Nurses' Attitudes Concerning Analgesia Administration for Pediatric Patients with Sickle Cell Disease in Jordan: A Cross-Sectional Study.

BACKGROUND: Pain management of vaso-occlusive crises is a fundamental priority in the lifelong care of children and adolescents with sickle cell disease. AIM: This study examined nurses' attitudes towards caring for children with sickle cell disease (SCD) and SCD pain management in those with vaso-occlusive pain. METHOD: A structured, self-reporting survey was provided to a convenience sample of 298 nurses across 10 hospitals serving Jordan's northern and middle regions. Descriptive and inferential statistics were applied for data analysis. RESULTS: Most nurses (77%) perceived their experience caring for children with SCD as positive. Many nurses (65%) felt frustrated about caring for these children during painful episodes. Participants identified workload and inadequate time as limiting their ability to address the analgesic needs of children with SCD. Receiving structured education specialized in pain management and more years of experience in nursing significantly predicted less hesitancy in administering opioid-based analgesia. CONCLUSIONS: The results of this study provided further insight into factors that potentially contribute to vaso-occlusive pain crises frequently being poorly managed and inadequately addressed among pediatric patients. Nurses' attitudes and understanding of SCD pain management must be addressed to advance the clinical practice of managing pain in children with SCD.

Nurses' beliefs and perceptions regarding family-centered care services in acute pediatric healthcare settings.

OBJECTIVES: To describe pediatrics nurses' beliefs about family-centered services (FCS) as a model of providing healthcare to children in acute care settings in Jordan. DESIGN AND METHODS: This is a cross-sectional descriptive study. Nurses who provide direct acute care to children (n = 246) completed the 'Measure of Beliefs about Participation in Family-Centered Service' questionnaire. Descriptive statistics were used to describe nurses' beliefs about participation, practical feasibility, implementation self-efficacy, principles, and potential adverse outcomes of FCS. RESULTS: Many nurses feel confident (70%) about their ability to work with others in providing FCS and perceive having the ability to operate according to family-centered care (FCC) principles (68%). Many (75%) nurses believed parents should be encouraged to decide how much they want to be involved in the child's care. However, only 46% of the nurses valued attending to family priorities if the health decisions made by the family differed from the healthcare providers' priorities. Many nurses (70%) believed that healthcare professionals' competencies and capacities to work utilizing FCC are more important than their personal preferences and opinion. CONCLUSIONS: The findings of this study clearly indicate that nurses positively viewed providing children's care within a FCS. This supports the efforts to reasonably integrate FCC as an operating model in the pediatric healthcare settings in Jordan. PRACTICE IMPLICATIONS: FCS is a complex task requiring integrating multidisciplinary effort and healthcare providers' positive attitudes toward families as care partners. Steps should help maximize the organizational resources to facilitate family presence and create opportunities for professional-families partnerships for children's care.

Communicating prognostic information and hope to families of dying patients in intensive care units: A descriptive qualitative study.

AIMS AND OBJECTIVES: To understand how prognostic information is communicated by Jordanian doctors and nurses to the families of dying patients in intensive care units, with an emphasis on exploring how hope and truth telling about patients' poor prognosis are managed. BACKGROUND: Improving end-of-life care requires a focus on adequate family-professionals prognostic communication, while maintaining a realistic level of hope and family support. DESIGN: A descriptive qualitative approach was applied. METHODS: Semi-structured interviews were conducted with 20 nurses and 15 resident doctors caring for dying patients. Bardin's procedure of categorical content analysis was applied. The COREQ checklist for reporting qualitative studies was followed. RESULTS: Two main categories emerged from the data of this study: 'perspectives on optimistic hope' and 'approaches to prognostic communication'. Health professionals experience extreme difficulty, and therefore, frequently avoid openly disclosing information about patients' poor prognosis to the families. Consequently, the health professionals adopted various methods to balance truth telling against sustaining hope among the patients' families. Providing false assurance was perceived as permissible and understandable, in order to nurture the families' hope. CONCLUSIONS: Improving end-of-life care in intensive care units in Jordan requires a focus on family-professional communication. Jordanian intensive care doctors and nurses perceived honest family-professional communication regarding dying patients to be extremely challenging. Healthcare professionals should develop their competency of meeting the informational and emotional needs of patients in ICUs and their families, while also honouring their cultural values, during prognostic communication. RELEVANCE TO CLINICAL PRACTICE: Effective training of healthcare professionals is vital on ways to enhance communication of prognostic information and to foster realistic hope among families of dying patients in intensive care units. There is a need to also explore the families' perspectives on prognostic communication in order to understand the similarities and differences between the professionals' and families' perspectives.

Nurses' Perceptions and Attitudes toward Family-Centered Care in Acute Pediatric Care Settings in Jordan.

PURPOSE: Perceptions and attitudes toward working with parents may influence nurses' family-centered clinical care practices. There is a paucity of research measuring family-centered care among nurses working with children and their parents in Jordan. The purpose of this study was to explore nurses' perceptions of family-centered care by examining nurses' attitudes toward working with children and their parents, as well as toward family-centeredness. Also investigated was the extent to which the selected demographic characteristics of nurses explain the discrepancies between their child- and parent-focused attitudes. DESIGN AND METHODS: Using a cross-sectional descriptive study, 246 nurses completed the 'Working with families' questionnaire. A paired t-test used to compare the working with children versus working with parents' attitude scores, and independent t-test and ANOVA to explore the influence of nurses' demographic characteristics attitude scores. RESULTS: The nurses scored higher for working with children than with parents, suggesting more positive attitudes toward the former than the latter (p < 0.001). The family-centeredness scores varied with nurses' years of clinical experience (p < 0.001) and years of employment (p < 0.005). CONCLUSIONS: The applicability of the family-centered care model in Jordan's hospitals is challenged by the fact that pediatric nurses register more positive attitudes for working with children than with parents. PRACTICE IMPLICATIONS: Nurses' attitude toward working with children's families requires more evaluation prior to implementing family-centered care in practice. Further research is needed to explore factors contributing to discrepancies between child- and parent-focused attitudes among nurses.

End-of-life Decisions at Neonatal Intensive Care Units: Jordanian Nurses Attitudes and Viewpoints of Who, When, and How.

PURPOSE: To explore factors predicting neonatal nurses' attitude towards end-of-life decisions in neonates, and to describe the nurses' viewpoints on end-of-life decisions; barriers to end-of-life decision making; parents', nurses', and ethical committees' involvement in the process of end-of-life decision making; and who should regulate end-of-life decisions regarding neonates. DESIGN AND METHODS: A cross-sectional descriptive correlational design was applied. Sample included 279 neonatal nurses working in 24 neonatal intensive care units across Jordan. Data were collected using internationally-accepted questionnaires. Descriptive and inferential statistics were applied in data analysis. RESULTS: Most nurses perceived that everything possible should be done to ensure a neonate's survival, even when they suffer severe prognosis (80%) and irrespective of the burden of the child's disability on the family (75%). Almost all nurses (96%) were against administering drugs with the purpose of ending the neonate's life and 63% were against continuing current treatment without adding others. The nurses' perceived effect of end-of-life decisions on their everyday life, and the importance of religious values to the nurses' personal lives, significantly predicted pro-life attitude scores. According to 80% of the nurses, legal constraints were the most significant barriers to end-of-life decision making. The majority of nurses (84%) indicated that non-religious bodies should establish end-of-life regulations for neonates. CONCLUSION: Generally, nurses' attitude was supportive of life saving decisions at end-of-life, regardless of the survival odds and the probable health outcomes of the neonates. PRACTICE IMPLICATIONS: Neonates' end-of-life care, and parents' bereavement care, should be standard practices in every NICU, worldwide.

Predictors of breakfast skipping among 14 to 16 years old adolescents in Jordan: The influential role of mothers.

AIM: To assess the prevalence and identify the predictors of breakfast skipping among 14- to 16-year-old adolescents in Jordan, focusing on mother-related variables. BACKGROUND: Breakfast is an essential meal across one's entire lifespan and especially important during the adolescent years. The practice of skipping breakfast has become so prevalent among adolescents that it is now a well-documented nutritional problem. DESIGN: A descriptive cross-sectional correlational design. METHODS: A proportional cluster stratified sampling protocol was used to select 1896 adolescents and their mothers (1013) during the period of March to June 2016. A self-reported questionnaire was used to collect data on breakfast-skipping rates, the perceived reasons for this behavior, the perceived importance of consuming breakfast, and maternal encouragement of breakfast consumption. RESULTS: The prevalence of breakfast skipping was 34.3% among adolescents and 21.5% among their mothers. A significant association was found between breakfast skipping among adolescents and their mothers (χ2 [1, n = 998] = 37.90, P = .001). Maternal encouragement of breakfast consumption, gender, and adolescent perception of the importance of this meal were found to be significant predictors of adolescent breakfast skipping. CONCLUSION: The findings highlight the importance of involving mothers in developing nutritional health plans aimed at promoting regular breakfast consumption among adolescents.

Maternal Sociodemographic Characteristics and Behaviors as Correlates of Preadolescent's Breakfast Habits.

PURPOSE: To explore factors affecting skipping breakfast rate, and to identify its perceived reasons among preadolescent students and their mothers in Jordan. DESIGN AND METHODS: Using cluster stratified sampling, preadolescent (10-11years) students (N=1915) and their mothers (N=1299) from 26 public and private schools completed a self-reported questionnaire. Breakfast skipping and its related habits were described. Children's and mothers' perceptions of regular breakfast eating and sociodemographic factors were analyzed in relation to breakfast skipping in children. RESULTS: Although the majority of both children and mothers perceived breakfast as very important, 23% of the children and mothers reported skipping breakfast. Male students skipped breakfast more than female students. Students whose mothers had a low level of education and students with a low value of breakfast consumption had a higher likelihood of skipping breakfast. Mothers' high value of breakfast and encouragement of children to eat breakfast were directly related to an increase in children's perceived importance of breakfast consumption. Preadolescents' and mothers' perceptions of the importance of breakfast and mothers' encouragement to eat breakfast were significant predictors of breakfast consumption among students. CONCLUSION: The high prevalence of breakfast skipping among students, and knowledge about association between mothers' perceived importance of breakfast consumption and encouragement highlighted the pivotal role of mothers in preadolescent's breakfast consumption. PRACTICAL IMPLICATIONS: The findings suggest that health care providers, including school health practitioners, are recommended to assess children's and mothers' perceived value of breakfast and to include mothers in health promotion interventions on breakfast consumption.

The Association Between Maternal Factors and Preadolescent Breakfast Skipping: The Mediating Role of Preadolescent Attitudes Toward Breakfast.

BACKGROUND: Although skipping breakfast is common among children and adolescents, daily breakfast consumption is a healthy habit that is particularly important in childhood. There is a link between children's attitudes toward breakfast, breakfast-skipping behaviors, and maternal factors. Evidence demonstrating a clear relationship between maternal factors and preadolescent attitudes and behaviors toward breakfast skipping is scarce. AIMS: This study aims to examine the mediation effect of preadolescent attitudes toward breakfast on the associations between maternal involvement (encouragement and control of breakfast eating) and preadolescent breakfast skipping. METHODS: A cross-sectional descriptive study was conducted across Jordan in public and private primary schools in 2015. A sample of 1,915 preadolescent students (10-11 years) and their mothers (N = 1,299) was generated through proportional cluster stratification sampling. The interrelationships were examined among the participants' demographics, the number of preadolescent skipped breakfasts during a given week, self-reported attitudes toward breakfast, and perceived maternal encouragement and control of breakfast-eating variables. RESULTS: Analysis revealed that preadolescent attitudes toward breakfast and mothers' involvement in preadolescent breakfast were negatively correlated with preadolescent breakfast skipping. Linear regressions revealed that maternal involvement (i.e., encouragement and control of breakfast eating, and educational attainment levels) was predictive of preadolescent attitudes toward breakfast consumption. Multiple regressions using bootstrapping analysis showed that preadolescent attitudes partially mediated the effect of mothers' control and encouragement of breakfast consumption over preadolescent breakfast-skipping behavior. LINKING EVIDENCE TO ACTION: Results suggest that preadolescent attitudes, maternal encouragement, and control of breakfast eating influenced preadolescent breakfast skipping. These findings emphasize the importance of carefully assessing preadolescent attitudes toward breakfast, maternal encouragement, and control of breakfast consumption when developing interventions aimed at reducing breakfast-skipping behavior.

Displaced Syrian children's reported physical and mental wellbeing.

BACKGROUND: Surviving a warzone inflicts harmful consequences on the physical health and the psychosocial wellbeing of children. This study aimed at exploring the physical and psychosocial perceived state of health of displaced Syrian refugee children in Jordan. METHODS: A cross-sectional explorative design was applied. Structured questionnaires were used to collect data through face-to-face interviews with 250 Syrian refugee children. Descriptive and inferential statistics were used. RESULTS: Children had fair levels of physical health; their health concerns were minor. Psychosocially, 25% (n = 63) suffered from loneliness and 24% (n = 59) reported feeling depressed. The majority of children (>60%) had low rates of somatic pain. Age had a negative correlation with hyperactivity (r = -.14, p = .034); gender differences were found in anger expression and anger trait (p < .05). CONCLUSIONS: The results in this study highlight a number of physical and psychosocial health concerns among refugee children. The health needs of displaced Syrian children need to be addressed using comprehensive assessment and care. Our findings documented the physical and psychosocial health needs of the displaced Syrian children in Jordan and addressed areas of focus to guide health promotion interventions and community health efforts for them.

Status of Neonatal Pain Assessment and Management in Jordan.

Current pain assessment and management in neonates need to be fully described before neonatal pain care can be optimized. This study's purpose was to report neonatal nurses' knowledge, existing pain assessment practice, and pharmacological pain management of neonates in Jordan. A cross-sectional descriptive study was conducted. Eighteen neonatal intensive care units in Jordan were included in the study. One hundred eighty-four neonatal nurses participated. Questionnaires were distributed by and returned to the neonatal intensive care units' managers between June and August 2014. Descriptive and inferential statistics were used to present study results. Of 240 questionnaires distributed, 184 useable responses were returned. Nurses' knowledge regarding neonates' neurological development, nociception, and need for neonatal pain management was suboptimal. The analgesics most commonly used to treat neonatal pain were acetaminophen (52%) and lidocaine (45%). Benzodiazepines, phenobarbitone, and muscles relaxants were also used. Most nurses (54%-97%) reported that pain emanating from most painful procedures was never or rarely treated. Circumcision, lumbar punctures, and chest tube insertion were assigned the highest pain scores (≥9), but were rarely accompanied by analgesia. Pain assessment scales were more likely to be used, and procedural pain was more likely to be treated, in private hospitals than public hospitals. Neonates who require special care still suffer unnecessary pain that could be avoided and managed by following best practice recommendations. Disparities between developed and developing countries in quality of neonatal pain care appear to exist. Resources for education and routine care are needed to address these discrepancies.

Symptom Clusters and Their Impact on Spiritual Well-Being Among Women with Breast Cancer.

Purpose: To explore symptom experience and symptom clusters among Jordanian women with breast cancer and investigate whether these clusters predict patients' spiritual well-being. Patients and Methods: A sample of 142 Jordanian women with breast cancer were asked to complete the Memorial Symptom Assessment Scale (MSAS), Functional Assessment of Chronic Illness Therapy- Spiritual Well-being (FACIT-Sp) scale, and socio-demographic questionnaire. Exploratory factor analysis was used to group symptoms into clusters, and multiple linear regression was used to explore the symptom clusters that predict spiritual well-being. Results: The most prevalent symptoms among women with breast cancer were fatigue, anxiety, tension, and pain. All these symptoms have a prevalence greater than 50%. Three clusters were found: treatment-related symptom cluster consisting of eight symptoms, gastrointestinal symptom cluster consisting of seven symptoms, and psychological symptom cluster consisting of five symptoms. The psychological symptom cluster was the only cluster predicting the women's spiritual well-being (t (141) = -3.049; p < 0.01). Conclusion: Women with breast cancer experience several concurrent symptoms and symptom clusters. Screening for psychological symptom clusters and their treatment improves patients' spiritual well-being. The majority of women with breast cancer did not receive any complementary therapies and hardly any spiritual or psychological support, which should be provided in the future to support their spiritual well-being.

Informing mothers of neonatal death and the need for family-centered bereavement care: A phenomenological qualitative study.

PURPOSE: To understand the lived experience of mothers surrounding the time of being informed of neonatal deaths in intensive care units. DESIGN: A phenomenological qualitative approach was employed. METHODS: Twelve mothers (age 24-41 years) were identified from the neonatal mortality records of two large neonatal intensive care units with high neonate turnover rates in Amman, Jordan. Data were collected using semistructured interviews with the participants. Interpretive phenomenology was used to generate themes regarding the essence of the mother's experience. RESULTS: Critical analyses of mothers' accounts revealed three major themes: (a) Minimize the hurt, which described how mothers intuited overprotection by their families while the news was conveyed indirectly to them; (b) The striking reality of death, which captured mothers' distressing experiences while realizing the loss of their neonates; and (c) Farwell my baby, which accentuated mothers' needs and experiences while neonates' bodies were honored and prepared for burial per the cultural norms in Jordan. PRACTICE IMPLICATIONS: Our findings highlighted the complex dynamics of familial interactions and cultural influences on mothers' bereavement experiences at the time of neonatal death. The grieving mothers expressed unfulfilled needs of receiving professional bereavement support at the time of neonatal death. Strategies are needed to optimize the supportive role of specialized nurses in providing family-centered bereavement care to mothers and their families who experience neonatal death.

Clinicians' Self-Reported Practices Related to End-of-Life Care for Infants in NICUs in Jordan.

OBJECTIVE: To examine how clinical decisions are made at the end of life for infants born with specific fatal and disabling conditions in NICUs in Jordan from the perspectives of neonatal health care providers. DESIGN: A cross-sectional survey of neonatal nurses and physicians. SETTING: Twenty-four NICUs in Jordan. PARTICIPANTS: Participants included 213 nurses and 75 physicians who provided direct care for infants in NICUs. METHODS: Using the EURONIC questionnaire, we asked participants to recall the last experiences of end-of-life decision making in which they were involved. The participants described factors and outcomes related to those experiences, and we used descriptive and inferential statistics to examine these factors. RESULTS: In 83% of the recalled situations, the physicians in charge of the infants' care or who were on duty were the primary decision makers. Parents, nurses, ethics committees, and NICU heads were less involved. The infants' primary diagnoses were significantly associated with the nature of decisions regarding end-of-life care (p < .001). Age, importance of religion, having their own children, and involvement in research activities were factors that significantly predicted nurses' perceived levels of involvement in decision making (χ2[4] = 23.140, p < .001). CONCLUSION: Our results suggest the need to improve clinical approaches to decision making regarding end-of-life care for infants in NICUs in Jordan to be more family focused and team based. This process should include parents, physicians, neonatal nurses, and ethics committees.

Physicians' standpoints on end-of-life decisions at the neonatal intensive care units in Jordan.

The purpose of this cross-sectional descriptive study is to explore pediatricians' and neonatologists' attitudes and standpoints on end-of-life (EOL) decision-making in neonates. Seventy-five physicians, employed fulltime to care for newborns in 23 hospitals in Jordan, completed internationally accepted questionnaires. Most physicians (75%) were supportive of using life-sustaining interventions, irrespective of the severity of the newborns' prognosis and the potential burden of the neonates' disabilities on their families. The general attitude of the physicians (59-88%) was against making decisions that limit life support at EOL; even those infants with what are, in fact, untreatable and disabling medical conditions (56-88%). Most physicians (77%) indicated that ethics committees should be involved in EOL decision-making based on requests from parents, physicians, or both. The results of this study indicate strong pro-life attitudes among the physicians whose role is to take care of infants in Jordan. The results also emphasize the need for (1) the creation of clear EOL-focused regulations and guidelines, (2) the establishment of special ethical committees to inform and assist healthcare providers' efforts during EOL care, and (3) raised awareness and competencies regarding EOL and ethical decision-making among physicians taking care of newborns in Jordan's intensive care units.

Maternal Bereavement: Mothers' Lived Experience of Losing a Newborn Infant in Jordan.

The death of a newborn infant is one of the most devastating situations a mother could experience. The aim of this study was to understand bereavement and its associated meanings as lived and experienced by the mothers who lost their newborn infants in the intensive care units of hospitals in Jordan. Data were generated using semistructured face-to-face interviews with 12 mothers who had the experience. A qualitative phenomenological approach was used for data analysis. Three main themes emerged from the analysis: (1) longing and grieving, as natural emotional responses to the loss; (2) adaptive work of coping, as the mothers internalized meanings to cope with their loss; and (3) moving forward but with a scar, as the mothers moved on with their lives while they carried the unforgettable memories of the newborns' death experience. Bereavement support services should be considered vitally important as soon as the news of a newborn's death is delivered to the mother. Palliative care nurses and other health care providers should give careful attention to the meanings that the mothers attached to the loss and support each bereaved mother's spiritual values and effective coping mechanisms.

The incidence, risk factors, and mortality of preterm neonates: A prospective study from Jordan (2012-2013).

OBJECTIVE: To explore the incidence of preterm delivery, maternal risk factors for having a preterm neonate, and preterm neonates' mortality in Jordan. MATERIALS AND METHODS: A cross-sectional population-based design was applied. Socio-demographic, perinatal, delivery risk factors, and survival information were gathered in pre- and post-hospital discharge interviews with 21075 women who gave birth to live neonates at ≥20 weeks of gestation in 18 hospitals in Jordan. Women were interviewed between 2012 and 2013. The sample was limited to singleton women who gave birth to live neonates. Women who gave birth to stillborn babies were excluded. RESULTS: Preterm delivery incidence was 5.8%, of which 85% were in 32-36 gestational weeks. Male sex, primigravidity, hypertension, preeclampsia, and diabetes were significantly associated with an increased risk of preterm delivery. Women aged 20-35 years had the lowest risk of preterm delivery. Mother's weight <50 kg, hospitalization at 24-34 gestational weeks, lack of antenatal care visits or <8 visits during pregnancy, a history of preterm delivery, and a history of stillbirth/neonatal death were associated with increased risks of preterm delivery. The neonatal mortality rate was 4/1000 live births among full-term and 123/1000 live births among preterm babies. Prematurity, congenital anomalies, and maternal diseases were the causes of 84% of preterm neonatal deaths. CONCLUSION: The mortality rate was considerably higher among preterm neonates than among term neonates; discrepancies between Jordan and other countries existed. Systematic prenatal risk assessment and quality postnatal health care improvements are required to improve the survival rates of preterm neonates.

Barriers That Impede the Provision of Pain Care to Neonates by Nurses in Jordan.

OBJECTIVE: To describe perceived barriers to neonatal pain care and suggest strategies to overcome these barriers among NICU nurses in Jordan. DESIGN: Descriptive study. SETTING: Eighteen NICUs in Jordan. PARTICIPANTS: One hundred eighty-four neonatal nurses. METHODS: Nurses completed a questionnaire on perceived barriers to neonatal pain care. Descriptive statistics were used to analyze the data. RESULTS: One of the main issues that hindered the effective practice of neonatal pain care was the underuse of structured pain measurements, especially for painful procedures (72%). Furthermore, participants indicated minimal knowledge about pain medication for neonates (66%) and feared adverse effects (50%). The participants received inadequate training about neonatal pain care during their initial orientation (24%) and while in service (19%). Participants perceived low interprofessional appreciation of any input into pain care decisions (72%). Finally, only 39% of participants supported the involvement of parents in pain care for their neonates, and 82% were against it during painful procedures. CONCLUSION: Efforts to improve neonatal pain care should focus on improving nurses' knowledge about neonatal pain, increasing competencies and involvement in pain management options, and improving channels of professional communication about neonatal pain.

Experience of Menarche Among Jordanian Adolescent Girls: An Interpretive Phenomenological Analysis.

STUDY OBJECTIVE: Menarche is a significant physical and emotional experience for adolescent girls, especially in certain cultures, where it is viewed as a rite of passage, affecting the meaning of lived experiences. The purpose of the study was to explore the menarche experience among Jordanian adolescent girls when they reach menarche. DESIGN: Interpretive phenomenological analysis. SETTING: Az-Zarqa City, Jordan. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A homogenous sample of 7 Jordanian girls, ages 12-14 years, who had their first menstruation within the past 6 months. Participants were asked to narrate their experiences through journal writing; their reports to be used for interpretive phenomenological analyses by 2 independent researchers, to ensure the findings' trustworthiness. RESULTS: Three major themes emerged as: (1) menstruation as a forbidden topic; (2) keeping the "topic" to oneself; and (3) no more secrets. Each theme was characterized according to distinct sets of emotions and knowledge-seeking patterns because Jordanian culture and Islamic teachings had greatly influenced the girls' experience of menarche. Menarche was considered a social taboo; not to be openly discussed. At the first signs of menarche, participants were shocked, scared, confused, and anxious. They had limited information and support from their family or school system. Therefore, they relied on self-perceptions about menarche, and viewed the experience of menstruation with profound negative emotions. Participants hesitated to share their experiences with their mothers and close friends. They felt alone and experienced their emotional turmoil in isolation and without support. CONCLUSION: Jordanian adolescent girls need formal health education to understand and manage the reproductive changes that occur in their bodies.