Determinants of breast cancer screening mammography uptake: Results from Jordan population and family health survey.

Background: Screening for breast cancer utilizing mammography is associated with reduced advanced cancer diagnosis and reduced breast cancer mortality. We aimed to assess the lifetime history of breast cancer screening utilization for Jordanian women aged 40 and 49 years and determinants of this utilization. Methods: This paper reports the analyzed data from the seventh cycle of the Jordan Population and Family Health Survey (JPFHS). For this study, the analysis was confined to 4486 women aged between 40 and 49 years at the time of data collection who reported their nationality as Jordanian. We used multivariate logistic regression analysis to assess whether any socio-demographic variables could predict greater breast cancer screening utilization. Results: Only 14% of all respondents aged 40-49 years reported ever having a mammogram. Results of multivariate logistic regression showed that area of residence, husband's level of education, younger age, and living in a wealthy status were strong predictors of lifetime history of breast cancer screening. Conclusions: This study elucidates that breast cancer screening mammography among Jordanian women has remained opportunistic and underutilized despite the efforts of national entities to promote screening and early detection of breast cancer. .: There is a geographic and social disparity in the utilization of mammography screening among Jordanian women.

The Relationship Between Nursing Care Delivery Models, Emotional Exhaustion, and Quality of Nursing Care Among Jordanian Registered Nurses.

Background: Inappropriately selected models of nursing care delivery and emotional exhaustion of nurses at work not only affect the nurses' health, but also the health of their patients. Purpose: To examine the relationship between nursing care delivery models, nurses' emotional exhaustion, and quality of nursing care. Methods: A cross-sectional survey that used a convenience sampling technique was employed. A total of 160 participants completed the study. Participants provided information about nursing care delivery models, nurses, emotional exhaustion, and quality of nursing care. Results: Participants had a moderate level of emotional exhaustion. No statistically significant difference in the scores of quality of nursing care and emotional exhaustion were found according to the type of care delivery model (P > .05). Emotional exhaustion was significantly and negatively correlated with the (nursing staff characteristics) subscale of quality of nursing care (r = -.183, P = .021). There was a significant difference in emotional exhaustion in regard to shift duty, marital status, education level, years of experience, salary, and working area). Only marital status significantly predicted emotional exhaustion (t = 2.57, B = -8.98, P = .011). Conclusions: Quality of nursing care was associated with nurses' emotional exhaustion rather than models of nursing care delivery. As nurses' emotional exhaustion could negatively affect the quality of nursing care, addressing the emotional exhaustion of nurses is important to improve patient outcomes.

Factors Affecting Jordanian Women's Surgical Treatment Decisions for Early-Stage Breast Cancer.

OBJECTIVE: This study aimed to assess factors influencing surgical treatment decisions for early-stage breast cancer among Jordanian women. METHODS: A descriptive correlational survey design was utilized to meet the study objective. A total of 180 Jordanian women diagnosed with unilateral early-stage breast cancer (Stages I-II) were recruited from the radiotherapy departments and outpatient surgical and breast cancer clinics at King Hussein Cancer Center (KHCC). Participants completed a structured questionnaire consisting of the Arabic version of the Depression Anxiety Stress Scale, Breast Surgery Beliefs and Expectations Scale, and the Arabic version of the Control Preference Scale. RESULTS: The majority of the participants underwent mastectomy as a definitive surgical treatment (i.e. 67%). Only stage at diagnosis and having a second opinion about surgical treatment options were significantly associated with the type of surgical procedure women opted for. The overwhelming majority of the participants in both groups cited the items of "Minimize the chance of breast cancer coming back" and "Minimize the chance of dying of breast cancer" as very important in their decisions for surgical treatment of unilateral early-stage breast cancer. Women who cited the item "remove breast for peace of mind" as important/very important were more likely to opt for mastectomy than women who cited the item as not important. CONCLUSIONS: Mastectomy is the preferred surgical treatment option for the majority of Jordanian women diagnosed with unilateral early-stage breast cancer at KHCC.

Evidence-based practice beliefs and implementations: a cross-sectional study among undergraduate nursing students.

BACKGROUND: Integrating evidence-based practice (EBP) into the daily practice of healthcare professionals has the potential to improve the practice environment as well as patient outcomes. It is essential for nurses to build their body of knowledge, standardize practice, and improve patient outcomes. This study aims to explore nursing students' beliefs and implementations of EBP, to examine the differences in students' beliefs and implementations by prior training of EBP, and to examine the relationship between the same. METHODS: A cross-sectional survey design was used with a convenience sample of 241 nursing students from two public universities. Students were asked to answer the questions in the Evidence-Based Practice Belief and Implementation scales. RESULTS: This study revealed that the students reported a mean total belief score of 54.32 out of 80 (SD = 13.63). However, they reported a much lower implementation score of 25.34 out of 72 (SD = 12.37). Students who received EBP training reported significantly higher total belief and implementation scores than those who did not. Finally, there was no significant relationship between belief and implementation scores (p > .05). CONCLUSION: To advance nursing science, enhance practice for future nurses, and improve patient outcomes, it is critical to teach nursing students not only the value of evidence-based knowledge, but also how to access this knowledge, appraise it, and apply it correctly as needed.

Smoking cessation counselling practices among health care providers dealing with cancer patients.

AIM: To asses smoking cessation counselling practices (SCC) among health care providers dealing with cancer patients. METHOD: A cross-sectional design was used with a sample of 300 providers from three hospitals in Jordan. A self-report questionnaire was distributed. RESULTS: During the initial visit, the most frequent practices were asking patients if they smoke and advise smokers to quit (50%, 45% respectively). Only 13% of providers reported treating or referring patients for smoking use cessation intervention. During the follow-up visits, the most frequent practice was reinforcing the stopping of tobacco use 39%. Overall, physicians had the highest scores of adherence to applying SCC practices. Besides, over 85% of participants believe that tobacco cessation should be a standard part of cancer interventions and clinicians need more training. Over 80% agreed that barriers of implementing SCC practices include lack of training and resources. Finally, receiving SCC training, more years since completion of the most senior degree, and more time spent with cancer patients predicted a higher score of total SCC practices (P < .05). CONCLUSION: It is essential to provide training, referral facilities, and supportive policies to encourage SCC practices.

The relationship between perceived competence and perceived workplace bullying among registered nurses: A cross sectional survey.

BACKGROUND: Workplace bullying is one of the most prevalent work-related psychological and physical issues in health care facilities. Workplace bullying has detrimental effects not only on the bullied person/persons but also on health care facilities and care quality and patient safety. AIMS: To examine the prevalence of workplace bullying and the relationship between workplace bullying and perceived competence among Jordanian registered nurses working in private hospitals DESIGN: A cross-sectional survey study. SETTING: Data were collected from registered nurses working in seven private hospitals in the Capital of Amman. PARTICIPANTS: Participants were 269 registered nurses who had a minimum of a bachelor degree, passed the hospital's competency nursing examinations, able to read and understand English, and were able and willing to complete the survey. METHODS: The Negative Act Questionnaire-Revised, and Nurse Professional Competence scale were used for data collection. Multiple linear regression analysis was conducted to assess predictors of greater reporting of perceived workplace bullying. FINDINGS: Almost 43% of the participants perceived themselves to be victims of severe workplace bullying while more than 31% perceived themselves to be victims of occasional workplace bullying. Person-related bullying was the most frequently reported type of workplace bullying followed by work-related bullying. Age, gender, and sum score on Nurse Professional Competence scale explained significant amount of variance in perceived workplace bullying. CONCLUSION: The majority of Jordanian nurses working in private hospitals perceive themselves as victims of either occasional or severe workplace bullying. Amongst all related variables, perceived competence is the most significant predictor of perceived workplace bullying.

Jordanian physicians' perceived barriers and facilitators to patient participation in treatment decision-making: An exploratory study.

BACKGROUND: Successful implementation of shared decision-making in clinical encounters is influenced by system, patient, and clinician factors that both facilitate and present barriers to patient-centered care. Little is known about which factors Jordanian physicians believe influence their ability to implement shared decision-making with cancer patients. AIMS: To determine Jordanian physicians' perceived barriers and facilitators to patient participation in treatment decision-making. SETTINGS AND DESIGN: A cross-sectional exploratory survey design was used in the study. A convenience sample of 86 Jordanian medical and radiation oncologists and surgeons was recruited. MATERIALS AND METHODS: A valid measure of physicians' views of shared decision-making was slightly modified from its original English and used to collect data. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) for windows version 19.0 (SPSS, Inc., Chicago, IL, USA). Descriptive and inferential statistics were carried as appropriate. RESULTS: Insufficient time to spend with the patient, patient expecting a certain treatment rather than a consultation, and the patient's family overriding the decision-making process were the most frequently reported barriers to patient participation in treatment decision-making. Physicians believed that patients trust in physicians and patient being accompanied at the consultation were important facilitators of patient participation in treatment decision-making. CONCLUSIONS: Jordanian physicians perceive multiple barriers to patient participation in treatment decision-making. Patient-related difficulties (e.g., indecision), and system-related difficulties, in particular, patient's family influence on the decision-making process are more prevalent among Jordanian physicians compared to Western physicians.

Promoting emancipated decision-making for surgical treatment of early stage breast cancer among Jordanian women.

To use the critical social theory as a framework to analyze the oppression of Jordanian women with early stage breast cancer in the decision-making process for surgical treatment and suggest strategies to emancipate these women to make free choices. This is a discussion paper utilizing the critical social theory as a framework for analysis. The sexist and paternalistic ideology that characterizes Jordanian society in general and the medical establishment in particular as well as the biomedical ideology are some of the responsible ideologies for the fact that many Jordanian women with early stage breast cancer are denied the right to choose a surgical treatment according to their own preferences and values. The financial and political power of Jordanian medical organizations (e.g., Jordan Medical Council), the weakness of nursing administration in the healthcare system, and the hierarchical organization of Jordanian society, where men are first and women are second, support these oppressing ideologies. Knowledge is a strong tool of power. Jordanian nurses could empower women with early stage breast cancer by enhancing their knowledge regarding their health and the options available for surgical treatment. To successfully emancipate patients, education alone may not be enough; there is also a need for health care providers' support and unconditional acceptance of choice. To achieve the aim of emancipating women with breast cancer from the oppression inherent in the persistence of mastectomy, Jordanian nurses need to recognize that they should first gain greater power and authority in the healthcare system.

Health-related information exchange experiences of Jordanian women at breast cancer diagnosis.

The aim of this study was to explore Jordanian women's experiences of information exchange following diagnosis of early stage breast cancer. A purposive sample of 28 women who had surgery for early stage breast cancer within 6 months prior to the interview and had treatment at three hospitals in Central and Northern Jordan was recruited for the study. Data were collected using semi-structured individual interviews focused on women's communication experiences at diagnosis and during cancer treatment. Interviews were audio taped, transcribed verbatim in Arabic, and analyzed using conventional content analysis. Three main themes associated with information exchange were revealed as follows: (1) knowledge about breast cancer and its treatment, (2) communication of cancer diagnosis and treatment, and (3) educating on treatment side effects. Misconceptions about breast cancer risk factors, consequences of breast cancer treatment, and breast cancer-related symptoms were common among participants. Women made important health-related decisions based on misconceptions. Physician's information giving, availability, and responses to women's questions varied by their level of education and the type and location of treatment facility. Informational exchange experiences vary among Jordanian women diagnosed with breast cancer and raise concern over opportunities offered these women to engage in informed decision making. Findings suggest a need for nurses to assess the information needs of Jordanian women newly diagnosed with breast cancer and provide education tailored to individual needs. There is also a need to develop Arabic educational materials and make these available for patients at treatment facilities in all regions of Jordan.

Shared decision making among individuals with cancer in non-Western cultures: a literature review.

PURPOSE/OBJECTIVES: To examine the extent to which shared decision making is a concept addressed within the published, empirical oncology decision-making research originating from non-Western countries from January 2000 to January 2012 and provide an overview of the outcomes of this research. DATA SOURCES: MEDLINE®, CINAHL®, Google Scholar, PsycINFO, Web of Science, and PubMed were searched for oncology decision-making literature published in English from January 2000 to January 2012. DATA SYNTHESIS: Charles's three-stage conceptual framework of shared decision making was used as an organizational framework for the 26 articles meeting the initial criteria and reporting on at least one decision-making stage. CONCLUSIONS: Although most patients wanted to be informed of their diagnosis, patient preferences for information and participation in decision making differed from that of physicians and varied among and within cultures. Few studies in this review addressed all three stages of shared decision making. Physician and patient attitudes, preferences, and facilitators and barriers to potential successful adoption of shared decision making in non-Western cultures require additional study. IMPLICATIONS FOR NURSING: Nurses should assess patients from non-Western countries regarding their knowledge of and desire to participate in shared decision making and provide decision support as needed. KNOWLEDGE TRANSLATION: Shared decision making may be new to patients from non-Western cultures, necessitating assessment, education, and support. Non-Western patients may value having family and friends accompany them when a cancer diagnosis is given, but assumptions based on culture alone should not be made. Nurses should determine patient preferences for diagnosis disclosure, information, and participation in decision making.

Positive work environments of early-career registered nurses and the correlation with physician verbal abuse.

BACKGROUND: Verbal abuse in the workplace is experienced by registered nurses (RNs) worldwide; physicians are one of the main sources of verbal abuse. PURPOSE: To examine the relationship between levels of physician verbal abuse of early-career RNs and demographics, work attributes, and perceived work environment. METHOD: Fourth wave of a mailed national panel survey of early career RNs begun in 2006. DISCUSSION: RNs' perception of verbal abuse by physicians was significantly associated with poor workgroup cohesion, lower supervisory and mentor support, greater quantitative workload, organizational constraints, and nurse-colleague verbal abuse, as well as RNs' lower job satisfaction, organizational commitment, and intent to stay. CONCLUSION: RNs working in unfavorable work environments experience more physician abuse and have less favorable work attitudes. Causality is unclear: do poor working conditions create an environment in which physicians are more likely to be abusive, or does verbal abuse by physicians create an unfavorable work environment?

Controlling fear: Jordanian women's perceptions of the diagnosis and surgical treatment of early-stage breast cancer.

BACKGROUND: Despite the fact that breast cancer is the most prevalent cancer among Jordanian women, practically nothing is known about their perceptions of early-stage breast cancer and surgical treatment. OBJECTIVE: The objective of this study was to gain understanding of the diagnosis and surgical treatment experience of Jordanian women with a diagnosis of early-stage breast cancer. METHODS: An interpretive phenomenological approach was used for this study. A purposive sample of 28 Jordanian women who were surgically treated for early-stage breast cancer within 6 months of the interview was recruited. Data were collected using individual interviews and analyzed using Heideggerian hermeneutical methodology. RESULTS: Fear had a profound effect on Jordanian women's stories of diagnosis and surgical treatment of early-stage breast cancer. Women's experience with breast cancer and its treatment was shaped by their preexisting fear of breast cancer, the disparity in the quality of care at various healthcare institutions, and sociodemographic factors (eg, education, age). CONCLUSIONS: Early after the diagnosis, fear was very strong, and women lost perspective of the fact that this disease was treatable and potentially curable. To control their fears, women unconditionally trusted God, the healthcare system, surgeons, family, friends, and/or neighbors and often accepted treatment offered by their surgeons without questioning. IMPLICATIONS FOR PRACTICE: Jordanian healthcare providers have a responsibility to listen to their patients, explore meanings they ascribe to their illness, and provide women with proper education and the support necessary to help them cope with their illness.