Symptom Clusters and Their Impact on Spiritual Well-Being Among Women with Breast Cancer.

Purpose: To explore symptom experience and symptom clusters among Jordanian women with breast cancer and investigate whether these clusters predict patients' spiritual well-being. Patients and Methods: A sample of 142 Jordanian women with breast cancer were asked to complete the Memorial Symptom Assessment Scale (MSAS), Functional Assessment of Chronic Illness Therapy- Spiritual Well-being (FACIT-Sp) scale, and socio-demographic questionnaire. Exploratory factor analysis was used to group symptoms into clusters, and multiple linear regression was used to explore the symptom clusters that predict spiritual well-being. Results: The most prevalent symptoms among women with breast cancer were fatigue, anxiety, tension, and pain. All these symptoms have a prevalence greater than 50%. Three clusters were found: treatment-related symptom cluster consisting of eight symptoms, gastrointestinal symptom cluster consisting of seven symptoms, and psychological symptom cluster consisting of five symptoms. The psychological symptom cluster was the only cluster predicting the women's spiritual well-being (t (141) = -3.049; p < 0.01). Conclusion: Women with breast cancer experience several concurrent symptoms and symptom clusters. Screening for psychological symptom clusters and their treatment improves patients' spiritual well-being. The majority of women with breast cancer did not receive any complementary therapies and hardly any spiritual or psychological support, which should be provided in the future to support their spiritual well-being.

Knowledge of pulse oximetry among emergency and critical care nurses.

BACKGROUND: The pulse oximeter is a simple, cost-effective and reliable device for estimating arterial blood oxygen saturation. Nurses are required to be knowledgeable in pulse oximeter use. Little is known about nurses' knowledge of pulse oximetry in the Middle East region. AIM: To assess nurses' knowledge of pulse oximetry among emergency and critical care nurses and to explore predictors of nurses' knowledge of pulse oximetry. METHODS: This is the second part of data analysis that was first presented in the 'proficiency in ECG' study conducted in Jordan. The original data used for both parts of analysis included a questionnaire with two tests; a knowledge of pulse oximeter test and an ECG proficiency test. Participants were asked to take, alone without receiving assistance, both tests. In this study, the second part of analysis, the focus is on the pulse oximeter test. The test consisted of 21 items that emphasize knowledge of basic physiological principles as well as device limitations; whether technical or interpretation. The test administration procedure also included asking participants to provide socio-demographic variables. In the original data collected in both parts of analysis, nurses working in the emergency department, cardiac care units or intensive care units from nine different hospitals (1 governmental, 6 private and 2 educational) and holding a bachelor degree or higher were asked to participate. RESULTS: The total number of participating nurses was 210; out of 247 approached (response rate, 85%). The mean score in the nurses' knowledge of pulse oximetry test was 12.33 out of 21, corresponding to 58.7%. The clinical area currently working in predicted the knowledge of pulse oximetry test score after controlling for all other variables. Emergency department and intensive care unit nurses scored higher than cardiac care unit nurses by 1.86 and 1.63 points respectively (58.2% and 60% respectively). CONCLUSION: Nurses consistently report inadequate education and training concerning pulse oximeter use and interpretation. A revision to hospital in-service education seminars and undergraduate nurses' curriculum to assure adequate preparation is needed. RELEVANCE TO CLINICAL PRACTICE: Knowledge of pulse oximetry among emergency and critical care nurses is modest. This is a challenge worldwide. Predictors of nurses' knowledge of pulse oximetery are the clinical area currently working in (ICU and ED nurses are more knowledgeable than CCU nurses), proficiency in electrocardiography and taking an advanced cardiac life support course.

The buffering role of social support on the severity of physical symptoms among patients living with cancer.

BACKGROUND: The role of perceived social support (the individual's perception that family, friends and others are available as psychological, social and material support) and its moderating effect on the psychological and physical factors among patients suffering medical problems is still debated. AIM: To explore the effect of perceived social support on the relationship between psychological and health-related factors on the severity of physical symptoms among patients with cancer. METHODS: A descriptive-correlational, cross-sectional design was used to recruit 459 patients with cancer from three major hospitals in Jordan. Data were collected using a self-administered questionnaire. RESULTS: Social support was significantly correlated to the severity of physical symptoms (p>.05) among patients with cancer, while psychological distress, sadness, disturbed body image and anxiety were not (p<.05). The multiple hierarchal regression model showed that social support has no significant moderation effect on the relationship between psychological and health-related factors and the severity of physical symptoms controlling for sociodemographic factors among patients with cancer. CONCLUSION: Patients with cancer suffering physical and psychological disturbances do not benefit from social support as a way of controlling the severity of their symptoms. Palliative nurses need to tailor a social support intervention to their patients with cancer, in order to use both professional and family resources.

The effect of spiritual well-being on symptom experience in patients with cancer.

PURPOSE: To explore the effect of spiritual well-being on the symptom experience of patients with cancer. METHODS: This is a cross-sectional survey that enrolled 459 patients with cancer from three large hospitals in Jordan in 2018. Participants completed questionnaires related to demographic data, spiritual well-being, and symptom experience. Additional information was obtained from the medical record review. We then conducted multiple regression to evaluate if spiritual well-being predicts the patients' reported symptom distress. RESULTS: Patients reported thirty-six symptoms. Of which 15 have a prevalence of more than 30%. Fatigue was the most prevalent symptom (n = 282, 61.4%), followed by pain (n = 243, 52.9%) and anxiety (n = 230, 50.1%). Spiritual well-being predicted 7.1% of the total variance in patients' symptom distress (F, 19.650; p < 0.0001). Additional predictors were gender, education level, having a problem covering the treatment cost, family cancer history, and whether taking a complementary treatment or not. CONCLUSIONS: Patients with cancer experience multiple symptoms related to the disease and its treatment. Improving patients' spiritual well-being through an increased sense of meaning and peace can improve cancer symptom experience by decreasing symptom distress. In general, hospitals in Jordan focus on direct symptom management and do not look after patients' spiritual needs. Raising awareness about the importance of patients' spiritual well-being and providing appropriate spiritual assessment and interventions to patients with spiritual distress can improve patients' symptom experience.

Mortality Rate, Demographics, and Clinical Attributes of Patients Dying in the Intensive Care Unit of a Comprehensive Cancer Center in Jordan: A Descriptive Study.

Very little is known about the provision of or the need for palliative care in the Middle East, including Jordan. This study investigated the mortality rate, demographics, and clinical attributes of patients with cancer who had died in the intensive care unit (ICU) of a national cancer center over a 3-year period in Jordan. We reviewed the records of 661 patients who had died and found that the majority of the people were terminally ill at the time of admission (had metastatic cancer, multisystem organ dysfunction, and seriously ill). This approach differs from the usual practice worldwide in which it is uncommon to admit patients with cancer to the ICU at the end of life. Improving end-of-life care in the ICUs in Jordan requires further exploration of the cultural context in which end-of-life care practice occurs in Jordan and developing a palliative care approach that fit with the Islamic and Arabic culture.

Prevalence and prognostic significance of long QT interval in patients with acute coronary syndrome: review of the literature.

BACKGROUND: Sympathetic hyperactivity is linked with several adverse cardiovascular events in patients with acute coronary syndrome (ACS). Sympathetic activity increases early in the process of ischemia through 2 mechanisms. One originates from the central nervous system and leads to enhanced sympathetic activity. The other mechanism originates at the infarct zone and leads to B receptor up-regulation and catecholamine supersensitivity. Nevertheless, sympathetic hyperactivity accompanied by an underlying myocardial structural damage is likely to increase the ventricular repolarization duration measured as QT interval on the body surface electrocardiogram. PURPOSE: The aims of the current review of the literature were to examine the physiological processes underlying the use of long QT interval as a risk prediction tool in patients with ACS and to critically review and critique the existing evidence related to this matter. CONCLUSION: The available evidence is contradictory and includes serious limitations in design and QT measurement and correction. Until accurate and reliable data are available, it is difficult to determine the additional clinical value and prognostic significance of long QT interval in patients with ACS beyond that in other patients. CLINICAL IMPLICATIONS: Long QT interval is not uncommon among patients with ACS. Automated continuous QT interval monitoring is superior to manual QT interval measurement with the standard 10-second electrocardiogram. Optimum care for patients with ACS requires nurses to keep monitoring the QT interval several days after the initial event.

Prevalence and prognostic significance of long QT interval among patients with chest pain: selecting an optimum QT rate correction formula.

BACKGROUND: Little is known about the prevalence and prognostic significance of long QT interval among patients with chest pain during the acute phase of suspected cardiovascular injury. OBJECTIVES: Our aim was to investigate the prevalence and prognostic significance of long QT interval among patients presenting to the emergency department (ED) with chest pain using an optimum QT rate correction formula. METHODS: We performed secondary analysis on data obtained from the IMMEDIATE AIM trial (N, 145). Data included 24-hour 12-lead Holter electrocardiographic recordings that were stored for offline computer analysis. The QT interval was measured automatically and rate corrected using seven QTc formulas including subject specific correction. The formula with the closer to zero absolute mean QTc/RR correlation was considered the most accurate. RESULTS: Linear and logarithmic subject specific QT rate correction outperformed other QTc formulas and resulted in the closest to zero absolute mean QTc/RR correlations (mean±SD: 0.003±0.002 and 0.017±0.016, respectively). These two formulas produced adequate correction in 100% of study participants. Other formulas (Bazett's, Fridericia's, Framingham's, and study specific) resulted in inadequate correction in 47.6 to 95.2% of study participants. Using the optimum QTc formula, linear subject specific, the prevalence of long QTc interval was 14.5%. The QTc interval did not predict mortality or hospital admission at short and long term follow-up. Only the QT/RR slope predicted mortality at 7year follow-up (odds ratio, 2.01; 95% CI, 1.02-3.96; p<0.05). CONCLUSIONS: Adequate QT rate correction can only be performed using subject specific correction. Long QT interval is not uncommon among patients presenting to the ED with chest pain.