Depression and caregiver burden experienced by caregivers of Jordanian patients with stroke.

Many stroke survivors will be cared for at home, primarily by their relatives. Providing care to a family member with a chronic disabling disease can be both emotionally and physically distressing for the caregivers. The purpose of this study was to investigate the relationship between patients' characteristics, duration of caregiving, daily caregiving time, caregiver's characteristics, caregiver depression and burden in caregivers of patients with stroke. A cross-sectional design was used with a convenience sample of 116 subjects. The Center of Epidemiologic Studies of Depression and the Caregiver Strain Index were used to identify caregiver depression and burden, respectively. Logistic regression analysis identified the influence of independent variables on caregiver depression and caregiver burden. Caregivers had high scores for depression and burden indices. Caregivers' health, receiving professional home health care and caregivers' burden were related to caregiver depression. Functional disabilities of patients with stroke and depression of caregivers were related to caregiver burden. To decrease caregiver depression and burden, nurses must provide caregivers with instructions for home management of patients with stroke. Development of specialized stroke home health services in Jordan that targets patients with stroke and their caregivers are recommended.

Who uses nursing theory? A univariate descriptive analysis of five years' research articles.

BACKGROUND: Since the early 1950s, nursing leaders have worked diligently to build the Scientific Discipline of Nursing, integrating Theory, Research and Practice. Recently, the role of theory has again come into question, with some scientists claiming nurses are not using theory to guide their research, with which to improve practice. AIMS: The purposes of this descriptive study were to determine: (i) Were nursing scientists' research articles in leading nursing journals based on theory? (ii) If so, were the theories nursing theories or borrowed theories? (iii) Were the theories integrated into the studies, or were they used as organizing frameworks? METHODS: Research articles from seven top ISI journals were analysed, excluding regularly featured columns, meta-analyses, secondary analysis, case studies and literature reviews. The authors used King's dynamic Interacting system and Goal Attainment Theory as an organizing framework. They developed consensus on how to identify the integration of theory, searching the Title, Abstract, Aims, Methods, Discussion and Conclusion sections of each research article, whether quantitative or qualitative. RESULTS: Of 2857 articles published in the seven journals from 2002 to, and including, 2006, 2184 (76%) were research articles. Of the 837 (38%) authors who used theories, 460 (55%) used nursing theories, 377 (45%) used other theories: 776 (93%) of those who used theory integrated it into their studies, including qualitative studies, while 51 (7%) reported they used theory as an organizing framework for their studies. Closer analysis revealed theory principles were implicitly implied, even in research reports that did not explicitly report theory usage. CONCLUSIONS: Increasing numbers of nursing research articles (though not percentagewise) continue to be guided by theory, and not always by nursing theory. Newer nursing research methods may not explicitly state the use of nursing theory, though it is implicitly implied.

The Disaster Preparedness Evaluation Tool: psychometric testing of the Classical Arabic version.

AIM: This paper is a report of a study conducted to translate the Disaster Preparedness Evaluation Tool into Arabic and to determine its psychometric properties, including reliability, validity and factorial structure. BACKGROUND: Worldwide numbers of natural and man-made disasters have greatly increased in recent years. Since disaster strikes without warning, all healthcare providers, especially nurses, must be prepared with appropriate skills and resources for disaster procedures and management during the three phases of disaster: pre disaster, during disaster and post disaster. Knowledge levels need to be evaluated to plan effective educational programmes. METHODS: The Disaster Preparedness Evaluation Tool was translated into Classical Arabic using Beaton's guideline for translation and validated by experts and a pilot study with 20 Registered Nurses from the target population. Data were collected in 2008 using self-administered questionnaires from 474 (79% return rate) Jordanian Registered Nurses who worked in randomly selected Ministry of Health hospitals and two university hospitals. RESULTS: Principal component analysis (Promax rotation with Kaiser Normalization procedure, SPSS version 15) was used to determined construct validity, and three factors explained 64% of the variance: knowledge, skills and post disaster management. Cronbach's alpha was 0.90, which demonstrated internal consistency. CONCLUSION: These results support the reliability and validity of the Disaster Preparedness Evaluation Tool as a measure of knowledge, skills and post disaster management. It can be used with confidence with an Arabic-speaking nursing population to measure their preparedness for disasters. Based on the results of such studies, effective disaster preparedness programmes could be developed to enhance nurses' disaster preparedness.

The effects of a cardiovascular disease prevention program on knowledge and adoption of a heart healthy lifestyle in Jordanian working adults.

BACKGROUND: Improving cardiac related knowledge to further healthy lifestyles is the best preventive strategy against coronary heart diseases (CHD). Previous studies revealed a critical shortage in all-around cardiac related knowledge, plus an overall shortage in adopting healthy lifestyle behaviors. AIMS: To evaluate the effectiveness of an education, counseling and behavioral skill-building program in Jordanian working adults' knowledge, attitudes, and beliefs about CHD and adoption of a healthy lifestyle. METHODS: A non-equivalent quasi-experimental design was used to evaluate the effectiveness of the intervention program that is based on Pender's Health Promotion Model. The Response Questionnaire and HPLP-II were used to measure subjects' knowledge, attitudes, beliefs and adoption of healthy lifestyle. RESULTS: One hundred six subjects completed the posttest questionnaires. Experimental group showed significantly better cardiac related knowledge, better scores for attitudes, and better scores for the health responsibility, nutritional behaviors, interpersonal relationships and total HPLP-II score. Subject's beliefs, physical activity, spiritual growth and stress management were not improved significantly. Men had better scores in beliefs and women had better scores for health responsibility. CONCLUSION: Individual commitment to healthier lifestyles should be encouraged, and researchers have to design and apply more specific interventions that are directed toward improving factors that are not significantly improved through traditional programs.

Oncology nurses' perceptions of obstacles and supportive behaviors at the end of life.

PURPOSE/OBJECTIVES: To determine the magnitude of selected obstacles and supportive behaviors in providing end-of-life (EOL) care to patients with cancer as perceived by oncology nurses. DESIGN: Cross-sectional survey. SETTING: National survey sample. SAMPLE: A geographically dispersed national random sample of 1,000 Oncology Nursing Society members who had cared for inpatient patients with cancer, could read English, and had experience in EOL care. METHODS: Eligible respondents received a 68-item questionnaire in the mail adapted from previous studies and were asked to rate the size of obstacles and supportive behavior items in caring for patients with cancer at the EOL. MAIN RESEARCH VARIABLES: EOL, oncology, barriers, supportive behaviors, oncology nurses, and survey research. FINDINGS: Returns after three mailings yielded 375 usable questionnaires from 907 eligible respondents for a return rate of 41%. The items with the highest perceived obstacle magnitude were (a) dealing with angry family members, (b) families not accepting what they are told about patients' poor prognosis, and (c) nurses being called away from dying patients to care for other patients. The three-highest scoring supportive behaviors were (a) allowing family members adequate time alone with patients after they died, (b) having social work or palliative care staff as part of the patient care team, and (c) having family members accept that patients are dying. CONCLUSIONS: EOL care can be improved by working to decrease the highest-rated barriers and by continuing to support the highest-rated supportive behaviors. IMPLICATIONS FOR NURSING: Oncology nurses are dedicated, experienced, and comfortable handling most issues in EOL care. Recommendations to support oncology nurses include strategies to interact effectively with angry, anxious, or overly optimistic family members as well as involving social work and palliative care staff on the oncology interdisciplinary team. In addition, the information regarding identified obstacles and supportive behaviors in oncology EOL care can be used to facilitate discussion and change within oncology interdisciplinary teams and improve EOL care for patients with cancer and their families.

Cardiac rehabilitation programme for coronary heart disease patients: an integrative literature review.

Previous Western cardiac rehabilitation (CR) purported to improve patients' quality of life and health-related parameters for cardiovascular diseases (CVD). Nursing's role in CR was minimally identified. The purpose of this integrative literature review was to determine the effectiveness of current CR programmes and to determine if nurses are included in multidisciplinary CR teams. An online search of databases for the National Institutes of Health Library, Medline, CINAHL, Blackwell Synergy and PsychINFO electronic databases, with keywords--cardiac rehabilitation, lifestyle modification, secondary prevention, quality of life, effects of rehabilitation--identified 13 articles published 2001-2006 for inclusion. Cardiac rehabilitation programmes provided significant improvement in participants' quality of life, exercise capacity, lipid profile, body mass index, body weight, blood pressure, resting heart rate, survival rate, mortality rate and decreased myocardial infarction (MI) risk factors, although there was limited participation. They also decreased depression and anxiety. Eight studies included Nurses as CR providers, but without clear descriptions of their role. Nurses in developing countries need to participate in CR programmes to improve patients' participation, and to focus on modalities with lower overhead costs, such as home-based CR, and to clearly articulate their unique contributions.

Emergency nurses' perceptions of size, frequency, and magnitude of obstacles and supportive behaviors in end-of-life care.

INTRODUCTION: Emergency nurses care for dying patients daily. The process of dying in an emergency department can be complicated. Research on specific obstacles that impede the delivery of end-of-life care in emergency departments and behaviors that support it is limited. METHODS: A 70-item questionnaire was mailed to randomly selected ENA members. Subjects were asked to rate items on the size, frequency, and magnitude of obstacles and supportive behaviors that relate to end-of-life care for ED patients. RESULTS: The perceived obstacles with the greatest magnitude were as follows: (a) ED nurses' work loads being too high to allow adequate time for patient care, (b) poor design of emergency departments, and (c) family members not understanding what "life-saving measures" really mean. The three highest-scoring supportive behaviors were as follows: (a) allowing family members adequate time to be alone with the patient after he or she has died; (b) having good communication between the physician and RN; and (c) providing a peaceful, dignified bedside scene for family members once the patient has died. DISCUSSION: It is hoped that the results of this study will help increase and facilitate the discussions regarding end-of-life care in emergency departments. Realistic initial implications include finding ways to decrease workloads of emergency nurses and increase direct patient care. Another important implication would be the improvement of ED designs. Further research in the area of end-of-life care in emergency settings is recommended.

Jordanian women's postpartum beliefs: an exploratory study.

This study was aimed to determine the beliefs among Jordanian women regarding 10 selected postpartum behaviours. Following Human Subjects approval, a descriptive quantitative questionnaire was administered to 40 postpartum women, 20 from two rural communities and 20 from two urban communities. The majority believed, incorrectly, in prolonged bed rest, that the baby's exhalation on the mother's breast can lead to infection, that kofaleyas (tightly secured wraps around the baby) do not harm newborns, that observation by others while nursing might 'steal' the mother's milk, and that a belt around the mother's abdomen will tighten muscles. The majority correctly believed that dieting affects breast-feeding. Most postpartum women could benefit from increased education about postpartum practices. Educational programmes can help women differentiate between helpful postpartum practices and those which might have adverse effects on the health of a mother and her newborn.

Iron deficiency anemia (IDA) perceptions and dietary iron intake among young women and pregnant women in Jordan.

To determine Iron Deficiency Anemia (IDA) perceptions and iron dietary practices of Jordanian female students and pregnant women, a descriptive quantitative questionnaire was administered to 271 participants: 206 female students and 65 pregnant women. This pilot study found that most participants can identify foods containing iron, but lack appropriate iron intake, because of eating habits and finances; more than 50% report daily symptoms of IDA, including dizziness, fatigue, depression, headaches, and loss of concentration and memory. There are no statistically significant differences in IDA perceptions and iron-related dietary practices based on education, and relatively few based on where participants live, their available financial resources, or their position (pregnant women or young women). Culturally sensitive intervention research, which addresses application of IDA education principles, temporary supplementation, and adequate income for dietary modification and long-term iron supplementation to prevent IDA is warranted.

Emergency nurses' perceptions of obstacles and supportive behaviors in end-of-life care.

INTRODUCTION: Little is known about emergency nurses' perceptions of either obstacles or supportive behaviors for providing end-of life (EOL) care to dying patients. The purpose of this study was to determine the perceived obstacles and supportive behaviors in providing EOL care to dying patients in emergency departments. METHODS: In this survey research, a 73-item questionnaire regarding EOL care was mailed to a geographically dispersed national random sample of 300 members of the Emergency Nurses Association. Descriptive statistics were calculated for the 54 Likert-type items and demographic items. Two open-ended questions were analyzed using content analysis. RESULTS: Returns after 3 mailings yielded 169 usable questionnaires from 284 eligible respondents for a return rate of 59.5%. The greatest obstacles were: (1) emergency nurses having too great a work load to care for dying patients; (2) emergency nurses having to deal with angry family members; and (3) the poor design of emergency departments that do not allow for privacy of dying patients or grieving family members. The most supportive behaviors were: (1) good communication between the physician and RN caring for the dying patient; (2) physicians meeting in person with the family after the patient's death; and (3) an emergency department designed so that the family has a place to grieve in private. DISCUSSION: Having a better understanding of emergency nurses' perceptions of obstacles and supportive behaviors in providing end-of-life care could help decrease the stress of caring for dying patients. Actions could be taken to decrease the highest rated obstacles and increase the ratings of supportive behaviors that may ultimately result in better end-of-life care for dying patients and their families in the emergency setting.

Post-traumatic stress disorder, depression, anxiety and quality of life in patients with traffic-related injuries.

AIMS: This paper reports a study to investigate and follow-up relationships between post-traumatic stress disorder, anxiety, depression and quality of life in patients after traffic-related injuries. BACKGROUND: Worldwide, traffic accidents kill 1.2 million people and injure 50 million people per year. Accidental injuries are fourth in the top five causes of death in Taiwan. For survivors, traffic accidents not only cause physical impairments, but also psychological trauma, such as post-traumatic stress disorder, depression and anxiety, all of which affect the quality of life. METHODS: An exploratory, correlational design was used, and participants were recruited consecutively. Data were collected at 1 and 6 weeks post-injury for 64 patients from two major medical centres in Taiwan. Instruments were the New Injury Severity Scale, Post-traumatic Stress Disorder Reaction Index, Beck Depression Inventory, State Anxiety Inventory and Medical Outcomes Study Questionnaire. The data were collected in 2002. RESULTS: Statistically significant improvements occurred in depression, anxiety and the quality of life between week 1 and week 6 (P<0.05); high levels of post-traumatic stress disorder symptoms at week 1 (87.5%) and at week 6 (82.8%) showed no statistically significant improvement. There was a positive correlation between post-traumatic stress disorder and depression (r=0.70, P<0.001) and between post-traumatic stress disorder and anxiety (r=0.57, P<0.001), and a negative correlation between post-traumatic stress disorder and quality of life (r=-0.47, P<0.001). Depression was the most important variable to predict post-traumatic stress disorder at week 6, with depression levels at week 6 being a more powerful predictor than those at week 1. Regression analysis revealed that depression (19%) at week 1, depression at week 6 (45%), anxiety (3.8%) at week 6 and post-traumatic stress disorder (5.8%) explained a statistically significant amount of the variance at week 6. CONCLUSIONS: The findings suggest that traffic accidents have an impact on people's psychosocial wellbeing. Healthcare professionals need to implement interventions to decrease post-traumatic stress disorder, depression and anxiety to increase the quality of life for patients following traffic injuries.

Threading spirituality throughout nursing education.

In a survey of 132 baccalaureate nursing programs in the United States, few had defined spirituality or spiritual nursing care. There is a paucity of literature on spirituality in nursing education. This article describes the integration of spirituality in a baccalaureate nursing program. Interventions such as establishing a trusting relationship, providing and facilitating a supportive spiritual environment, responding sensitively to the patient's spiritual and cultural belief systems, demonstrating caring, acknowledging the importance of "presence" during spiritual distress, and integrating spirituality into the plan of care are reflected in student clinical journal entries.

The left ventricular assist device.

Of the 400,000 people in the United States who develop end-stage heart failure each year, 60,000 are unresponsive to medical therapy and 2,500 undergo heart transplantation. Surgically implanted pumps, called LVADs, are extending many lives.