The Relationship Between Self-Efficacy and Functional Capacity Among Discharged Heart Failure Patients in Jordan.

BACKGROUND: Self-efficacy is an important factor associated with healthy lifestyle changes in heart failure treatment. Functional capacity testing of heart failure patients (HFPs) can stratify prognosis. Reduced functional capacities in HFPs are linked to a poor heart failure prognosis. Limited research has examined the potential relationship between self-efficacy and functional capacity. AIM: The aims of this study were to assess self-efficacy level and functional capacity among HFPs after hospitalization, and examine whether there is a relationship between them. METHODS: A descriptive correlational design was used. A convenience sample of 220 HFPs was recruited from 2 hospitals in Jordan. The Arabic version of Cardiac Self-Efficacy Questionnaire was used to assess self-efficacy, the 6-Minute Walking Test (6-MWT) was used to assess functional capacity, and the Borg rating of perceived exertion scale (Borg Scale) was used to assess exertion during 6-MWT. RESULT: The sample included 46.8% male (n = 103) and 53.2% female (n = 117). The mean age was 52.66 ± 8.91 years. Most of the HFPs were categorized based on New York Heart Association classification as class I, 35.9% (n = 79), and class II, 41.4% (n = 91). The mean ejection fraction was 41.46 ± 9.44. The global self-efficacy was moderate (32.98 ± 9.92), and the mean score for the 6-MWT was 494.35 ± 143.37. The Borg Scale mean was 10.94 ± 3.34. In addition, there was a positive relationship between self-efficacy and 6-MWT (r = 0.63, n = 220, P = .01). CONCLUSION: This study provides baseline data for further research on treatment of HFPs, and the development of evidence-based tailored health interventions to maintain and improve self-efficacy and functional capacity among these service users. Moreover, replicated researches can test the study results considering different methodologies, such as using objective functional capacity tool and longer follow-up periods.

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.

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.

The Relationship Between Emotional Intelligence and Nurse-Nurse Collaboration.

PURPOSE: The purpose of this study was to examine the relationship between emotional intelligence and nurse-nurse collaboration among registered nurses in Jordan. DESIGN: This study used a cross-sectional, quantitative survey design to query 342 nurses who worked in two hospitals in Jordan. METHODS: We used Arabic versions of valid, reliable instruments to measure emotional intelligence and nurse-nurse communication. FINDINGS: A total of 311 questionnaires were returned (91% response rate). Nurses' emotional intelligence was positively and significantly correlated with the nurse-nurse collaboration subscales. The results also indicated a statistically significant mean difference in communication subscale scores by gender and nursing unit. CONCLUSIONS: The present study demonstrated that nurse-nurse collaboration is linked to benefits for nurses in terms of improved job satisfaction, better nurse retention, improved quality of patient care, and enhanced healthcare efficiency and productivity. This suggests that improving nurse-nurse collaboration may have spillover effects of benefits, not only for nurses but for patients, organizations, and the overall healthcare system. CLINICAL RELEVANCE: Building an environment that encourages collaboration among nurses can greatly impact the performance of nurses and its benefit to nurses. Encouraging employees to participate in activities and to collaborate in making this an integral part of their evaluation will contribute to improving the teamwork in patient care.

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.

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.

The Most and the Least Performed Self-Care Behaviors Among Patients With Heart Failure in Jordan.

Assessing self-care is important aspects among patients with heart failure. However, few studies were conducted to assess self-care among patients with heart failure in Jordan. Therefore, this study aimed to assess the most and the least performed maintenance self-care behaviors and to examine the relationship between maintenance self-care behaviors and selected sociodemographics. A cross-sectional design utilizing a convenience sample of 226 patients with heart failure was used. The maintenance self-care mean was 53.89 and considered below the clinical target level (≥70). Asking for low salt item and performing physical exercises were the most performed self-care behaviors, while "trying to avoid getting sick" and "checking ankles for swelling" were the least performed self-care behaviors. Limited self-care behaviors indicated the need to implement cardiac education that may improve self-care behaviors. Cardiac education should target mainly patients with low income, low educational level, elderly, living alone, unemployed, and who are using traditional treatment.

Impacts of Treatment Modalities on Physical Activity After First Acute Myocardial Infarction in Jordan.

BACKGROUND: Promoting physical activity is a priority after coronary revascularisation for effective long-term cardiovascular care and to avoid further disease progression and complications. But little is known about the effect of different types of acute myocardial infarction (AMI) treatment modalities in changes in physical activity level post-AMI. OBJECTIVE: This study aimed to examine changes in physical activity among patients treated with different treatment modalities post-first AMI during early recovery phase at week 2 (time 1) and week 6 (Time 2) after hospitalization. METHODS: A descriptive study was done using a repeated-measures design. Physical activity was measured by a body-worn activity monitor (activPAL3 monitor) for 24 hours a day for full 7 consecutive days at time 1 and time 2 after hospitalization. Demographic and clinical data were collected from patients' records. The study was conducted in 1 setting in Jordan. Participants were met at time 1 and time 2. The study recruited a convenience sample of 94 patients with AMI. Participants did not have access to cardiac rehabilitation. The participants were categorized according to type of AMI treatment modalities into 3 groups: ST-elevation myocardial infarction treated by primary percutaneous coronary intervention, ST-elevation myocardial infarction treated by thrombolytic therapy, and non-ST-elevation myocardial infarction treated by medication. RESULTS: Patients treated by primary percutaneous coronary intervention had a statistically significant effect on changes in mean steps count and mean stepping time per day better than patients treated by other treatment modalities between weeks 2 and 6 after hospitalization. CONCLUSION: The study showed that patients treated with primary percutaneous coronary intervention had better mean steps count and mean stepping time per day between weeks 2 and 6 after hospitalization in comparison with other treatment modalities. These findings could be used for development of effective intervention in the future. Further research using different research methods such as longitudinal studies among different cultures to confirm the finding of this study is recommended.

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.

Coping Strategies Used by Syrian Refugees in Jordan.

This study examined the coping strategies used by Syrian refugees in Jordan in relation to their demographics. A cross-sectional correlational study was conducted with a convenient sample of 550 Syrian refugees. Out of all the study participants, 88% reported seeking social support, 64.5% reported using avoidance, and 39.5% reported using problem solving. Participants who were male, single, and younger, and who had a higher education and a higher total income were satisfied with their income, were employed and free of chronic illnesses, and had higher problem-solving scores. Higher social support-seeking scores were associated with being female, older, and widowed; having a lower education and lower total income; being dissatisfied with their income; being nonemployed; and having chronic illnesses. A number of significant predictors were identified for each coping strategy. The results of this study could be used to formulate programs and develop services regarding the stressors encountered by Syrian refugees and their coping strategies.

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.

Research Use of Nurses Working in the Critical Care Units: Barriers and Facilitators.

BACKGROUND: There is a distinct gap between theory and practice with respect to research use in clinical practice, particularly in critical care units, that could be related to the presence of a number of barriers that hinder the use of research findings. AIMS: The aims of the study were to identify barriers and facilitators to research use as perceived by Jordanian nurses in critical care units and to examine the predictors of research use among those nurses. METHODS: The study used a cross-sectional, correlational design. The self-administered "Barriers Scale" was introduced to 200 registered critical care nurses, using the drop-and-collect technique, between October and November 2015. RESULTS: The results revealed that "nurse does not have time to read research at work" was the top ranked barrier that hinders research use (mean [SD], 3.45 [0.79]). The first 7 ranked barriers were related to the organizational subscale. Managerial support was the top perceived facilitator for research use. Only "attending special training courses in nursing research" was the significant predictor of research use and explained 59.1% of the variance in research use, t(190) = -3.93, P = .003. The most identified barriers toward research use revealed by the qualitative data include dominant routine nursing tasks, existence of gap between theory and practice, shortage of nursing staff, and public negative image about nursing profession. Participants suggested the importance of increasing organizational support and creating an organizational research culture to further promote research use in clinical nursing practice. CONCLUSIONS: Research use has not been widely implemented yet in Jordan because of various barriers. The organization-related barriers were the most influential. Factors hindering research use are multidimensional, and optimizing them should be a shared responsibility of nurse managers, researchers, clinicians, and academicians. Further initiatives are required to raise awareness of the importance of using evidence-based practice.

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.

Predictors of Coping Strategies Employed by Iraqi Refugees in Jordan.

The purpose of this study was to examine coping strategies used by Iraqi refugees in Jordan based on their demographic details. A cross-sectional design was used. A representative sample of 333 refugees living in Jordan participated in the study. The Cope inventory and the demographic details were compiled to produce and collate the relevant data. Being older, female, educated, single, and living with more than three family members was associated with greater use of the problem solving coping strategy. Being female, educated, and unemployed was associated with greater use of the active emotional coping strategy. In addition, being older, male, illiterate, unemployed, and living with less than three family members was associated with greater use of the avoidant emotional coping strategy. This study recommends a multidisciplinary approach intervention as being the best method of addressing and fulfilling the health and socioeconomic needs of older, male, illiterate, unemployed people.

Psychometric properties and characteristics of the Diabetes Self Management Scale.

OBJECTIVE: Assessing diabetes self care management is essential for nursing care for diabetes. There is a need to have valid and reliable scales that assess the actual performance of diabetes self management. The purpose of this study was to revise and conduct psychometric testing and analysis of the Diabetes Self Management Scale (DSMS). METHODS: A cross-sectional methodological design was used. A convenience sample was used and 78 adults with diabetes and taking insulin from five sites in the Midwest area of the U.S participated in the study. Reliability analysis was done using Ferketich techniques to make decisions about whether any given item should be retained or deleted. RESULTS: A descriptive analysis for the 60 items of the scale was conducted; several items had low variability compared to the other items on the scale. The correlation matrices showed that a total of 20 items had poor item characteristics. These 20 items were deleted resulting in developing 40- item version of the scale. The 40 - item scale had high level of internal consistency (Cronbach's α = 0.947). The validity testing of the 40 - item scale was guided by the Research Model for Diabetes Self Care Management; results were congruent with the model and showed strong correlation with self efficacy, moderate correlation with self care agency, and weak correlation with diabetes knowledge. CONCLUSION: The items and the scale (DSMS) have undergone careful psychometric testing. The 40-item DSMS is a reliable and valid instrument to measure diabetes self care management among people with diabetes.

The influence of treatment modality on illness perception and secondary prevention outcomes among patients with acute myocardial infarction.

OBJECTIVES: This study aims to determine if patients with acute myocardial infarction differ in illness perception and secondary prevention outcomes depending on the treatment they received. METHODS: A repeated measures design was used to compare patients with acute myocardial infarction receiving three different treatment modalities: ST-elevation myocardial infarction treated by primary percutaneous coronary intervention, ST-elevation myocardial infarction treated by thrombolytic therapy, and non ST-elevation myocardial infarction treated by medication. A convenient sampling technique was used to recruit 206 patients with acute myocardial infarction who agreed to participate in the current study. Patients' illness perception, physical activity, and demographical and clinical data were collected during hospital admission and again at 6 months. RESULTS: A total of 186 patients completed the study. Results showed that the primary percutaneous coronary intervention group perceived their illness as acute rather than chronic (P = 0.034) and has lower personal control (P = 0.032), higher treatment control (P = 0.025), and higher perception of illness coherence (P = 0.022) compared with patients receiving thrombolytic therapy and treated after non-ST segment infarction. Moreover, they report low control of their blood pressure (P = 0.013) and less physical activity (P = 0.001). CONCLUSION: The results of this study revealed that patients' treated with primary percutaneous coronary intervention had negative illness perception and limited behavioral changes 6 months after hospitalization in comparison with other treatment modalities such as percutaneous coronary intervention and thrombolytic treatment. Further research is recommended to confirm this association with longer follow-up study and among different cultures.

Illness perception in patients with coronary artery disease: A systematic review.

The aim of this study was to conduct a systematic review that investigates the differences in illness perception with age and gender in patients diagnosed with coronary artery disease. Previous studies show some discrepancies regarding the influence of age and gender on the specific dimensions of coronary artery disease patients' illness perception. A systematic review using a narrative synthesis process included preliminary synthesis, exploration of relationships and assessment of the robustness of the synthesis and findings was conducted. Search terms were used to identify research studies published between 1996 and December 2014 across four key databases: CINAHL, Medline, PsycINFO and Web of Science. A total of 14 studies met the inclusion criteria of the review. The review found that men had a stronger perception that their own behaviour had caused their illness than women. In addition, older patients had lower perceptions of the consequences and chronicity of their illness. This analysis concludes that some dimensions of illness perception vary according to age and gender of patients with coronary artery disease. These differences should be taken into consideration, particularly when providing health education and cardiac rehabilitation.

Salivary Nitric Oxide, a Biomarker for Stress and Anxiety?

OBJECTIVE: To investigate if salivary nitrate correlates to the daily psychological stress and anxiety in a group of human subjects. METHODS: The convenient sample recruitment method was employed; data from seventy three subjects were analyzed. The Perceived Stress Scale (PSS) and Hamilton Anxiety Rating Scale (HAM-A) inventories were used to determine stress and anxiety scores respectively. Salivary nitric oxide was measured through nitrate (NOx) levels using the Griess reaction method. RESULTS: Although stress and anxiety were correlated. No significant correlation exists between salivary nitrate and daily psychological stress and anxiety in the study's participants. CONCLUSION: While all previous studies focused NOx levels in acute stress models. This is the first study to investigate the correlation between salivary nitrates and daily psychological stress and anxiety. Although stress and anxiety were correlated, there is no correlation between salivary nitrates and daily psychological stress and anxiety. Further studies are required to investigate this correlation using other biological samples such as plasma.