Palliative care knowledge and attitudes toward end-of-life care among intensive care unit nurses in Jordan.

BACKGROUND: There is a growing need for palliative care globally due to the rapid aging of the population and improvement in cancer survival rates. Adequate knowledge and a positive attitude are vital for palliative care nurses. The study's purpose was to examine nurses' knowledge and attitudes toward palliative care. METHODS: A cross-sectional design with convenience sampling was used. The study included 182 intensive care unit (ICU) nurses from Jordanian hospitals in all sectors. Self-administered questionnaires were used to assess nurses' knowledge and attitudes toward palliative care. Descriptive statistics, analysis of variance, and the Kruskal-Wallis H test were used to analyze the data. RESULTS: We measured nurses' knowledge using the Palliative Care Quiz for Nursing, and we measured nurses' attitudes using the Frommelt Attitude Toward Care of the Dying scale. The mean total knowledge and attitude scores were 8.88 (standard deviation [SD], 2.52) and 103.14 (SD, 12.31), respectively. The lowest level of knowledge was in psychosocial and spiritual care (mean, 0.51±0.70). The percentage of nurses with unfavorable attitudes was 53.3%. Significant differences in knowledge and attitude levels were observed according to educational level, experience, and hospital type. CONCLUSIONS: ICU nurses have insufficient knowledge and inappropriate attitudes toward palliative care. Knowledge of psychological and spiritual aspects of palliative care was particularly lacking as were appropriate attitudes towards communication with dying patients. Improving knowledge and attitudes toward palliative care in nursing schools and hospitals would help overcome this problem.

Importance of preemptive analgesia and pain assessment as perceived by intensive care unit nurses.

Background: The importance and efficacy of Preemptive analgesia in reducing pain for patients undergoing painful procedures still debatable and seldom investigated. The aim of this study was to describe intensive care nurses' perception of the importance of pain assessment and Preemptive analgesia prior painful procedures in critical care settings in Jordan. Method: A cross-sectional descriptive design was used. The sample consisted of 300 registered nurses recruited from 22 intensive care units in Jordan. The data was gathered using a self-administered questionnaire. Results: The results showed that nurses considered pain assessment moderately and extremely important for surgical (n = 263, 87.7%), burn (n = 261, 87%), and trauma patients (n = 256, 85.3%). The majority of nurses rated pain assessment as moderately to extremely important for invasive line placement 80.3%, wound care 78.3%, and drain removal 69%. Nurses assessed the need for Preemptive analgesia more frequently before wound care 70.7%, and before invasive line placement 69.7%. Nurses perceived pain assessment for Preemptive analgesia as less priority for unconscious patients. Conclusion: Effective assessment and management of pain for critically ill patients is mandatory. Thus, it is important to improve nurses' knowledge regarding the Preemptive analgesia and its effects in relieving post-procedural pain in critically ill patient. It is recommended to ensure proper clinical training on how to assess critically ill patients and auditing system.

Barriers and enablers of intensive care unit nurses' assessment and management of patients' pain.

BACKGROUND: Inadequate pain assessment and management is a problem in hospitalized patients that impairs their well-being. Intensive care unit nurses' pain practices are affected by several barriers and enablers. AIMS AND OBJECTIVES: To explore intensive care unit nurses' pain education, perceived barriers, and enablers of pain assessment and management practices among critically ill patients. DESIGN: A cross-sectional descriptive design was used in the study. METHODS: Convenience sampling technique was used, including 300 nurses recruited from 22 intensive care units in Jordan. The Pain Assessment and Management for Critically Ill Adults Survey was used to collect data. Descriptive statistics, spearman correlation, and chi-square tests were used to analyse the data. RESULTS: Only 127 (42.3%) of the nurses reported moderate to extreme satisfaction about receiving professional development education related to pain among critically ill patients. Nurse workload (65.3%), patient instability (54.4%), patient inability to communicate (53.3%), and sedation interfering with pain assessment (50%) were reported by nurses as the most frequent barriers impacting pain assessment and management. Enablers of pain assessment and management reported most frequently were "pain assessment and management is a unit priority" (63.7%), "enthusiastic and motivated staff" (61.3%), "protocols and guidelines are in use" (57.4%), and "standardized assessment tools are in use" (57%). Some barriers and enablers to pain assessment and management and pain education differed significantly according to nurses' experience and hospital type. CONCLUSION: This study identified a range of enablers and barriers to pain assessment and management practices perceived by intensive care unit nurses. Nurse workload was an important barrier while making pain assessments, and management a unit priority was an important enabler for pain assessment and management. Frequent assessment of barriers and enablers of pain assessment and management is needed in critical care units to improve nurses' practices. Pain education should be included in the hospitals' continuous educational program.

Nursing students' attitudes towards death and caring for dying patients.

AIM: To examine the attitudes of undergraduate Jordanian nursing students towards death and caring for dying patients. DESIGN: A cross-sectional correlational design. METHODS: The Frommelt Attitude Toward Care of the Dying and Death Attitude Profile-Revised scales were used in this study with a convenience sample of 555 students from nursing schools in Jordan. RESULTS: Nursing students had positive attitudes towards death (M = 153.7, SD = 21.5) and a positive attitude towards caring for dying patients (M = 98.1, SD = 9.2). Fear of death, escape acceptance and death avoidance were significant negative predictors, while neutral acceptance, higher academic level and female gender were significant positive predictors of caring for dying patients (F = 4.5). CONCLUSION: Nursing students had positive attitudes towards caring for dying patients that was influenced by university type, academic level and gender. Nursing education must further focus on death, dying and end-of-life care across the core courses of nursing curricula, theory and practicum.

Sleep quality, sleep latency, and sleep duration: a national comparative study of university students in Jordan.

BACKGROUND: Sleep problems have significant negative health consequences on university students. STUDY AIM: To assess subjective sleep quality, sleep latency, and sleep duration in a national sample of university students and investigate differences in these components with selected variables. METHODS: A cross-sectional analysis and multi-stage sampling were conducted to select a sample of 1308 students from three major areas in Jordan. Sleep quality, sleep latency, and sleep duration were measured by an Arabic version of the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed using measures of frequency and central tendency and Kruskal-Wallis tests. RESULTS: Two-thirds of university students described their sleep quality as fairly bad and very bad and 20 reported sleep latency of more than 30 min during the past month. There was a significant difference in subjective sleep quality according to the student's place of residence. Sleep latency differed according to students' income, physical activity, use of media devices before sleep, smoking status, and academic achievement. Significant differences were also found in sleep duration with students' academic achievement, academic level, and body mass index. CONCLUSIONS: University students suffer from poor sleep quality, delayed sleep phase, and sleep deprivation. Lower-income, smoking, physical inactivity, and using media devices before sleep contributed to students' sleeping problems. IMPLICATIONS: Interventional programs that focus on improving physical activity, controlling tobacco use, healthy sleep education, and reducing screen time are essential public health interventions to reduce sleep problems among youth.

Prevalence and differences in habitual sleep efficiency, sleep disturbances, and using sleep medication: a national study of university students in Jordan.

BACKGROUND: Sleep quality has a significant impact on the physical and mental health of the young population. STUDY AIM: To evaluate sleep efficiency, sleep disturbances, and use of sleep medication among university students in Jordan and to examine differences in these problems in relation to selected demographic and health-risk behaviors. METHODS: The study used a cross-sectional design and a multi-stage sampling technique. Three public universities were randomly selected from three major governorates in Jordan. The Arabic version of the Pittsburgh Sleep Quality Index was used to measure sleep efficiency, sleep disturbances, and the use of sleep medication. Descriptive statistics and Kruskal-Wallis tests were used to analyze the data. RESULTS: Of 1308 students who participated in the study, 27% reported sleep efficiency less than 85%, 45% of the students reported nocturnal awakening, 30% reported getting up to use the bathroom, and 9% reported using medication to help sleep. Differences in sleep efficiency, sleep disturbances, and use of sleep medication were found in relation to students' gender, income, marital status, smoking status, and academic achievement. CONCLUSIONS: Poor sleep efficiency, sleep disturbances, and the use of sleep medications are significant problems affecting sleep quality among university students. Students' gender, marital status, income, smoking status, and academic achievement are important factors associated with sleep quality. IMPLICATIONS: Sleep screening among university students is required to identify and provide treatment for sleep problems. Furthermore, educating university students about the effects of smoking on health in general and on sleep in particular should be mandated.

Perceived barriers to healthcare utilization among Jordanian families: A family centered approach.

AIM: This study aimed to understand the barriers to health services utilization by Jordanian families. BACKGROUND: Access to quality healthcare services is a significant issue facing healthcare systems. Healthcare systems must identify and apply measures to overcome barriers that face utilizing health services and thus increase clients' satisfaction. METHODS: A cross-sectional qualitative research design was used in this study. Semi-structured interviews were conducted with twenty-five families to elicit the model of health services barriers. RESULTS: The analysis of the family interviews led to four main themes related to health services barriers: service system, structural/physical barriers, equipment and medication, and staff competency. This study would increase awareness about underserved populations that avoid seeking medical care. CONCLUSION: Public health efforts are required to increase awareness about the importance of contacting the healthcare system as early as possible. However, public health policy may require developing new initiatives that reduce these perceived barriers, such as enhancing communication skills among healthcare workers, increasing supervision and inspection of healthcare quality, and enhancing patient engagement by using phone calls and messages as appointment reminders and careful follow-up.

Perceptions of Health and Illness: A Qualitative Study of Jordanian Mothers.

PURPOSE: To explore: 1) the perceptions of Jordanian mothers of their children's health and illness; and 2) the strategies of Jordanian mothers regarding disease prevention and health promotion. DESIGN AND METHODS: A qualitative descriptive design was used to select a sample of Jordanian mothers (n = 20) of children aged 6 to12 years. Semi-structured interviews generated data to which thematic analysis was applied. RESULTS: Four central themes emerged for Jordanian mothers' perceptions of their children's health and illness: physical, functional, wellbeing, and coping. Mothers used a variety of biomedical and psychosocial strategies for health promotion and disease prevention for their children. CONCLUSION: Jordanian mothers' perceptions of health and illness were multidimensional. Mothers used positive strategies to prevent disease and promote the health of their children. The mothers overlooked some important aspects related to promoting children's health, such as minimizing the harm from tobacco and the importance of regular dental checkups. PRACTICE IMPLICATIONS: Community or school-based health programs that target both children and their parents are needed to address the effect of smoking on children's health, highlight the importance of oral hygiene and regular dental checkups, and emphasize the role of exercise and healthy nutrition on children's health.

An explorative study of workplace violence against nurses who care for older people.

Aim: To explore the prevalence of workplace violence among nurses who care for older people and its association with working stress, job satisfaction and quality of care in Jordan. Design: A cross-sectional design was used. Methods: A cluster random sampling was used to select three public hospitals, three private hospitals and 17 healthcare centres in Amman, Jordan. The researcher used a convenience sampling method to select 485 nurses. Data were collected between 2015-2016. Results: Almost 60% of the participants have been victims of violence at the workplace during the past year. Nurses who consider violence a problem at work have high levels of working stress (p < .01) as well as lower levels of quality of care (p < .01) and job satisfaction (p < .001).

Perception and predictors of school climate among Jordanian adolescents.

BACKGROUND: School climate has great effects on adolescents' outcomes. It offers possible protective or harmful sets of factors that have significant contributions to adolescents' health, development, and academic outcomes. PURPOSE: The purpose of this study was to investigate adolescents' perception of school climate and its predictors. DESIGN AND METHODS: A cross-sectional design was used to recruit a convenient sample of 567 students with mean age of 14.6 years. Health Behavior in School-Aged Children questionnaire subscales of perceived school climate, peer support, and teacher support were used to collect data. Descriptive, parametric, bivariate, and regression analysis tests were used in the analyses of the study data. RESULTS: The study showed that less than half of the students felt that they belonged to their schools. One-third of responding students were involved in making rules. Perceived academic performance, adolescents' age, peer support, and teacher support were the predictors of school climate. Significant differences existed between adolescents' perception of school climate in relation to age, gender, and perceived academic performance. CONCLUSION: Some aspects of school climate should be further addressed by the school nurse, policy makers, and school administrators in order to improve Jordanian adolescents' outcomes in term of their developmental needs and academic performance.

Predictors of quality of care provided for older adults.

BACKGROUND: The work conditions in which the nurses provide care for older adults affect the quality of care. STUDY AIM: (a) To describe the quality of care for older adults as perceived by the nurse; (b) to examine the relationship between occupational stress, work climate, employee development and quality of care for older people; and (c) to determine the predictors of quality of care provided for older adults. METHODS: A descriptive correlational design was used in this study. A multi-strategic sampling technique was used to recruit a sample of 500 nurses providing care for older adults in hospitals and health care centres. RESULTS: Almost 80% of the participating nurses reported that their workplace was insufficiently staffed. Quality of care was significantly associated with occupational stress, nurses' competence and employee development. Significant predictors of quality of care were occupational stress, work climate and employee development. CONCLUSION: Enhancing nurses' work climate, decreasing occupational stress and increasing chances for employee development would improve the quality of care provided for older adults. IMPLICATIONS FOR NURSING MANAGEMENT: Health institutions have the opportunity to implement work environment improvements that increase support for advancing staff knowledge and skills by providing additional support for continuing education regarding the care of older adults.

Predictors of school satisfaction among adolescents in Jordan: a cross-sectional study exploring the role of school-related variables and student demographics.

BACKGROUND: Understanding factors associated with adolescents' satisfaction with school is necessary to enhance their physical and psychological well-being. PURPOSE: To investigate relationships among school-related variables, demographics, and school satisfaction and identify factors that predict school satisfaction among adolescents. METHODS: A cross-sectional descriptive design was used to recruit 1,200 Jordanian students aged 11-16 years. A multistage cluster-sampling technique was used to select participants, and the Health Behavior in School-Aged Children self-administered questionnaire was used to collect data. Data were analyzed using linear regression analysis to identify predictors of adolescents' school satisfaction. RESULTS: Linear regression analysis showed that the adolescent's satisfaction at school was predicted by age, male sex, teacher support, peer support, fair rules at the school, and tiredness in the morning. These factors explained 41% of variance in school-satisfaction scores. CONCLUSION: Social support at home and school were helpful for better satisfaction with school life among adolescents in Jordan.

Predictors of nurses' stress working with older people admitted to acute care setting.

AIM: To identify the predictors of nurses' work stressors who care for older people (i.e., over age 65 years) in Jordan. BACKGROUND: Nurses sometimes experience stress which could occur as results of caring for older people, for example, with multiple physical and psychological needs. This stress could affect the job satisfaction and reduce the quality of care provided to older people. Thus, identifying sources of stress and predictors that cause stress for nurses is required to enhance quality of care for older people. DESIGN: A cross-sectional design. METHODS: Cluster random sampling was used to select study settings (i.e., 3 public hospitals, 3 private hospitals and 17 healthcare centres) in Amman, Jordan. A convenience sampling method was used to select 485 nurses. The Quality-Work-Competence questionnaire and Nurses' Working Life Questionnaire were used. Multiple linear regressions were used to identify predictors of job stress for nurses providing care for older people. The data were collected between June 2016 and January 2017. RESULTS: Job satisfaction, competence, development skills, gender, organisational climate and employee development, all have demonstrated significant correlations with stress. The regression analysis showed that the model significantly predicted a sizable portion of variance (R2  = 0.27, p < 0.001) in the physical and psychological stress among nurses working in the older people care settings. CONCLUSION: The nursing profession and the employing agencies should support nurses who care for older people in practice by conducting special training programmes to cope with stress. Interventional studies should be conducted to confirm the association between the nurses' work stress who care for older people and job satisfaction, competence, development skills, gender, organisational climate and employee development. IMPLICATIONS FOR PRACTICE: It is recommended that rotating appropriate competent nurses who care for older people, in particular dementia patients who are usually very ill may have greater needs due to their cognitive status, through other wards would temporarily reduce the nurses' stress. The nursing profession and the employing agencies should support nurses who care for older people in practice by conducting special training programmes focusing on the teaching skills and knowledge of how to deal with stress.

Factors Affecting Jordanian School Adolescents' Experience of Being Bullied.

PURPOSE: The purpose of this study was to identify the Jordanian school adolescents' experience of being bullied, and to examine its association with selected socio-demographic variables. DESIGN AND METHODS: This cross sectional descriptive study used multi-stages cluster sampling technique to recruit a sample of in-school adolescents in Jordan (N=436). The Personal Experiences Checklist was used to measure the experience of bullying. Descriptive statistics and parametric tests were used in the analysis. RESULTS: Relational-verbal bullying was the most common form of bullying while cyber bullying was the least common type. Male adolescents experienced bullying more than females. In addition, adolescents belonging to low-income families experienced bullying more than those from moderate-income families. Finally, being bullied was negatively correlated with academic performance of students. CONCLUSIONS: This study indicated that risk factors for bullying are multifaceted which necessitate the development of prevention and intervention strategies to combat bullying taking into consideration these factors. PRACTICE IMPLICATIONS: Schools should introduce environmental changes to discourage bullying and establish a policy with specific guidelines of what constitutes bullying behavior and expected disciplinary procedures. Staff training on information about the definition of bullying, current trends, and the effects of bullying is also recommended.