Genomic Literacy among Nurses in Jordan: A Population-based Study.

The current study aimed to measure genomic literacy among Jordanian nurses by evaluating their understanding of key genomic concepts and how they view genomics in nursing practice. Descriptive, Cross-sectional, and Correlational designs were used in this study. A descriptive design was used using the Genomic Nursing Concept Inventory (GNCI©), a 31-item instrument. Data were collected from a total of 751 participants. A total of 406 participants were female, and 395 (52.6%) were single. The mean score of the genome basics was 2.33, ranging from 0 to 13. The mean score of the knowledge about mutation was 0.57, ranging from 0 to 3. At the same time, the mean score for inheritance and genomic healthcare was 1.74 and 1.53, respectively. Nurses working in the oncology center had the highest genomic knowledge score (mean = 7.05, SD = 4.24) compared with nurses in other healthcare sectors (p = < .001). There is a low level of genomic literacy among Jordanian nurses. Nurses must have sufficient genomic literacy to provide the best nursing care to patients, their families, and the community. Jordanian nurse authorities must develop competencies representing a minimum standard of care to provide competent genomic and genetically focused care.

Barriers to implementing palliative care in intensive care units: perceptions of physicians and nurses in Jordan.

BACKGROUND: Palliative care (PC) aims to relieve a person's suffering and provide the best possible quality of life (QoL) to people with chronic illnesses. Despite the significant impact of PC services on the QoL of patients, barriers exist that prevent healthcare providers from facilitating PC in intensive care units (ICUs). AIM: The purpose of this study was to explore the perceived barriers to implementing PC in ICUs. METHODS: A qualitative approach was used to conduct 17 semi-structured interviews with clinicians across two ICUs (urban and suburban) in Jordan. Thematic analysis was used for the transcribed interviews. RESULTS: Five main themes emerged: the ICU is a demanding and complex care environment; lack of preparation to implement PC; PC is a nicety, not a necessity; healthcare system-related barriers; and lack of cultural acceptance of PC. Lack of knowledge and training was identified as a major barrier for the effective implementation of PC by both physicians and nurses. CONCLUSION: Equipping healthcare providers with the knowledge and expertise to provide PC is essential to dispel myths related to PC and facilitate PC provision. Developing an interdisciplinary care team will support the effective implementation of PC services in any setting. Establishing national PC policies will foster the ethical and legal practice of PC in Jordan.

The impact of a standard pain assessment protocol on pain levels and consumption of analgesia among postoperative orthopaedic patients.

BACKGROUND: Pain is a leading concern in post-surgical orthopaedic settings; andeffective pain assessment tools are important aspects of pain management. OBJECTIVE: This study assessed the effect of using standard pain assessment protocols (SPAP) on pain levels, pain management, and analgesia consumption among patients in the first 24 h following orthopaedic surgery. METHODS: In total, 101 patients were recruited and assigned to the comparison group (n = 50) and experimental group (n = 51). SPAP was used in the experimental group while the comparison group received routine care. Pain levels at rest and during movement and analgesic consumption were compared between the two groups. FINDINGS: There were significant differences in pain levels between the comparison and experimental groups. The experimental group consumed significantly less pain medication at 8-11 h of opioid medications and 12-15 h of non-opioid medications (P < .001). The use of non-pharmacological modalities was significantly higher in the experimental group compared to the comparison group (P < .001). CONCLUSIONS: Regular pain assessment and management using SPAP can promote pain management and reduce pain levels as well as reduce analgesia administration and promote the use of non-pharmacologic approaches. These outcomes can result in fewer side effects for patients. IMPLICATIONS: The findings suggest that using SPAP can result in improved outcomes as well as the use of non-pharmacologic approaches to pain management. This approach can result in better outcomes and increased communication between the nurse and the patient.

Impact of Structured Nurse Leader Rounds on Satisfaction With Nursing Care Among Patients With Cancer.

BACKGROUND: The patient satisfaction rate is considered a challenge for nurse leaders, especially among patients with cancer, due to the complexity of the disease, diagnostic procedures, and treatment. AIM: The purpose of this study was to evaluate the impact of structured nurse leader rounds (NLRs) on satisfaction with nursing care among patients with cancer. Moreover, we assessed the relationship among NLRs, patient satisfaction, and demographical variables. METHODS: A two-group posttest design was used in four adult inpatient oncology units in a specialized oncology center. A stratified random sampling technique was utilized to select 169 patients for the experimental group (80 patients) and control group (89 patients). Structured leader rounds were conducted by nurse leaders using a scripted nurse leader tool to standardize the rounds in the experimental group, while the unstructured leader round was conducted in the control group. Patient satisfaction was measured using the Patient Satisfaction with Nursing Care Quality Questionnaire. RESULTS: The findings revealed that there was a significant difference in total score of patients' satisfaction between study groups (t = -9.213, p > .001). Conversely, the structured leader round has a significant impact on the patient's experience with nurse concern and caring (t = -2.054, p = .042). CONCLUSIONS: Adoption of a structured NLR has a significant impact on improving patient satisfaction in an oncology setting where patients receive care from many disciplines, such as surgical, medical, radiotherapy, and radiology. CLINICAL RELEVANCE: Efficient structured NLRs of nursing professionals are important for enhancing the quality of nursing care and patient satisfaction.

Relationship between Vitamin D Deficiency, Diabetes, and Obesity.

AIM: This study aimed to assess the prevalence of VDD in Saudi Arabia, revealing the lifestyle and nutritional habits; and assesses the association between VDD, Diabetes Mellitus, and obesity. METHODS: A descriptive, cross-sectional, and correlational design was used in this study. A convenience sampling method of 350 participants participated in the study. RESULTS: The results revealed that the probability of having vitamin D Deficiency was higher among females (OR = 2.06, p > .05); younger age-whereby with each one year decrease in age there was about 0.03 probability of having Vitamin D Deficiency (B = -0.03; p > .05); individuals with higher incomes (OR = 1.44, p > .05); smokers (OR = 0.08, p > .05); and a lack of exposure to the sun (OR = 8.50; p > .05). In addition, exercise is also a predictor of Vitamin D deficiency (OR = 3.8; p > .05). Moreover, less Vitamin D intake (OR 9.7; p > .05), less intake of Calcium (OR = 12.2, p > .05); In addition increase one unit in the BMI, cholesterol, LDL, HDL, and FBS increased the log odd of having liability of Vitamin D deficiency by 3.2; 1.9, 1.8, 1.0, and 2.4 (p > .05). CONCLUSION: Vitamin D Deficiency was prevalent in both males and females across different age groups in the citizens of Saudi. Because of the connection between Vitamin D Deficiency and main chronic disease, it is necessary to emphasize the need to recognize Vitamin D Deficiency screening for risk factors. It may be reasonable for the nutritionists, nurses, and physicians, to encourage the community on approaches to enhance dietary Vitamin D or suggest supplementation.

Impact of Obesity on Clinicopathologic Characteristics and Disease Prognosis in Pre- and Postmenopausal Breast Cancer Patients: A Retrospective Institutional Study.

Purpose: To investigate the association between obesity and breast cancer clinicopathologic characteristics at presentation along with prognostic impact among Jordanian breast cancer patients. Such data are lacking in Arabian countries. Methods: In this retrospective study, 348 breast cancer patients were included. Analyses were conducted for associations between body mass index (BMI) and age at diagnosis, tumor clinicopathologic characteristics, and molecular subtypes. Eight prognostic factors were considered, and total prognostic scores were calculated. The analysis was stratified by menopausal status. Multivariate logistic stepwise regression analysis was conducted to identify predictors for breast cancer recurrence and death. Results: Mean age at diagnosis was 50.98 ± 10.96 years. Mean BMI at diagnosis was 29.52 ± 5.32 kg/m2. Mean age at diagnosis was significantly higher for overweight and obese patients compared to underweight/normal patients (P < 0.001). A significant positive correlation was observed between patient age and BMI at diagnosis (r = 0.251, P < 0.001). Grade of carcinoma was significantly correlated with BMI in the whole population examined (P=0.003). Obese breast cancer patients had significantly higher prognostic scores compared to nonobese cases, indicating worse prognostic features at presentation (P=0.034). Stratification of data analysis based on menopausal status revealed significant associations between obesity and each of tumor stage and grade among postmenopausal but not premenopausal patients (P=0.019 and P=0.031, respectively). Similarly, postmenopausal obese patients had significantly higher prognostic scores compared to nonobese counterparts (P=0.007), indicating worse prognosis, a finding which was also absent among premenopausal breast cancer patients. No significant association between BMI with expression status of hormone receptors, HER2, lymphovascular invasion, and molecular subtypes was found among patients. BMI was a significant predictor for disease recurrence in which obese breast cancer patients had greater odds (2-fold) to develop locoregional and distant recurrence compared to nonobese cases (P=0.011). Conclusions: Obesity was associated with advanced stage and grade of breast carcinoma at diagnosis. The impact of BMI on clinicopathologic characteristics and prognosis was confined to postmenopausal cases. Jordanian obese breast cancer patients are at greater risk of breast cancer recurrence and reduced survival compared to their nonobese counterparts.

The effect of short message system (SMS) reminder on adherence to a healthy diet, medication, and cessation of smoking among adult patients with cardiovascular diseases.

BACKGROUND: Cardiovascular Disease is the leading cause of death worldwide. Non-adherence to a recommended regimen among patients with Cardiovascular Diseases represents a significant problem which could lead to an increase in Cardiovascular Diseases. PURPOSE: This study aimed to assess the effects of Short Message System (SMS) reminders on adherence to a healthy diet, medication, and cessation of smoking among adult patients with Cardiovascular Diseases. METHODS: Randomized controlled trial design with three groups was used for this study. A non-probability convenient sample of 160 patients was recruited in this study. The participants were assigned randomly to an experimental group (received SMS regarding adherence to a healthy diet, medication, and smoking cessation), placebo group (received general messages) and control group (routine care). Morisky 8-Item Medication Adherence Scale (MMAS), Mediterranean Diet Adherence Screener (MEDAS), and Readiness to Quit Ladder, were used to assess patients' adherence to medication, adherence to Mediterranean diet, and smoking cessation, respectively. The outcomes were assessed at the beginning of the study and three months later, following completion of the intervention. RESULT: One way ANONVA was used to assess the study hypothesis. Significant differences between study groups found in terms of adherence to medication (p=.001) and adherence to a healthy diet (p=.000); however, no significant difference was found between groups, in terms of intention to quit smoking, and/or the number of cigarettes smoked (p= .327), (p=.34), respectively. CONCLUSION: It is documented that SMS is effective in improving adherence to a healthy diet and medication. SMS could be a promising solution for management of different chronic diseases. IMPLICATION OF THE STUDY: It is recommended to apply Short Message System (SMS) via cellphone services to improve patient's adherence to a healthy diet and medication. However, further research is needed to support the effectiveness of SMS.

The Effectiveness of Hologram Bracelets in Reducing Chemotherapy-Induced Nausea and Vomiting Among Adult Patients With Cancer.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) affects cancer patients' quality of life, despite the provision of antiemetic medication. OBJECTIVES: The aim of this study is to assess the clinical effectiveness of the hologram bracelet in the management of CINV among adult patients with cancer. METHODS: An experimental, double-blinded design spanning 3 courses of chemotherapy was used; 175 oncology patients were randomly assigned to 3 groups: placebo (n = 53), control (n = 54), and intervention (hologram bracelet) (n = 68). Daily diaries were used to detect the severity and the frequency of CINV and to detect the frequency of using antiemetic medications. The Functioning Living Index-Emesis was used to examine the impact of CINV on the activities of daily living. RESULTS: Significant CINV differences existed between groups. The mean total Functioning Living Index-Emesis score was significantly lower in the intervention group for total vomiting and total nausea. CONCLUSION: Hologram bracelet use among patients with cancer had a positive effect on CINV. The level of CINV decreased and activity of daily living scores increased. However, effects varied among the types of CINV. IMPLICATIONS FOR PRACTICE: Further study is recommended to explore the benefits of the bracelet.

Media use for seeking health/cancer-related information: findings from knowledge, attitudes and practices towards cancer prevention and care survey in Jordan.

Understanding of public health/cancer information-seeking behaviour could play key role in promoting health behaviour and reducing cancer burden. In the current study, data from 'Knowledge, Attitudes and Practices toward Cancer Prevention and Care Survey in Jordan' were used. A total of 3196 participants (18 years and older) were included in the study. The results indicated that 82% (n = 2609) of the participants had never looked for health/cancer information from any sources. The majority of those surveyed (97%) reported watching TV habitually, whereby 948 participants (26%) indicated that they watched health information on the local/satellite TV channels, whereas 1603 (45%) reported doing so on non-local/satellite TV channels. Internet was the most searched source for information (36%); however, it is one of least preferred sources. Health-care providers are the most preferred source for cancer-related information, followed by TV and someone with cancer. The majority of participants (82%; n = 489) indicated the absence of barriers in seeking information about cancer. The results suggest that although the Jordanian public use of different media and channels for seeking health/cancer-related information, health-care providers and TV might be effective tools for health education. In addition, joint efforts must be established to initiate awareness programmes at the local and regional levels.

Complementary alternative medicine use among a sample of Muslim Jordanian oncology patients.

PURPOSE: The purpose of this study was to assess the frequency of use of Complementary and Alternative Medicine (CAM) therapies among a sample of Muslim Jordanian patients diagnosed with cancer. METHOD: Interviews using a modified structured questionnaire from Lengacher et al. survey with a convenient sample of 123 patients diagnosed with cancer. RESULT: Of 123 participants, 54.5% were men, with a mean age of 44.5 years (26.8%) had some college education and 82.9% were living in urban areas. The mean number of the therapies used was 6.6 (SD = 4.3, R = 0-17). There was a significant positive moderate correlation between the time since diagnosis and the number of CAM therapies used (r = 0.3, P < 0.05). There was a positive correlation between chemotherapy as a treatment modality and the number of CAM therapies used (r = 0.4, P < 0.05). The highest usage of dietary and nutritional supplements occurred with honey, olive oil, black seeds, and dates. The highest stress reducing CAM techniques included reading the Holy Qur'ãn, praying, and Ruqya. Other CAM treatments involved ZamZam water, cinnamon, black seeds oil, and the use of a plant called Zaamtoot (primrose). CONCLUSION: Even though a range of CAM therapies are used by Jordanian oncology patients it is suggested that both patients and medical staff be educated about the possible benefits or harmful effects of using these treatments.

The practice of withholding and withdrawing life-support measures among patients with cancer in Jordan.

In Jordan, an Arabic Islamic country, decisions around withholding and/or withdrawing life support measures still present both moral and professional dilemmas. The purpose of this study was to explore the use of such measures among patients with cancer in Jordan. The medical records of 436 patients with cancer who were at least 18 years old and who died at a specialized cancer centre in Jordan in 2008 were reviewed retrospectively. Of those, 212 (48.6%) had a written decision to withhold or withdraw life support measures. Among the 436 charts reviewed, only 7 patients (1.6%) had treatment withdrawn, while 212 (48.6%) had treatment withheld. Resuscitation was the most common treatment withheld, followed by medication, and poor prognosis was the most common reason for the decision. The time period between a decision being made and the death of the patient was short, indicating that treatment plans are not being made well in advance. A cultural and religious consensus regarding such decisions is needed to help ensure that a greater proportion of terminally ill people plan their care in advance, and to aid health-care providers in advising their patients and acting in the patients' best interests.

Cancer as a problem to be solved: internet use and provider communication by men with cancer.

Increasingly, cancer-related Web sites have been developed to provide information for patients. More needs to be done to understand the experience of men with cancer using the Internet. Heideggerian hermeneutics is the interpretive approach used to guide this study. Fifteen men with cancer who used the Internet were recruited through a prostate cancer support group and snowball sampling. Participants were individually interviewed and asked to tell stories of Internet use and practices. Transcribed interviews provided data for interpretive analysis. The overall constitutive pattern describing the men's experience is "cancer diagnosis as a problem to be solved." Five related themes included (1) seeking disease and treatments information from the Internet for decision making, to become comfortable with treatment plan; (2) organizing information to facilitate provider encounters and to monitor for reoccurrence; (3) evaluating Web information by credibility and usability with trust in the physician influencing the end decision point; (4) symptom management by knowing possibilities by hearing patient stories; and (5) navigating through the healthcare system politics and power. Men with cancer are incorporating Internet use into their cancer journey. They perceive changing provider-patient relationships when they participate in treatment decisions and monitor for reoccurrence.

Jordanian patients' and caregivers' use of the internet for seeking health information.

The objective of this pilot study was to evaluate Internet use among Jordanian patients and caregivers. The study included a convenience sample of patients with different health problems and diseases and caregivers. A survey modified from a study by Dickerson et al was used. A total of 78 patients and caregivers participated (37 patients and 41 caregivers), and 56.4% of the respondents were Internet users. Among Internet users, the Internet accounted for only 4.6% of their sources of health information, while physicians accounted for 11.3% and 17.6% among users and nonusers, respectively. Twenty-five of the participants (32.0%) reported high dependence on the media to obtain health information. Among all participants, a surprising percentage (37.2%) did not seek health information from any sources. The results of the survey provide insight into the need to study information-seeking behavior in general before studying specific technology to seek health information.

Healthcare needs of noninstitutionalized Jordanian cancer patients: an exploratory descriptive study.

Despite all advances in healthcare, provision of healthcare for cancer patients remains one of major continuing challenges for healthcare professionals. One of these challenges is shorter hospital stay. In this fast-paced environment, identification of cancer patients' needs is limited yet necessary to initiate an appropriate treatment plan for this group of patients. The major purpose of this study was to identify healthcare needs of noninstitutionalized patients with cancer from Arab Jordanians' perspective. The study was conducted at a chemotherapy clinic of a major university hospital in Jordan. An exploratory descriptive design using a structured interview was used to collect the data. The questions of the interview composed of items of several scales including the Patient Need Scale. Sixty-two participants met the inclusion criteria and agreed to participate. The participants were patients with cancer, were receiving chemotherapy, and were (a) Jordanian male or female patients, (b) able to communicate in Arabic, (c) 19 years of age or older, and (d) free from psychiatric or mental illnesses. Participants reported 70 existing needs (68.6%). However, 50% of these identified needs were perceived as being not met. Jordanian patients with cancer reported more healthcare needs than patients in Western cultures. Individualized comprehensive assessment of patients' needs from their perspective is essential to initiate an effective treatment plan.

Jordanian nurses' knowledge and practice of breast self-examination.

AIM: This paper is a report of a study to evaluate the knowledge and practice of Jordanian nurses in relation to breast self-examination. BACKGROUND: Studies have shown that women who have learned about breast self-examination have positive attitudes toward breast cancer and practise breast self-examination more frequently, and that nurses who teach their clients about methods of early detection and breast self-examination are more knowledgeable about breast cancer screening and breast self-examination techniques than those who do not. Therefore, it is important to understand nurses' knowledge about breast cancer and its early detection. METHODS: A cross-sectional design was used, with a convenience sample of 347 Registered Nurses at three large cities in Jordan (response rate 95%). Data collection took place in 2005 using a self-administrated questionnaire with three parts and based on the American Cancer Society's guidelines: demographics, knowledge, and practice of breast self-examination. RESULTS: Nurses reported high levels of knowledge of breast self-examination (M = 7.6, SD. 2.7). A high proportion of nurses reported doing breast self-examination in the past 12 months (85%), but only 17.7% reported doing so on a monthly basis. None of the demographic characteristics was found to be associated with the practice of breast self-examination. CONCLUSION: More health education about monthly breast self-examination and prevention strategies is needed for nurses and their women patients, especially for Arabic women.