Exploring the causes and consequences of non-nursing tasks among nurses in Jordan: An in-depth qualitative investigation.

AIM: To investigate the perceptions of Jordanian nurses regarding Non-Nursing Tasks (NNTs) and their consequences, as well as the underlying factors that contribute to the occurrence of NNTs. BACKGROUND: Nurses play a crucial role in providing high-quality patient care, but they often engage in NNTs, which can hinder their ability to deliver care effectively. Western countries have primarily conducted research on NNTs, while Middle Eastern countries such as Jordan have received limited attention. Expanding our understanding of NNTs is essential for improving nursing care. METHODS: A qualitative-exploratory approach was adopted. The research was conducted at three hospitals in Amman, Jordan. A purposeful sampling approach was used to select the participant and a focus group-interview method was used to gather the data. The derived data were analyzed using a thematic analysis approach. RESULTS: The final sample of this study included 38 participants. The findings highlighted that nurses often perform NNTs due to staff shortages and limited resources, as well as weaknesses in nursing administration and education. The finding also highlights the consequences of NNTs on nurses' professional lives, including impaired nursing care, physical and mental health strain, and a lack of efficiency and productivity. CONCLUSIONS: The present study's results provide valuable insights into the impact of NNTs on nurses in Jordan. These findings underscore the need for healthcare stakeholders to actively address the issue of NNTs. It also emphasized the need for more explicit job descriptions and processes, along with support for nurses to fulfilling their responsibilities and prioritizing patient care.

Current practices for assessing clinical judgment in nursing students and new graduates: A scoping review.

OBJECTIVE: To map current assessment practices for learning outcomes related to nurses' clinical judgment from undergraduate education to entry to practice. DESIGN: Scoping review using the Joanna Briggs Institute guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). DATA SOURCES: Electronic databases-Cumulative Index of Nursing and Allied Health Literature (CINAHL Complete; EBSCOhost), EMBASE (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science (Social Sciences Citation Index, Citation Index Expanded)-using a combination of descriptors and keywords related to nursing students, newly graduated nurses, clinical judgment and related terms (e.g., critical thinking, clinical reasoning, clinical decision-making, and problem-solving), and assessment. METHODS: Two reviewers independently extracted study characteristics and, for each outcome relevant to clinical judgment, the concept, definition and framework, assessment tool, and the number and schedule of assessments. Data were synthesized narratively and using descriptive statistics. RESULTS: Most of the 52 reviewed studies examined the outcome of a discrete educational intervention (76.9 %) in academic settings (78.8 %). Only six studies (11.5 %) involved newly graduated nurses. Clinical judgment (34.6 %), critical thinking (26.9 %), and clinical reasoning (9.6 %) were the three most frequent concepts. Three assessment tools were used in more than one study: the Lasater Clinical Judgment Rubric (n = 22, 42.3 %), the California Critical Thinking Skills Test (n = 9, 17.3 %), and the Health Science Reasoning Test (n = 2, 3.8 %). Eleven studies (21.2 %) used assessment tools designed for the study. CONCLUSION: In addition to a disparate understanding of underlying concepts, there are minimal published studies on the assessment of nursing students and nurses' clinical judgment, especially for longitudinal assessment from education to clinical practice. Although there is some existing research on this topic, further studies are necessary to establish valid and reliable clinical competency assessment methods that effectively integrate clinical judgment in clinical situations at relevant time points.

Quality and safety issue: language barriers in healthcare, a qualitative study of non-Arab healthcare practitioners caring for Arabic patients in the UAE.

OBJECTIVES: To identify language-related communication barriers that expatriate (non-Arabic) healthcare practitioners in the UAE encounter in their daily practice. DESIGN: Qualitative study utilising semi-structured in-depth interviews. The interviews were conducted in English language. SETTING: Different healthcare facilities across the UAE. These facilities were accessed for data collection over a period of 3 months from January 2023 to March 2023. PARTICIPANTS: 14 purposively selected healthcare practitioners. INTERVENTION: No specific intervention was implemented; this study primarily aimed at gaining insights through interviews. PRIMARY AND SECONDARY OUTCOMES: To understand the implications of language barriers on service quality, patient safety, and healthcare providers' well-being. RESULTS: Three main themes emerged from our analysis of participants' narratives: Feeling left alone, Trying to come closer to their patients and Feeling guilty, scared and dissatisfied. CONCLUSIONS: Based on the perspectives and experiences of participating healthcare professionals, language barriers have notably influenced the delivery of healthcare services, patient safety and the well-being of both patients and practitioners in the UAE. There is a pressing need, as highlighted by these professionals, for the inclusion of professional interpreters and the provision of training to healthcare providers to enhance effective collaboration with these interpreters.

Perceived barriers to effective use of telehealth in managing the care of patients with cardiovascular diseases: a qualitative study exploring healthcare professionals' views in Jordan.

BACKGROUND: The use of telehealth in the management of care and care delivery has been increasing significantly during the COVID-19 pandemic. Telehealth is an emerging technology used to manage care for patients with cardiovascular diseases (CVDs) in Jordan. However, implementing this approach in Jordan faces many challenges that need to be explored to identify practical solutions. PURPOSE: To explore the perceived challenges and barriers to using telehealth in managing acute and chronic CVDs among healthcare professionals. METHODS: A qualitative, exploratory study was conducted by interviewing 24 health professionals at two hospitals in different clinical areas in Jordan. RESULTS: Several barriers were reported by participants that affected the utilization of telehealth services. The barriers were categorized into the following four themes: Drawbacks related to patients, Health providers' concerns, Procedural faults, and telehealth To complement the service only. CONCLUSIONS: The study suggests that telehealth can be instrumental in supporting care management for patients with CVD. It means that understanding the advantages and barriers to implementing telehealth by the healthcare providers in Jordan can improve many aspects of the healthcare services for patients with CVD within the healthcare settings in Jordan.

Electrolyte Imbalance Among Patients With and With No ST-Elevation Myocardial Infarction: A Cohort Study.

Electrolytes imbalances are highly prevalent and have shown a high impact on mortality in patients with acute myocardial infarction. These electrolytes imbalance have prognostic value in predicting mortality in patients with acute myocardial infarction. The purpose of this study was to assess the prognostic value of electrolyte imbalances in predicting 1-month mortality among patients with myocardial infarction with and with no ST-elevation. This cohort study was conducted in a referral hospital in the West Bank, Palestine. All patients with confirmed medical diagnosis of acute myocardial infarction and admitted to the medical coronary care unit in the hospital were eligible participants. A convenience sample of 186 participants was obtained. These participants were followed up for 1 month to assess their survival (alive or dead). Demographic and clinical data were recorded by reviewing their health records. The derived data were analyzed using SPSS version 19. About 36% of all patients were found to be hyponatremic, 15% of them have hypokalemia, and 9% of patients had hypocalcemia. There was a significant difference between STEMI and non-STEMI in sodium (t = 4.7, P < .001). A multivariate logistic regression analysis was performed to predict 1-month mortality for patients with myocardial infarction with and with no ST-elevation. The predictors that were found to be significant are sodium (odds ratio [OR] = 0.789, P = .010), calcium (OR = 0.221, P = .014), diastolic blood pressure (OR = 0.933, P = .047), and blood urea nitrogen (OR = 0.821, P = .005). Electrolyte imbalance was highly prevalent among patients with acute myocardial infarction. Hyponatremia and hypocalcemia were present and associated significantly with predicting 1-month mortality. Health care providers should take into consideration the electrolytes of patients with acute myocardial infarction from the first moment of admission and correct them early to maximize the clinical outcomes and survival for patients.

Utilizing telehealth intervention to support patients with cardiovascular diseases in Jordan: A qualitative study.

INTRODUCTION: Telemedicine is one of the new technological solutions used to facilitate treatment and intervention in patients with Cardiovascular Diseases (CVD). Nevertheless, the utilization of telehealth in Jordan is under-researched. PURPOSE: To explore the perspectives and experiences of patients with cardiovascular disease (CVD) and healthcare providers on how telehealth can help manage critical and long-term CVD health problems. METHOD: A qualitative, descriptive approach was employed, whereby individual interviews were conducted with 12 healthcare providers and 12 cardiac patients from Abdali and Prince Hamzah Hospitals in Jordan. The derived data were analyzed using thematic analysis, according to the method expounded by Braun and Clarke (2014). RESULTS: The analysis of collected data revealed that telehealth deployment exhibited several advantages from the participants' perspectives, these can be divided into the following six themes: mitigating associated risks, qualified and friendly staff, streamlined work processes, effective and structured services, accessibility and privacy of patient information, affordable and convenient services. CONCLUSION: The current study suggests that telehealth can be helpful and convenient in many aspects of the health care services for patients with CVD, mainly during the crucial times of the COVID pandemic. With this study, stakeholders and Jordanian managers can better understand the telehealth advantages. This will enable them to improve the quality of care in their health organizations in the future.

The Associations Between Patients' Characteristics and the Quality of Life Among Acute Coronary Syndrome Patients in Jordan: A Cross-Sectional Study.

Introduction: Acute coronary syndrome (ACS) is one of the most significant leading causes of death and disability in the world. The quality of life (QoL) score is used to evaluate the impact of ACS treatments on the patients' physical, emotional, and social functioning. It is considered a significant indicator of the progress of the patients' health status and is useful in predicting patients' needs for continuing, modifying, or changing their treatment plans. Objective: To identify the associations between patients' characteristics and the QoL among ACS patients in Jordan. Methods: A descriptive cross-sectional study was conducted using a convenience sample of 372 participants with ACS from six referral hospitals in Jordan. Results: Jordanian patients with higher educational level and exercise had significant and positive association with QoL (ß = 0.257, p < .001), (ß = 0.191, p < .001), respectively. Also, patients who reported having dyslipidaemia and having unstable angina (UA) had lower score of QoL (ß = -0.165, p < .001), (ß = -0.149, p < .001), respectively. Finally, gender and working status did not significantly appear to have an association with the total QoL. Conclusions: This study sheds light on the importance of increasing the level of patients' awareness about their illness by educating them about it and encouraging them to engage in physical activity programs.

Challenges to online education during the time of COVID-19: A focus group study.

AIM: To explore the experience of online education during coronavirus disease 2019 (COVID-19) from the perspectives of nurse educators, postgraduate students, and undergraduate students in two universities in the Occupied Palestinian Territory (OPT). This article only highlights the challenges faced by nurse educators and students. METHOD: A qualitative design using a focus group strategy was employed. The data were collected from two universities in the OPT from September 2020 to October 2020. The maximum variation sampling strategy was used. FINDINGS: Seven focus groups were conducted with nurse educators (n = 2), postgraduate students (n = 1), and undergraduate students (n = 4). The findings revealed that nurse educators and students faced several challenges when they were abruptly turned to online learning. These challenges included challenges concerning clinical courses, lack of resources, lack of interaction, evaluation, and their home environment. CONCLUSIONS: This study is the first to demonstrate the challenges involved in nursing education in OPT during the COVID-19 pandemic. IMPACT: The findings of this study can be used to improve the online learning experience during COVID-19. As a recent change to nursing education, it is vital to understand the nature of the problems related to this sudden change.

The impact of online teaching on stress and burnout of academics during the transition to remote teaching from home.

BACKGROUND: The higher education institutions worldwide have been transformed unexpectedly to online teaching. This sudden movement from blended learning or traditional face-to-face teaching has severely disrupted university activities and posed many challenges for teaching staff, who were asked to develop online versions of their courses overnight. This study explores the effect of the current changes in education style and working from home on the stress and burnout levels of teaching staff. METHODS: This study utilized a cross-sectional design, whereby 278 participants (faculty and course instructors) from 17 campuses of one of the largest colleges in United Arab Emirates completed a web-based survey. Numerous instruments were utilized to obtain the following data: participants demographics; their perceived stress during online teaching; their perception of the impact of teaching from home on their family's daily life, physical health, mental health and ability to cope with stress; burnout level; and their satisfaction with online teaching. RESULTS: Around 60% of participants reported moderate stress level during online teaching (moderate stress = 5 to 8) under COVID-19 (M 6.21 ± 2.26). An independent sample t-test and ANOVA tests revealed that participants with 7-10 years of online teaching experience reported more stress than participants who have 4-6 years online teaching experience (M 7.29, ±1.11 Vs. 5.30, ±2.69; P = 0.04). Moreover, multiple regression analysis showed that higher stress levels and lower satisfaction with the online teaching experience were associated with more significant personal and working burnout. Married participants with school-age children were at greater risk of personal burnout. CONCLUSION: The transition to remote education imposed mental burdens and stress on faculty members. Supportive professional development strategies to enrich faculty with online teaching skills are urgently required.

The effectiveness of an interactive digital-based educational program in improving breastfeeding knowledge, attitudes and self-efficacy among primiparous women in Egypt.

Malnutrition is the main cause of two-thirds of deaths among Egyptian under five children, which could be due to reduced rates of breastfeeding, as it is one of the contributing factors. Breastfeeding is the optimal solution for health promotion to mothers and their infants. It has various benefits not only for the mother and infant but also for society. Breastfeeding educational programs are essential for the enhancement of knowledge and self-efficacy of new mothers, and to ensure a longer duration of breastfeeding. Therefore, this study aims to evaluate the effects of an interactive digital-based educational program about breastfeeding on the knowledge, attitudes, and self-efficacy of primiparous women in Egypt. A quasi-experimental study design was adopted. The study was held in Itay El-baroud maternal and child health center, whereby 120 pregnant women were purposively selected. Then, they were randomly assigned to either a study group (60) or control group (60). The derived data were statistically analysed using SPSS version 20, Pearson correlation coefficient, chi-square test and independent sample t test were utilized. Four tools were utilized for data collection. A statistically significant mean difference was found concerning total breastfeeding knowledge scores after one month and three months. The total attitude and self-efficacy scores showed highly statistically significant differences after one month and three months from the start of the program. Moreover, breastfeeding self-efficacy was found to be positively correlated with knowledge and attitude. In conclusion, the interactive digital-based educational program about breastfeeding was suggested to be effective in enhancing the knowledge, attitude and self-efficacy of the primiparous women, in combination with other health education activities. Therefore, it is recommended that web-based educational sites are created for first-time mothers.

Assessing sense of coherence as an element of primary-focused health services in schools for children and adolescents with complex health care needs.

AIM: This study aimed to clarify if sense of coherence (SOC) could be used as an element of primary-focused health services in schools. BACKGROUND: The United Arab Emirates (UAE) is striving to develop a high-quality, primary-focused health care system. School health care services are well established in the UAE but have not yet been fully used to play a key role in this development. METHODS: This is a cross-sectional survey study to explore adolescents' SOC and their behavioural, psychosocial and clinical outcomes. RESULTS: A total of 408 adolescents participated in this study. Compared with others, adolescents with higher SOC had better adherence to treatment, fewer visits to the school nurse, better self-efficacy, fewer hyperactivity problems, fewer emotional problems, more prosocial behaviours and fewer conduct problems. CONCLUSION: Implementing interventions that improve SOC may support improved well-being among adolescents. The findings also support the use of SOC and salutogenesis as a framework to reinforce primary health care services for this population. IMPLICATIONS FOR NURSING MANAGEMENT: Health service managers can utilize SOC as a framework to focus service on illness prevention and health promotion, they should collaborate with education authorities to include more health-related topics as part of school curricula to promote students' SOC and, finally, they should assess and build awareness of SOC and associated tools among school nurses and primary health care providers.

Parental Child Rearing Practices in Palestine: A Cross-Sectional Study.

The objectives of this study were to explore parenting practices from the perspectives of Palestinian parents and their children, and concordance between parents and children in their reports of parenting practices, in a culture that is underrepresented in the literature. A descriptive cross-sectional design was used. The Alabama Parenting Questionnaire (APQ) was administered to 120 parents and 120 children drawn from 4 districts in Palestine. Children had higher scores on parental involvement, positive parenting, poor monitoring, inconsistent discipline, and corporal punishment. Three significant parent-child relationships were obtained1: parental involvement (r = .276, P = .003), positive parenting (r = .0301, P = .001), and poor parental monitoring (r = -.241, P = .008). The findings of this study might be used by Palestinian authorities and policy-makers to formulate guidelines and training to aid parental decision-making about child rearing.

Comparison of blended versus traditional classrooms among undergraduate nursing students: A quasi-experimental study.

BACKGROUND: Blended learning is a relatively new educational approach that has been introduced into higher education in Palestine. While it has many advantages, there is no empirical evidence, nor any case studies from Palestine to support the use of blended learning over traditional classroom. OBJECTIVES: To compare students' learning outcomes, learning perceptions of their educational environment, and satisfaction of blended learning versus traditional classroom. DESIGN: A quasi-experimental study. SETTING: A public university in Palestine. PARTICIPANTS: 102 Bachelor of Science in nursing students enrolled on the maternal health course. METHODS: Students freely chose to register for the blended teaching section (49 students) or traditional classroom (53 students), then the teaching method for each section was assigned. Student demographics, course component grades, perceptions of the educational environment, measured by the Arabic version of Dundee Ready Education Environment Measurement (DREEM) inventory, and degree of satisfaction were collected in this study. Descriptive statistics and the Independent Sample t-test were used to analyze the data. RESULTS: The sample included 49 students in the blended teaching section and 53 students in the traditional section. Overall DREEM scores, Student Perceptions of Learning, and Student Perceptions of Teachers were significantly higher for students taught with the blended method compared to traditional classroom settings. The total DREEM scores were between 101 and 151 for both sections, indicating that all students, regardless of teaching method, had more positive than negative perceptions of their educational environment. Moreover, there was no significant difference in scores and total course GPA (Grade Point Average), both with and without assignment grades, or between blended and traditional learning in first, second and final exams. However, students taught with the blended format scored significantly higher in assignments than students taught the traditional classroom. CONCLUSIONS: Blended learning can be a useful educational approach in nursing education and Palestinian universities may consider using it for nursing courses.

The experience of family carers of children with incurable cancer: a qualitative study from the occupied Palestinian territory.

BACKGROUND: Treatments for childhood cancers have raised the survival rate, however different forms of malignancy continue to cause untimely deaths, and cancer remains a leading cause of death among children. Global research on paediatric cancer is limited for several reasons. Most research has focused on specific methodologies, including questionnaires with heterogeneous samples. In addition, many studies have covered a broad range of cancer diagnoses, and a wide range of children's ages and periods between diagnosis and treatment. These methods are unable to capture the essence of experiences and cultural differences. This study aimed to explore the experience of family carers of children with incurable cancer in occupied Palestinian territory. METHODS: The study was conducted in the Paediatric Cancer Department of Beit Jala Hospital, which is the first public cancer department for children in the West Bank. The family carers of children aged 1-18 years with any type of incurable cancer in this hospital were considered eligible for participation, and the individual most involved in the care of the child was selected. To recruit participants, head nurses of medical and surgical paediatric floors provided assistance in approaching the carers of eligible children. The main objectives of the study were then discussed with the family carers. Semi-structured interviews were conducted with participants, and an interpretative phenomenological analysis approach was used to analyse the collected information. Ethical approval was obtained from the Beit Jala Hospital ethical review board and written informed consent was obtained from all participants. FINDINGS: 14 interviews were conducted. Participants were nine mothers, four grandmothers, and one father. Family carers discussed their caring experiences, including their experiences in administering special treatments, their suffering due to treating irritable children, and the information given to them about their children's illness. Family carers reported that they changed the focus of their care from an initial emphasis on normalising their children's lives to relieving their physical and psychological discomfort. This change of focus accompanied changes in carers' understanding of their child's disease over time. As carers became more realistic regarding the future of their children, they attempted to make their lives as comfortable as possible. Finally, carers discussed the support system around them; they found several resources to support them in the care of their children, including the experiences of other parents of children with similar diseases, the hospital environment, and their religious beliefs. Nevertheless, they stated that they needed more support during this difficult time of their lives. INTERPRETATION: There is a need to support parents of children with incurable cancer in the occupied Palestinian territory. Suggestions to improve the quality of care provided for these parents include the education and recruitment of health care professionals, including social workers and psychologists, to provide emotional and spiritual support. FUNDING: None.

The lived experience of family members who care for children with cancer: An interpretative phenomenological approach.

PURPOSE: This study aimed to explore the lived experiences of family carers in the care of children with cancer. METHOD: A phenomenological hermeneutic approach was conducted, informed by the philosophy of Martin Heidegger. Fourteen interviews were conducted with family members: mothers (n = 9), grandmothers and fathers (n = 5). Fourteen family carers were voluntarily enrolled from a public children's oncology department in Bethlehem in the Occupied Palestinian Territories. Interpretative Phenomenological Analysis (IPA) was used to analyze the data. RESULTS: Three major themes emerged from the data analysis. The first theme was the caring experience, which included three subthemes: changing priorities over time, information given about children's illness, and parents suffering due to treating irritable children. The second theme was the challenges to effective care, which illustrates the most significant challenges faced during caring, including the effects of family relations and emotional support. The final theme was around the support system; family carers found several resources to support them in their children's care, including other parents' experiences with similar diseases, the hospital environment, and their religious beliefs. CONCLUSIONS: This study informs parents and healthcare providers about the daily lived experiences of family carers. Healthcare providers can fulfil a significant role in giving emotional support and relief to family carers. However, they will need continuous practise to equip them with the communication skills they require to deal with the family carers in these difficult situations.

Perceptions of nurses about reporting medication administration errors in Jordanian hospitals: A qualitative study.

INTRODUCTION: Reporting Medication Errors (MEs) is a critical issue that confronts healthcare providers and institutions all over the world, yet this issue has only recently been examined in developing countries. PURPOSE: To explore the perceptions of Jordanian nurses around reporting MEs and to identify potential barriers to reportage in their context. METHODOLOGY: A qualitative descriptive approach was followed; whereby24 Jordanian nurses were interviewed. RESULTS: Two main themes emerged. The first revolved around nurses' perceptions of ME reporting, and the second theme pertained to the daily barriers that prevented them from reporting MEs. CONCLUSION: This study identified many individual behaviors and system defects that exacerbate the lack of ME reporting in Jordan. The results point to an opportunity for Jordanian hospital managers to acknowledge these problems and thereby facilitate their resolution and increase the quality of healthcare in their organizations.

Nurses' perceptions toward factors that cause medication errors in Jordan: A qualitative study.

AIMS: The aim of this study was to investigate nurses' experiences related to medication errors (MEs) from the perspective of Jordanian nurses. This article reports the findings concerning the factors that cause MEs from the perspectives of Jordanian nurses. BACKGROUND: MEs are critical issues facing healthcare providers and health institutions. Most of the studies on MEs were conducted in Western countries. However, there is little research that seeks to understand this issue in the developing countries and Jordan is one of these countries. DESIGN: A qualitative descriptive approach was used in three hospitals in different clinical settings in Jordan. METHODS: Individual semi-structured face-to-face interviews were conducted with 24 nurses. RESULTS: The data that emerged from the interviews was arranged and contextualized in two major themes, individual and systemic factors, that explained the main causes of MEs. From the individual side, lack of knowledge and experience ranked as the highest concerns, and from the systematic side workload was the most important factor. CONCLUSION: This study provides an opportunity for stakeholders and Jordanian managers to increase their awareness of these factors and address them in the future, thereby increasing the level of care provided in their health organizations.

Exploring the Reliability and Validity of the Adapted Arabic Sense of Coherence Scale.

BACKGROUND AND PURPOSE: Applying strategies that improve sense of coherence (SOC) may positively affect adolescents' wellbeing. This may be particularly beneficial for those with chronic conditions. Therefore, having a valid measurement tool for SOC is important. This study assessed the validity and reliability of the Arabic version of the SOC questionnaire (A-SOC). Secondary objectives were to establish baseline data on SOC levels in a population of adolescents in the United Arab Emirates. METHODS: We used a cross-sectional correlational design. RESULTS: The A-SOC was found to be a valid tool, with a Cronbach's alpha of 0.75. The mean A-SOC score in the study sample was 57.38. CONCLUSIONS: Following an initial assessment of children's SOC, healthcare professionals could implement strategies that improve SOC for this population, thereby improving their general wellbeing.

Coping among adolescents with long-term health conditions: a mixed-methods study.

BACKGROUND: Adolescents with long-term health conditions may be at risk of developing psychological comorbidities and adopting ineffective coping mechanisms if they are not adequately supported at home or school. AIM: To understand the strategies adolescents use when dealing with challenging health situations, and gain an in-depth understanding of the characteristics of their preferred care environment if they have unexpected health crises. DESIGN: The study used a concurrent mixed-methods design, with data gathered between January and May 2019. Descriptive and non-parametric tests were used to analyse quantitative and qualitative data. RESULTS: 'Problem-focused disengagement' was the most-often used coping strategy. The second and third most common strategies were 'problem-focused engagement' and 'emotion-focused engagement'. Finally, girls tended to adopt more negative coping strategies than boys. The analysis revealed that most adolescents preferred home over school as the care environment because these caring agents were close and available, knew how to care for them and had the resources to provide or access care, and listened and understood them. CONCLUSION: Adolescents adopted disengagement and negative coping strategies early in their attempts to cope with stressful events before adopting more positive strategies. This is alarming, especially as school health services are not sufficiently supportive of adolescents at times of stress and illness. Adolescents often perceive school providers as unavailable and lacking knowledge about their health needs.