Pain and anxiety in patients with breast cancer treated with morphine versus tramal with virtual reality.

The treatment of pain and anxiety in cancer patients includes both pharmaceutical and non-pharmacological approaches. The researchers of this study aimed to compare the effectiveness of morphine versus Tramal with virtual reality therapy (VR) in reducing pain and anxiety in female patients with breast cancer. The sample was composed of 80 women with breast cancer who where treated at a specialized cancer center in Jordan. A quasi-experimental design was used in the study intervention. When used with VR, the tramal analgesics did not differe significactly from the effect of morphine in reducing the pain and anxiety. However, both groups had a significant drop in the level of pain and anxiety. When combined with VR, the use of weak opioids such as Tramal will have nearly the same effect as strong opioids such as Morphine in reducing pain and anxiety in breast cancer patients.

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.

Health satisfaction and family impact of parents of children with cancer: a descriptive cross-sectional study.

BACKGROUND: The impact on parents of coping with a child who has cancer can be both severe and multifarious. Considerable distress persists throughout the treatment phase, persisting even after completion of treatment with heightened anxiety and stress associated with thoughts of recurrence or relapse. AIM: The purpose was to investigate the links between parents' satisfaction with the health care offered to their child with cancer and the impact on families of caring for such a child (including their health-related quality of life) in a Middle Eastern country. STUDY DESIGN: A descriptive, correlational, cross-sectional design was adopted. Arabic versions of parent-completed, validated instruments were completed by 113 parents whose child had cancer. RESULTS: Family relationship was found to be the best functioning domain, and daily activities were seen to be the poorest. In general, parents expressed satisfaction with their child's health care, but inadequate attention had been paid to their emotional needs. Cases in which children were reported to exhibit more emotional and behavioural problems correlated with greater negative impact on the family and disrupted family functioning. DISCUSSION: Parental quality of life was more severely affected than family quality of life. This results from mothers taking up most of the caregiver burden, and the impact on mothers was significantly greater than that on fathers. Children were protected from stress and anxiety by their mother. This burden on mothers resulted in deficits in emotional, social and physical functioning. PRACTICE AND POLICY IMPLICATIONS: Nurses and other health professionals should redress the balance between family-centred care strategies and child-centred approaches. Effort is needed to provide psychological support to parents by ensuring adequate preparation of staff, especially nurses, to recognise need and provide support in a therapeutic environment. Support may be needed for years after the diagnosis. This is a health professional role that may currently be neglected, and for which training is essential.

Prolonged Grief Disorder and Its Relationship With Perceived Social Support and Depression Among University Students.

The purpose of the current study was to examine the association between prolonged grief disorder, perceived social support, and severity of depression among Saudi Arabian university students after the death of a significant individual. A cross-sectional design was used to examine descriptive characteristics, correlational relationships, and statistical mean differences between male and female participants on prolonged grief disorder (PGD) scores in a convenience sample of Saudi Arabian college students. The Prolonged Grief Disorder-13 tool, Multidimensional Scale of Perceived Social Support, and the revised Beck Depression Inventory® were completed by 226 Saudi Arabian undergraduate students. Students reported moderate perceived social support from family, friends, and significant others. Only 13 (5.8%) individuals reported perceived support from academic staff. Students with the highest PGD scores were the least well-supported and most depressed. The need for academic staff and social workers to provide more social support to grieving students is discussed. [Journal of Psychosocial Nursing and Mental Health Services, 57(2), 44-51.].

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.

Depression and perceived social support among Saudi patients with multiple sclerosis.

PURPOSE: To examine the association between depression level and perceived social support among patients with multiple sclerosis (MS) in Saudi Arabia. DESIGN AND METHODS: A cross-sectional, descriptive, correlational design was used with 140 patients. A self-reporting questionnaires were used. FINDINGS: The age range of the participants was 18-59 years (mean 34.3 years, SD 7.69). The mean score for reported depression was 27.5 which is considered as moderate level of depression. The mean score of the Multidimensional Scale of Perceived Social Support (MSPSS) was 45.3 (SD = 16.2). Patients with MS who received higher level of social support exhibits lower level of depression. PRACTICE IMPLICATIONS: Aside from addressing physiological needs, healthcare providers must ensure that patients with MS receive positive social support to decrease level of depression.

Psychometric Properties of the Coping Behavior Inventory Among Students of Arabic Universities.

PURPOSE: To examine the psychometric properties of the Coping Behavior Inventory (CBI) among Arab students in Jordanian universities. METHODS: A stratified random sampling technique was used to select the universities and classes from each university. The total sample size was 587 students recruited from seven universities during the academic year 2015. The structure of the CBI was analyzed by exploratory factor analysis (EFA) using Statistical Package for Social Science and confirmatory factor analysis (CFA) using AMOS software. EFA for the original CBI showed poor factors structure with low reliabilities. RESULTS: EFA and CFA revealed the modified 15-item and 3-factor scale (Problem Solving, Avoidance, Stay Optimistic), with high goodness of fit indices and strong items loading. CONCLUSION: The use of the modified version of CBI with students at the university level is recommended.

Stress and coping strategies among Saudi nursing students during clinical education.

PURPOSE: The purpose of this study was to determine the stress level and coping strategies among undergraduate Saudi female nursing students during their clinical education. DESIGN AND METHODS: In this study, a descriptive correlational cross-sectional design was used. The Demographic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were completed by 121 female Saudi undergraduate nursing students. FINDINGS: The findings showed that stress from taking care of the patient subscale (M = 12.0, SD = 5.0) was ranked the highest mean among all perceived stress subscale scores. The most commonly used coping strategies among nursing students in clinical practice was a problem-solving strategy (M = 15.8, SD = 4.3). PRACTICE IMPLICATIONS: Facilitating the use of effective coping strategies in nursing students will promote quality of care for their patients.

The Psychometric Properties of an Arabic version of the PedsQL Multidimensional Fatigue Scale Tested for Children with Cancer.

Fatigue is considered to be one of the most reported symptoms experienced by children with cancer. A major aim of this study was to develop an Arabic version of the Pediatric Quality of Life (PedsQL) Multidimensional Fatigue Scale (child report) and to test its psychometric proprieties for the assessment of fatigue in Arabic children with cancer. The PedsQL Multidimensional Fatigue Scale (Arabic version) and the PedsQL TM 4.0 Generic Core scale (existing Arabic version) were completed by 70 Jordanian children with cancer. Cronbach's alpha coefficients were found to be 0.90 for the total PedsQL Multidimensional Fatigue Scale (Arabic version), 0.94 for the general fatigue subscale, 0.67 for the sleep/rest fatigue subscale, and 0.87 for the cognitive fatigue subscale. The PedsQL Multidimensional Fatigue Scale scores correlated significantly with the PedsQL TM 4.0 Generic Core scale and demonstrated good construct validity. The results demonstrate excellent reliability and good validity of the PedsQL Multidimensional Fatigue Scale (Arabic version) for children with cancer. This is the first validated scale that assesses fatigue in Arabic children with cancer. The English scale has been used with several pediatric clinical populations, so this Arabic version may be equally useful beyond the field of cancer.

Testing of the Hospital Anxiety and Depression Scale in Patients With Chronic Obstructive Pulmonary Disease.

PURPOSE: The aim of this study was to develop the Arabic version of the Hospital Anxiety and Depression Scale (A-HADS) and test its psychometric proprieties for the assessment of anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). METHOD: The A-HADS and Quality of Life Index Pulmonary version were completed by 67 Jordanian patients with COPD. RESULTS: Cronbach's alpha coefficient has been found to be 0.75 for the A-HADS anxiety subscale and 0.82 for the A-HADS depression subscale. A-HADS scores correlated significantly with the Quality of Life Index Pulmonary version and demonstrated construct validity. IMPLICATIONS: This preliminary validation study supports the A-HADS as a reliable and valid instrument for the assessment of anxiety and depression in Arabic speaking patients with COPD.

Health-related quality of life and its association with self-esteem and fatigue among children diagnosed with cancer.

AIMS AND OBJECTIVES: To identify the links between self-esteem, fatigue and health-related quality of life for children and young people during and following treatment for cancer. BACKGROUND: Measures to minimise adverse outcomes for survivors of childhood cancer have been developed, but the crucial periods of returning to school and transition to adult life and adult services are not addressed so well. Screening of quality of life, fatigue and self-esteem in childhood cancer patients during and after treatment is important for optimising the nursing response and improving outcomes for children. DESIGN: A cross-sectional, descriptive, correlational, comparative survey was designed. METHODS: Validated measures of the attributes being studied were used. This study was conducted in private rooms on the ward and in the outpatient clinic of a major oncology hospital in Jordan in 2015. Seventy children aged 5-16 years were included. Ethical approval was secured. RESULTS: The age range of the children was 5-16 years (Mean 10·17, SD 3·4 years). Thirty were girls and 40 were boys. The total quality of life scores ranged from 21-100 (M = 65·5; SD = 17·6). The total scores of fatigue range from 12·5-100 (M = 65·79; SD = 22·20). Children with a high level of fatigue experienced lower quality of life. CONCLUSION: Continuing education centres at hospitals may find the results of this study helpful to provide professional updates and training events to enhance nurses' understanding of psychosocial distress responses and ability to intervene effectively within the multiprofessional effort. RELEVANCE TO CLINICAL PRACTICE: The outcomes of this study may enhance the development of guidelines for routine assessment by nurses and others of these factors among children with cancer. The nursing role in ensuring holistic care and attention to the problems of most concern to patients could be strengthened.

Prevalence of Internet Addiction and Its Association With Psychological Distress and Coping Strategies Among University Students in Jordan.

PURPOSE: The purpose of this study was to measure the prevalence of Internet addiction (IA) and its association with psychological distress and coping strategies among university students in Jordan. DESIGN AND METHODS: A descriptive, cross-sectional, correlational design was used with a random sample of 587 university students in Jordan. The Perceived Stress Scale, Coping Behavior Inventory, and Internet Addiction Test were used. FINDINGS: The prevalence of IA was 40%. IA was associated with high mental distress among the students. Students who used problem solving were more likely to experience a lower level of IA. PRACTICE IMPLICATIONS: This study should raise awareness in nurses and other healthcare providers that IA is a potential problem for this population.

Correlates of Stress and Coping among Jordanian Nursing Students during Clinical Practice in Psychiatric/Mental Health Course.

Training in psychiatric settings is stressful for nursing students. The purpose of this study was to examine the correlations between the students' characteristics, their stress degrees, stressors and types of coping strategies they experience during training in psychiatric course. A descriptive, correlational, longitudinal design was used. Sixty-five undergraduate nursing students were recruited randomly from five Jordanian universities. Self-report questionnaires were administered at the second semester of the 2012-2013 academic year. The findings showed that students who utilized avoidance or transference strategies reported high stress degrees. Moreover, the results showed that those students who were in the fourth year, with a low family income, who avoid extracurricular activities, with a low academic grade or who registered in other clinical course(s) reported high stress degrees. These findings present a worthy data for the clinical instructors that facilitate students training in psychiatric settings and promote their psychosocial well-being. Copyright © 2014 John Wiley & Sons, Ltd.

The factor structure of the internet addiction tool with university students in Jordan.

Internet addiction is a growing phenomenon affecting people in varying ways around the globe. This study examined the factor structure and internal reliability of the Internet Addiction Test (IAT) with a heterogeneous sample of university students in Jordan. The study used a cross-sectional design, and all the questionnaires were completed in classrooms. A sample of 587 students from seven universities in Jordan was obtained. The exploratory and confirmatory factor analyses of the 20-item IAT revealed that a four-factor solution offered the most parsimonious explanation of the data. The IAT reliably assesses distinct domains of Internet addiction. These domains are Excessive Use, Loss/Suffer, Attached To, and Impaired Social Relations. Thus, it is recommended to use the obtained four factors when assessing Internet addiction among a similar population.

Psychosocial correlates of Internet addiction among Jordanian university students.

Internet addiction is a significant international mental health problem among university students. The purpose of the current study was to investigate the correlation of Internet addiction with university students' characteristics in Jordan using a descriptive, correlational, cross-sectional design. The Internet Addiction Test, Beck Depression Inventory, and Multidimensional Scale of Perceived Social Support were administered to a random sample of 587 undergraduate university students. The findings demonstrated that university year level, student age, depression, and family support were significant correlates of Internet addiction. The current study should raise awareness in nurses and other health care providers that Internet addiction is a potential mental health problem for this student population. The findings from the current study will help develop appropriate interventions for these students and inform future research.

Quality of life, anxiety and depression among patients with chronic obstructive pulmonary disease and their spouses.

Chronic obstructive pulmonary disease (COPD) could have a negative impact on quality of life (QoL) and is associated with anxiety and depression in both patients and informal caregivers. The aim of this study was to examine the relationships between anxiety, depression and QoL of both Jordanian patients with COPD and their spouses. The selected design used in this study was a cross-sectional, descriptive, correlational design. A total of 67 patients and spouses were interviewed in 2011, using self-administered questionnaires. Descriptive statistical analysis was applied. Bivariate correlation analysis was undertaken to examine the relationship between variables. The results showed that patients and spouses with high levels of anxiety and depression reported a poor QoL. Patients had a lower QoL than their spouses. A better understanding of patient and spouse psychological wellbeing and QoL will provide nurses with the information needed in terms of developing strategies for reducing patients' and spouses' anxiety and depression and thus improve their QoL. The health-service agencies and government should improve policy by improving family-centred services for both patients and spouses.

Dyspnea-12-Arabic: testing of an instrument to measure breathlessness in Arabic patients with chronic obstructive pulmonary disease.

OBJECTIVE: The aim of this study was to develop the Dyspnoea-12-Arabic (D-12-A) questionnaire and test its reliability and validity for the assessment of breathlessness in Arabic speaking patients with chronic obstructive pulmonary disease (COPD) in Jordan. BACKGROUND: Breathlessness is a complex multidimensional symptom which incorporates physiology and psychology. METHODS: The D-12-A, Hospital Anxiety and Depression Scale (HADS), and Quality of Life Index pulmonary version (QLI-P) were completed by 67 Jordanian patients with COPD. Cronbach alpha was used to assess internal consistency, and Pearson product-moment correlation calculated for construct validity. RESULTS: The D-12-A and its sub-components ('physical' and 'affective') demonstrated excellent internal reliability (Cronbach alpha range from 0.88 to 0.91). D-12-A scores correlated significantly with other relevant outcome measures and demonstrated good construct validity. CONCLUSIONS: The D-12-A should provide clinicians and researchers with a useful tool for the assessment of breathlessness in Arabic speaking patients with COPD.

Perceived stress and coping strategies among Jordanian nursing students during clinical practice in psychiatric/mental health courses.

Clinical practice in the psychiatric/mental health nursing (PMHN) field is considered a highly-stressful experience for nursing students. The purpose of the present study was to identify the degrees of stress, the types of stressors, and coping strategies perceived by undergraduate nursing students during their clinical practice in PMHN courses. A descriptive, longitudinal design was used. Sixty-five students registered in PMHN clinical courses were recruited from five Jordanian universities using a systematic random-sampling method. Data collection was conducted in the second semester of the 2012-2013 academic year at two points of time: pre-PMHN clinical training and post-PMHN training. The Basic Information Questionnaire, Perceived Stress Scale, and Coping Behavior Inventory were administered. Students' ages ranged from 20 to 25 years. The findings illustrate that the highest reported types of stressors at both data-collection times were taking care of patients, stress related to teachers and nursing staff, and from assignments and workloads. The most utilized coping strategy at both data-collection times was problem solving. The findings of the present study are useful for clinical educators in identifying nursing students' stressors, easing their learning in the clinical setting, and establishing an efficient PMHN course programme.

Perceived breathlessness and psychological distress among patients with chronic obstructive pulmonary disease and their spouses.

The purpose of this study was to describe the impact of breathlessness on Jordanian patients with chronic obstructive pulmonary disease (COPD) and their spouses' perception of the patients' breathlessness. A cross-sectional, descriptive, correlational design was used with a sample of 67 Jordanian patients with COPD related breathlessness and their spouses. The Dyspnoea 12 Scale (D-12) and Hospital Anxiety and Depression Scale (HADS) were administered to both patients and spouses. There was a significant positive correlation between total patients' D-12 scores and total HADS scores. Spouses who perceived the patients to have more severe breathlessness affect (D-12 affect subscale) were more likely to experience a higher level of psychological distress (HADS total). Both patients and spouses reported clinically significant levels of anxiety and depression. There was no statistical difference in total D-12 and HADS scores between COPD patients and their spouses. The finding of this study indicates the importance of healthcare providers in supporting both patients with breathlessness and their spouses and the need to develop family-centred services.

Diagnosis, prognosis and awareness of dying in nursing homes: towards the Gold Standard?

BACKGROUND: In Western society and increasingly elsewhere, death has become medicalised and 'hospitalised' even when people are enduring deteriorating terminal conditions such as dementia and heart failure. In an attempt to rationalise and dignify the place and manner of death, evidence is emerging that the adoption of end-of-life care pathways and models can improve the experience of the end-of-life care across a range of care settings. Each of these demands skills and knowledge in the assessment and prediction of the dying trajectory. AIM: In this study, we report complexities facing relatives, residents and nursing home staff in the awareness, diagnosis and prediction of the dying trajectory. METHODS: Data were collected and analysed within a broadly qualitative methodology. The contexts were two nursing homes in the Greater Manchester area, each at different stages of implementing 'Gold Standards Framework' approaches to planning end-of-life care with residents and their relatives. From 2008 to 2011 and with appropriate consent, data were collected by a mixture of interviews and participant observation with residents, relatives and staff. Appropriate ethics approvals were sought and given. RESULTS: Key emerging themes were diagnosis and awareness of dying in which there is no substitute for experience. Significant resource is needed to engage staff, residents and relatives/carers with the idea of advance care planning. CONCLUSIONS: Talking to residents and relatives about their feelings and wishes for care at the end of life remains especially difficult, but education and training in key skills and knowledge can engender confidence. Challenges include diagnosing and predicting dying trajectories. IMPLICATIONS FOR PRACTICE: Advance care planning can reduce the distress from and number of inappropriate hospital admissions, but requires determination and consistent application of the approach. This can be very challenging in the face of staff rotation and the unpredictability both of the dying trajectory and the decision-making of some out of hours medical staff.