Enhancing PC in this population can improve outcomes and decrease LOS and morbidity.

Depressive Symptoms and Complications Early after Acute Myocardial Infarction: Gender Differences.

BACKGROUND: Cardiovascular disease is the first leading cause of death worldwide. Coronary heart disease is the most common manifestation of cardiovascular disease. Acute myocardial infarction is the primary manifestation of coronary heart disease. Depression is a common and predicted complication after acute myocardial infarction. Limited studies evaluated gender differences in depressive symptoms after acute myocardial infarction especially in developing countries. OBJECTIVE: The study aimed to determine whether there was a difference in depression levels and rate of complications based on gender early after acute myocardial infarction. METHOD: This was a prospective comparative study on 230 patients (150 men and 80 women) with a confirmed diagnosis of acute myocardial infarction. All participants signed an informed consent, filled sociodemographic and clinical questionnaire and the Depression Subscale of the Hospital Anxiety and Depression Scale. Clinical data were abstracted from the participants' medical record after discharge. RESULTS: Eighty-six participants (37.4%), 54 men and 32 women, developed 1 or more complications during hospitalization. Female patients were more depressed (14.4±3.5 vs. 8.3 ± 2.6) and developed more complications (1.9 ± 0.9 vs. 0.8 ± 0.5) than male patients did. Depressive symptoms increased the occurrence of complication by 40% and 33% for female and male patients respectively after controlling for sociodemographic and clinical variables. CONCLUSION: Depressive symptoms independently predicted complications after acute myocardial infarction in both men and women. The inclusion of depression assessment tools in acute myocardial infarction treatment protocols is highly recommended.

Maturity Level of the Stigma Concept Associated with Cancer Diagnosis in the Nursing Literature

Objective: This study aimed to evaluate the maturity level of stigma as a concept in nursing and its relationship to care provided for patients with cancer. Methods: The four principles of Morse and his colleagues were used to evaluate the maturity level of the stigma concept: epistemological, logical, pragmaticl, and linguistic. Analysis was conducted with the literature published between 2006 and 2016. Results: The findings of this study suggest that the concept of stigma in nursing is immature, defined inconsistently, and measured with different instruments. How stigma is defined can influence nurses in their assessment of patients with cancer and identification of their needs. Conclusion: Although extensive studies have been conducted in the field of mental illness, it is only recently that the effect of stigma on treatment of cancer patients has attracted attention. Thus, substantial work yet needs to be done to understand the breadth and scope of stigma impacting on individuals with cancer.

Nurses' Experiences of Grief Following Patient Death: A Qualitative Approach.

PURPOSE: To explore the lived experiences of nurses' feelings, emotions, grief reactions, and coping mechanisms following their patients' death. BACKGROUND: On a daily basis, nurses are experiencing patients' death, which exposes them to grief. Nurses' grief has not been sufficiently addressed in practice settings, although it has been a well-known threat to health and work performance. DESIGN: A qualitative design guided by a phenomenological approach was adopted. METHOD: Data were collected from a purposive sample of 21 Jordanian nurses by conducting three focus groups and analyzed using Colaizzi's framework. FINDINGS: Four themes were generated in which participants reported feelings of grief following their patients' death. Their grief emotions were reported as sadness, crying, anger, shock, denial, faith, fear, guilt, fear of the family's reaction, and powerlessness. CONCLUSIONS: The study provided evidence that nurses respond emotionally to patients' death and experience grief. Nurses are burdened by recurrent patients' deaths and try to cope and overcome their grief. This study emphasizes the importance of developing strategies to help nurses positively cope with their grief from a holistic perspective. This will reflect positively on the nurses' performance.