Decision Making Near End of Life: A Qualitative Exploration of the Lived Experiences of Jordanian Healthcare Providers.

BACKGROUND: Discussions related to a patient's prognosis and interventions near end of life are challenging and stressful for healthcare providers. Many reported experiencing emotional distress and discomfort during the decision-making process. OBJECTIVES: The aim of this study was to describe the lived experience of nurses and physicians who participate in decision making near the end of a patient's life. METHODS: A descriptive, phenomenological approach was used with a purposive sample of 7 nurses and 6 physicians from 2 palliative and end-of-life care institutions in Jordan. Data derived from focus group discussions conducted online via the ZOOM video communication application, and analysis followed Colaizzi's qualitative methodology. RESULTS: Three major themes emerged from the healthcare providers' experiences. Initially, the participants described how they "strive toward optimal decision-making near end of life," "the overwhelming experience of decision making near end of life," and finally, their struggle in sharing details about the end of life when patients ask and whether to tell or not to tell them as "the time for hard talk." CONCLUSIONS: The healthcare providers' experiences revealed several issues of decision making near a patient's end of life, such as a lack of appropriate training and administrative support, emotional distress, fear of legal liability, and the burden of a hard talk with patients. These findings necessitate institutional support of setting appropriate policies and guidelines, staff counseling, and healthcare provider support. IMPLICATIONS FOR PRACTICE: Institutions providing palliative and end-of-life care can use this study's findings to support their staff by setting appropriate practice guidelines and providing staff training and counseling.

Nursing Faculty Experience With Online Distance Education During COVID-19 Crisis: A Qualitative Study.

BACKGROUND: COVID-19 pandemic influenced education and forced universities to shift from face-to-face teaching to remote online teaching. This sudden shift in educational pedagogy provoked several challenges to educators. PURPOSE: The purpose of this study is to explore the first experience of nursing faculty members with online distant education (ODE) within the context of COVID-19 national curfew. METHODS: A qualitative descriptive design guided by a phenomenological approach was used utilizing purposive sampling for exploring the experiences of fifteen nursing faculty members by two focus group discussions through Zoom. RESULTS: Qualitative analysis, using Colaizzi's method revealed four major themes including: (1) resolving immediate reaction toward abrupt compulsory online teaching; fulfilling teaching responsibilities; managing the challenges of ODE, (2) struggling with available resources and capabilities; (3) ODE defeated geographic and time boundaries, and interrupted personal time management: yet a new learning experience; insufficiency of ODE; and (4) achieving clinical competencies and learning outcomes. CONCLUSIONS: This study provides evidence on the importance of preparing and training faculty to embrace and sustain the mastery of ODE to ensure the success of ODE. It also emphasizes the institutional and infrastructure readiness to enhance the transition from traditional teaching and learning to ODE.

Involvement of Jordanian Patients and Their Families in Decision Making Near End of Life, Challenges and Recommendations.

This study aims to explore the challenges in involving patients and their families in decision making near end of life and to provide recommendations to overcome these challenges. A qualitative descriptive phenomenological approach was used with a purposive sample of 8 patients, 7 family caregivers, 7 nurses, and 6 physicians from 2 institutions that provide palliative and end-of-life care services in Jordan. Data were collected using interviews with patients and family caregivers and focus group discussions with nurses and physicians. Colaizzi's method was used to analyze the data. The thematic analysis revealed 5 themes representing the participants' experiences of challenges with decision making near end of life. The identified challenges are (1) struggle with lack of information; (2) improper communication; (3) patient's or family's decision: the cultural taboo; (4) health care providers prefer staying in their comfort zone; and (5) the paradox of surviving and letting go. In addition, the participants endorsed several recommendations to raise public awareness of palliative and end-of-life care, amplify the patients' voice, and raise the bar of communication sensitivity. Decision making near the end of life is a challenge. However, the current study highlighted several areas for improvement that can improve the process and optimize patients' and their families' involvement.

Experiences of nursing students under the unprecedented abrupt online learning format forced by the national curfew due to COVID-19: A qualitative research study.

BACKGROUND: The unprecedented abrupt shift to remote online learning (OL) within the context of the national lockdown due to the 2019 coronavirus disease (COVID-19) highlights the importance of addressing students' preparedness in managing their first experiences with OL. PURPOSE: To investigate the experiences of undergraduate nursing students during their first uses of OL to increase the understanding of their encountered opportunities and challenges. DESIGN: A descriptive qualitative design guided by a phenomenological approach was used. METHODS: The study used a purposive sampling technique to recruit 18 undergraduate nursing students from two universities. Data were collected using two focus group discussions, and the discussions with participants were audio/video recorded through the online platform Zoom due to the national imposed curfew. Content analysis employed Colaizzi's steps to derive the themes/categories. RESULTS: The study revealed four themes: experience of helplessness, burdens, and burnout; the need for social and technical support to manage OL; the propensity to consider OL as a positive opportunity; and the deficiency of OL in fulfilling the educational outcomes of clinical courses. CONCLUSIONS: Abrupt remote OL was a challenge to clinical encounters. This format was very stressful; however, it was also useful. The current study highlighted the need for further research on the effectiveness of remote OL platforms in regard to the achievement of the intended learning outcomes of clinical courses.

The health-related quality of life of Syrian refugee women in their reproductive age.

BACKGROUND: Health-Related Quality of Life (HRQoL) for refugee women in reproductive age is highly affected by physical, political, psychosocial and environmental conditions in countries of asylum. HRQoL is enormously affected by the satisfaction of this vulnerable group with the physical, psychological, emotional and social care services provided in this critical time. Therefore, this study aimed toassess the HRQoL among Syrian refugee women of reproductive age living outside camps in Jordan. METHODS: A cross-sectional correlational study was conducted with a convenience sample of 523 Syrian refugee women in the host communities in Jordan.Health-related quality of life (HRQOL) was measured using the short-form 36 (SF-36) questionnaire. RESULTS: Significant negative correlations were found between SF-36 individual subscales score and the length of marriage, the number of children, parity and family income. The strongest correlations were between pain scale and length of marriage (r =  - .21), and between Energy/Fatigue and 'number of children' (r =  - .21). Conversely, antenatal care was positively correlated with physical, role emotional, pain, and general health. Physical functioning and general health were predicted significantly with less years of marriage, younger age at marriage, less violence and by higher family income. CONCLUSION: This study suggests low HRQoL scores for women of reproductive age across all domains. Several factors such as years of marriage, age at marriage, the number of children, violence, antenatal care and family income affected the women's general health. The provision of appropriate and accessible reproductive and maternal healthcare services in antenatal visits is critical for ensuring the immediate and long-term health and wellbeing of refugee women and their families.

Developing an Understanding of Adolescents' Knowledge, Attitudes, and Practices Toward COVID-19.

Adolescents are more likely to engage in risky health practices related to COVID-19. Their compliance with infection control measures is a key factor to mitigate the spread of the disease. The purpose of this study was to explore the knowledge, attitudes, and practices toward COVID-19 and their correlates among Jordanian adolescents. An online cross-sectional survey was utilized. A total of 1,054 Jordanian adolescents aged 12-18 completed and returned the survey. Overall, Jordanian adolescents showed a good base of knowledge regarding COVID-19 (regardless of their demographic characteristics) and tended to hold positive attitudes toward the country's curfew and other protective measures. The majority of adolescents reported that television and social media were their main source of information on COVID-19, while few reported receiving such information from their schools. The majority reported practicing effective health protective behaviors to prevent the spread of COVID-19, which was significantly predicted by their knowledge and attitudes toward these measures. However, there was a relatively small, yet clinically significant, percentage of adolescents who showed poor knowledge on COVID-19, had negative attitudes toward protective measures, and reported being engaged in risky practices related to infection spread. Tailored efforts are needed to improve the levels of knowledge, attitudes, and practices among adolescents. Raising awareness and promoting positive attitudes are vital to change adolescents' health practices. Policy makers should ensure that school nurses are available in all schools and working to their full scope. School nurses are the eyes and ears of public health and primary care. They are essential members on pandemic preparedness, reopening and reentry planning teams, and can lead health care in schools and practice in a holistic culturally competent proactive manner to address the needs of students.

Perception of diabetes management and cardiovascular disease risk among men with type 2 diabetes: A qualitative study.

Aim: The aim of this study was to explore the perception and understanding of men with type 2 diabetes about their illness control, risk for CVD and their adherence to healthcare management plans in Jordan. Design: A qualitative descriptive design was used, recruiting a purposive sample of 13 men diagnosed with type 2 diabetes. Methods: Data were collected between February and April 2019 through in-depth semi-structured interviews and analysed using content analysis. Results: Data analysis revealed four themes: (a) Perception of diabetes control; (b) Perception of cardiovascular disease risk; (c) Coping with disease-imposed limitations; and (d) Information validation. Conclusion: The study concludes that the perception of disease control does not necessarily coincide with actual disease control. Examining patients with diabetes perception and knowledge of their healthcare management and increased CVD risks is essential. An individualized culture and gender-sensitive health education and counselling involving spouses are recommended. Social media to disseminate scientific valid health instructions can enhance adherence.

Knowledge, Attitudes And Practices Of Syrian Refugee Mothers Towards Sexually Transmitted Infections.

PURPOSE: Refugee women are vulnerable to sexually transmitted infections (STIs) due to risk factors associated with displacement. This study aimed to assess the knowledge, attitudes, and practices related to STIs among Syrian refugee mothers in Jordan. METHODS: A cross-sectional correlational study was conducted with a convenience sample of 523 Syrian refugee mothers in host communities in Jordan. RESULTS: A moderately positive relationship between the mothers' knowledge of and attitudes towards STIs (p<0.001) was found. Although Syrian refugee mothers' attitudes towards STIs were reasonably good, they had poor knowledge about non-HIV causes of STIs and clinical symptoms. Spousal acceptance of using a condom was significantly associated with mothers' STIs knowledge, attitude, length of being a refugee in Jordan and duration of marriage (p<0.05). Almost all Syrian refugee mothers (91.6%) and their spouses (95%) did not follow regular check-ups for STIs. Two-thirds of mothers'- spouses (66.6%) did not accept the usage of a condom during sexual intercourse. CONCLUSION: Syrian refugee mothers have poor knowledge about non-HIV causes of STIs and clinical symptoms. They have poor practices concerning STI screening and prevention. It is imperative that nurses address these issues especially among refugees where in locales where resources are scarce.

Jordanian Nursing Student and Instructor Perceptions of the Clinical Learning Environment.

Background Training within clinical areas is a vital part of nursing education. In order to effectively modify and facilitate such training, it is important to understand the perceptions of nursing educators and students about what constitutes effective practices. OBJECTIVE: This study explores perceptions of Jordanian nursing students and clinical instructors related to clinical training and the learning environment. DESIGN: Interpretative phenomenological qualitative approach was used in this study. METHOD: semi-structured focus group interviews in two Jordanian Universities Results: The study identified four themes focused on the experiences of these participants. Themes were attributes of clinical training placement, attributes of clinical instructors, attributes of clinical nursing curriculum and student's attributes. The first theme had two subthemes "Structure and nature of clinical placement" and "Nurses' collaboration". CONCLUSION: The study recommendations are: nursing schools should plan students' clinical experience taking into consideration the challenges associated with these attributes.

Nursing research in the Arab Region: A bibliometric analysis.

AIMS: Scientific discovery in general, and nursing research specifically, is an increasingly global effort consistent with changing demographics and the need to provide culturally competent care in a diverse society. Given that Arabs account for an increasing proportion of the populations in many Western countries, this study presents findings from the first bibliometric analysis of nursing research conducted through December 2017 in the Arab region. METHODS: We used quantitative and qualitative indicators to analyse bibliometric data from Scopus. RESULTS: We provided significant data on Arab nursing publication output and growth trends; types of published documents; publication geographic loci, focus, and subject categories; authors' collaboration patterns; core publishing journals and their impact; and citation patterns. CONCLUSIONS: Our findings highlighted the need for Arab policy makers and funding agencies to allocate research funding that supports the dissemination of Arab nursing research into the broader scientific community so that Western researchers, policymakers, and health care providers can appropriately address the health care needs of Arab individuals and families. The insights gleaned regarding the performance of journals, authors, countries, and institutions are discussed in relation to the potential impacts of the publish-or-perish culture of the current academic world.

Transcultural Adaptation and Validation of Champion's Health Belief Model Scales for Prostate Cancer Screening.

BACKGROUND: Examining men's health beliefs regarding prostate cancer screening is a vital issue and requires a reliable and valid scale. PURPOSE: Modify Champion's Revised Health Belief Model Scale to measure Jordanian men's beliefs about PCS, translate to Arabic, culturally adapt, and test its psychometric prosperities. METHOD: This was a methodological study in which 432 healthy men were selected by convenient sampling. Analysis included estimation of content validity indices, internal consistency, construct validity, and predictive validity. RESULTS: Exploratory factor analysis yielded seven significant factors which explained variance 68.9% of variance. Confirmatory factor analysis demonstrated that scale fit the data significantly. Cronbach's alpha coefficient ranged from .83 to .92. CONCLUSION: Scale was found to be a valid and reliable for use with Jordanian men.

Quality of life, depression, adherence to treatment and illness perception of patients on haemodialysis.

The purpose of this study was to explore the relationship between quality of life, depression, perception of seriousness of illness and adherence to treatment among Jordanian patients with end stage renal disease on maintenance haemodialysis. The study was carried out using a descriptive, correlation design. A convenience sample of 244 participants was recruited from four major dialysis units in Amman. A self-report questionnaire included demographic data, adherence to treatment and perception of seriousness of illness. Quality of Life Index and Beck Depression Inventory were used for data collection. There was a negative correlation between quality of life and depression (r = -0.05, P = 0.000). Depression was higher among women than men, whereas both gender had low quality of life scores. Higher quality of life has been associated with perceived seriousness of illness and more adherence to treatment regimen. This study provides preliminary evidence to develop culturally sensitive nursing strategies to asses and manage depression, enhance quality of life and adherence to treatment of patients on haemodialysis.

Hemodialysis stressors and coping strategies among Jordanian patients on hemodialysis: a qualitative study.

The aim of this study was to examine the lived experiences of Jordanian patients with chronic kidney disease who received hemodialysis. Qualitative interviews were conducted to identify patients' lived experiences. Transcripts analyzed led to seven common themes: lifestyle change, time wasted, symptom-related suffering, marital and family role disruption, religious commitment disruption, motivators to alleviate stressors, and experience of healthcare providers' support. Findings revealed areas where nurses and other healthcare providers can improve care for this patient population and for patients with other chronic illnesses.

Spirituality, illness and personal responsibility: the experience of Jordanian Muslim men with coronary artery disease.

Spiritual care is an aspect of nursing in many parts of the world; however, there is very little evidence of this in an Arab Muslim country. This qualitative study explores the meaning of spirituality as experienced by Jordanian Muslim men living with coronary artery disease. A hermeneutical phenomenological orientation was used to explore the experience of spirituality as lived by Arab Muslim men with coronary artery disease. A purposive sample of 19 men was selected from the Coronary care Unit (CCU) in a teaching hospital in Jordan. Data were collected using semi-structured interviews. Data were analyzed using Colaizzi's steps of phenomenological analysis. Four themes emerged from the data. The participants explained that faith facilitated their acceptance of illness and enhanced their coping strategies, that seeking medical treatment did not conflict with their belief in fate, that spirituality enhanced their inner strength, hope and acceptance of self-responsibility and it helped to them to find meaning and purpose in their life. In this study, Parse's theory of human becoming served as the foundation for understanding the paradoxical rhythmical pattern of the human experience of spirituality in illness. The findings suggest that patients' faith plays a central role in the choices they make either healthy or unhealthy, or accepting or rejecting their personal responsibility in promoting their future health and well-being. In addition, it provide nurses with the basis for providing spiritual care and developing a culturally sensitive healthcare plans in this population.

Islamic religious leaders' knowledge and attitudes towards AIDS and their perception of people living with HIV/AIDS: a qualitative study.

PURPOSE: This qualitative descriptive study explored Muslim religious leaders' perception, knowledge and attitudes towards AIDS, AIDS prevention and their attitudes towards people living with HIV/AIDS (PLWHA). METHODS: Twenty Islamic religious leaders (males and females) participated in two audio-taped focus group discussions. A content analysis approach was used to analyse the data as appropriate for descriptive qualitative inquiry. FINDINGS: The study results showed that Muslim religious leaders do not perceive AIDS as a major health problem in Jordan, and that following the Islamic values lowers the risky behaviours. The religious leaders reflected varied responses to PLWHA but they agreed that they have responsibilities towards the prevention of HIV/AIDS, and that sex education contributes to healthy behaviours, and consequently to the prevention of HIV transmission. CONCLUSION: The findings of this study provided an insight into Muslim religious leaders' perception of PLWHA and highlighted the importance of their role in the prevention of AIDS. The study recommended that health care professionals, including nurses and health policy makers, should involve religious leaders in all efforts directed at planning and setting policies aimed at the prevention of HIV/AIDS and the treatment of infected people. Nurses should be responsible for conducting HIV/AIDS prevention programs in different settings utilizing relevant religious guidelines and teachings, in addition to providing holistic care to AIDS patients with emphasis on the spiritual dimension.