Experiences on health-related quality of life of Jordanian patients living with heart failure: A qualitative study

BACKGROUND

Quantitative studies have provided valuable statistical insights into Health-Related Quality of Life (HRQoL) among patients with Heart Failure (HF), yet they often lack the depth to fully capture the nuanced, subjective experiences of living with HF particularly in the specific context of Jordan. This study explores the personal narratives of HF patients to understand the full impact of HF on their daily lives, revealing HRQoL aspects that quantitative metrics often miss. This is crucial in developing regions, where the increasing prevalence of HF intersects with local healthcare practices, cultural views, and patient expectations, providing key insights for tailored interventions and better patient care.

METHODS

Utilizing a phenomenological qualitative design, this study conducted face-to-face semi-structured interviews with 25 HF patients to deeply explore their lived experiences. Thematic analysis was employed to identify major themes related to their perceptions of HF as a disease, its impact on various HRQoL domains, and their recommended strategies to enhance HRQoL.

RESULTS

The study involved 25 participants (13 males, 12 females), aged 26-88 years (mean 63), with diverse education and heart failure (HF) severities. It revealed three themes: HF perceptions, its impact on health-related quality of life (HRQoL) across physical, psychosocial, spiritual, cognitive, and economic domains, and HRQoL improvement strategies. Participants had varied HF knowledge; some lacked basic understanding. The physical impact was most significant, affecting daily life and causing symptoms like breathing difficulties, coughing, edema, and fatigue. This physical aspect influenced their psychosocial and spiritual lives, cognitive functions, and economic stability, leading to fear, frustration, worry, social isolation, spiritual and cognitive challenges, and employment problems.

CONCLUSIONS

The results underscores the need for holistic healthcare approaches, integrating medical, psychological, and social support. Key recommendations include integrated care models, comprehensive patient education, support networks, and policy interventions to enhance HF patient care.

The Effect of Benson's Relaxation Technique on Fatigue and Quality of Life of Patients Diagnosed With Heart Failure

Patients with heart failure (HF) reported poor quality of life (QOL) due to different reasons among which fatigue is the most important. Improving QOL is a crucial objective for patients with HF and their primary health care providers. Managing fatigue with medication is not enough. Benson's relaxation technique (BRT) is a complementary therapy used to manage fatigue among different populations with limited studies checking its effect among patients diagnosed with HF. The purpose of this quasi-experimental study was to check the effect of BRT on fatigue and QOL among 140 (68 intervention and 72 control) patients diagnosed with HF. Intervention group performed BRT for 20 minutes twice a day for 2 months. Control group received regular care from their health care providers. At baseline, there were no differences between intervention and control groups regarding fatigue, physical component summary, and mental component summary. At follow-up, intervention group had higher scores in physical and mental component summaries than control group (45.48 ± 10.52 vs 37.97 ± 14.78) and (46.22 ± 8.39 vs 41.01 ± 10.36), respectively. Also, intervention group had lower levels of fatigue than control group (2.54 ± 0.87 vs 6.33 ± 0.61). In conclusion, the use of BRT as a complementary therapy for patients with HF might decrease fatigue level and improve QOL.

Floating to intensive care units: Nurses' messages for instant action to promote patient safety

BACKGROUND

The overwhelming number of patients admitted to intensive care units (ICUs) combined with a nursing staff deficit sometimes requires the redeployment of nurses from other areas, meaning non-critical care nurses are asked to assist in treating critically ill patients. This may affect patient safety, especially in poorly resourced ICUs with financial constraints, such as in some developing countries. Nurses and nurse managers need specific strategies to address this issue and ensure patient safety.

AIM

To explore ICU and floating nurses' perspectives of the floating experience and describe how the use of floating nurses could threaten the safety of patients in Egyptian ICUs.

STUDY DESIGN

This was a qualitative descriptive study. Data were collected in in-depth interviews and analysed using Colaizzi's method of analysis. Forty-seven interviews were conducted, 22 with ICU nurses/managers and 25 with floating nurses.

RESULTS

Two main themes were extracted: (1) Lived work experience of floating and ICU nurses during the floating period which included three subthemes: Being a floating nurse: living a double experience of a professional role, Being an ICU nurse: feeling overloaded, and small failures leading to bigger, more serious issuses; and (2) Messages for patient safety from floating and ICU nurses' perspectives which also comprised three subthemes: education and training, putting the patient in the safety zone, and poilcy reform.

CONCLUSIONS

Promising strategies for ICUs to ensure patient safety when transferring nurses from other units include providing ongoing education and appropriate training for floating nurses to put patients in the safety zone.

RELEVANCE TO CLINICAL PRACTICE

Our findings provide a foundation for nursing practitioners, managers, and policymakers to prevent medical errors and optimize nursing workforce allocation. Nursing managers should consider floating nurses' competence levels when assigning ICU patients. Moreover, teamwork and communication between ICU nurses/managers and floating nurses should be strengthened. Close supervision and use of technology to minimize medical errors are potential strategies to ensure patient safety when using floating nurses.

Quality of life among patients with supraventricular tachycardia post radiofrequency cardiac ablation in Jordan

BACKGROUND

Supraventricular tachycardia (SVT) is a common arrhythmia with associated symptoms such as palpitation, dizziness, and fatigue. It significantly affects patients' quality of life (QoL). Radiofrequency cardiac ablation (RFCA) is a highly effective treatment to eliminate arrhythmia and improve patients' QoL. The purpose of this study was to assess the level of QoL among patients with SVT and examine the difference in QoL before and after RFCA.

METHODS

One group pre-posttest design with a convenience sample of 112 patients was used. QoL was assessed by 36-Item Short Form (SF-36). Data were collected at admission through face-to-face interviews and 1-month post-discharge through phone interviews.

RESULTS

There was a significant difference between QoL before (33.7±17.0) and 1 month after (62.5±18.5) the RFCA. Post-RFCA patients diagnosed with atrioventricular nodal reentrant tachycardia had higher QoL than other types of SVT. Moreover, there were significant negative relationships between QoL and the number and duration of episodes pre- and post-RFCA. There were no significant differences in QoL based on: age, sex, working status, marital status, smoking, coronary artery disease, diabetes mellitus, and hypertension.

CONCLUSIONS

After RFCA, the QoL of patients with ST improved for both physical and mental component subscales.

The Effectiveness of Benson's Relaxation Technique on Pain and Perceived Stress Among Patients Undergoing Hemodialysis: A Double-Blind, Cluster-Randomized, Active Control Clinical Trial

Benson's relaxation affects many symptoms among hemodialysis patients. A cluster-randomized active control clinical trial with three repeated measures; pre, 1-week, and 1-month post-intervention sought to evaluate the effectiveness of Benson's Relaxation on pain and perceived stress (P&PS) among hemodialysis patients. Two governmental hospitals were randomly assigned to intervention and control. Thirty-six participants were randomly selected; 18 were intervention, and 18 were controlled. The intervention group performed Benson's Relaxation twice a day for 10 minutes for 8 weeks after a training session. The control group received an educational session about Progressive Relaxation. Findings revealed a statistically significant reduction in the PSS-10 and PRI scores between pre-intervention and 1 month after-intervention (p < .001) and at 1 week after intervention and 1 month after-intervention (p < .001). A non-statistically significant reduction between pre-intervention and 1 week after-intervention (p > .05). Benson's Relaxation significantly relieved P&PS among hemodialysis patients but not after only 1 week of practicing.

Quality of life as a mediating factor in the relationship between fatigue and perception of safety among critical care nurses in the United Arab Emirates

BACKGROUND

A scientific understanding of the relationships between intensive care unit nurses' well-being and patient safety will allow nurse managers, administrators, and policymakers to simultaneously manage crucial organisational goals of nurses' health and patient safety. Understanding predictors of fatigue among intensive care unit nurses may help to balance personal and organisational impacts (e.g., turnover intention, sick leave) and provide a way to positively influence their safety perception.

OBJECTIVE

The aim of this study was to explore the association between work fatigue and perception of patient safety among nurses working in critical care units and determine whether their quality of life levels mediated this relationship.

METHODS

This study used a cross-sectional correlational comparative design. Participants were a sample of 250 intensive care unit nurses recruited conveniently from three large hospitals in the United Arab Emirates. The self-reported questionnaire included the Nursing Quality of Life Scale, the Fatigue Severity Scale, and the Safety Attitudes Questionnaire (SAQ)-ICU version, as well as sociodemographic characteristics and work-related information.

RESULTS

Of the 250 participating nurses, 76.8 % reported low QoL. There was a statistically significant correlation between nurses' Quality of Life and fatigue levels (r = 0.234, P = 0.000). Overall, 52.8 % of the sample had high fatigue and 49.6 % had poor safety perception. Multiple regression analysis using the Baron and Kenny approach showed that QoL, marital status, gender, and work environment were predictors of nurses' perception of safety.

CONCLUSION

Intensive care unit nurses had high levels of fatigue and poor Quality of Life. High Quality of Life and a favourable work environment were independent predictors of good patient safety perception. Efforts should be directed to maximize staffing resources that positively impact patient safety. These findings are comparable with international studies, suggesting that these issues may be ubiquitous.

IMPLICATIONS FOR CLINICAL PRACTICE

Intensive care practitioners, managers and policymakers should adopt measures to modify intensive care nurses' exhausting working conditions and provide a supportive environment. these interventions might improve nurses' perception of patient safety and consequently prevent safety incidents.

Barriers and facilitators to enrolling in nursing programs as perceived by male students: a qualitative study in the United Arab Emirates

OBJECTIVES

Despite the cultural challenges and stigma associated with nursing in the United Arab Emirates, there has been an increase in male nursing students. It is therefore important to understand barriers and facilitators that influence their decision to choose nursing education.

METHODS

This qualitative study used purposive sampling to recruit 30 male undergraduate students. Semi-structured interviews were conducted and data were analyzed with thematic analysis.

RESULTS

Ten themes were identified that described barriers and facilitators to choosing nursing programs as perceived by male students. Four themes reflected barriers and six themes were identified that encompassed facilitators to choosing nursing programs.

CONCLUSIONS

For international audiences, our findings could be helpful in enhancing both the recruitment and educational opportunities for male nursing students. Male students may be inspired to pursue the nursing profession by the presence of men in the profession and favorable male role models. Effort is needed to recruit male role models in nursing schools.

Level and predictors of caring behaviours of critical care nurses

BACKGROUND

Advanced technologies in intensive care units, including artificial intelligence and digitization, has implications for psycho-emotional aspects of caring in terms of communication, involvement, and holistic provision in a safe, effective, and efficient manner. Critical care nurses must maintain a balance between their technological and humanistic caring behaviours during the provision of individualized holistic patient care. Therefore, this study was conducted to examine level and predictors of caring behaviours among critical care nurses in two Arab countries.

METHODS

A cross-sectional design was used to achieve the objective of this study, whereby a quantitative online questionnaire survey was administered to 210 adult intensive care unit nurses at two government hospitals in Sharjah (United Arab Emirates), and two university hospitals in Amman (Jordan). Based on G* Power analysis, 200 participants were adequate to run the analysis.

RESULTS

On average, 49% of the whole sample had 'good' caring behaviours. Among nurses who were working in Emirati intensive care units, 48.5% had good caring behaviours, compared to 47.4% of Jordanian intensive care unit nurses. Additionally, the results showed that predictors of caring behaviours among nurses include female gender, holding a master's degree, interest in nursing profession, and a 1:1 nurse-to-patient ratio.

CONCLUSIONS

About half of the ICU nurses in this study had low levels of caring behaviours. The present study highlights the requirement for integrating the concept of holistic and patient-centred care as the essence of the nursing profession in nursing curricula to improve the level of care provided by all nurses working in intensive care units. Continuing education programs and specific interventional programs should be directed toward predictors of caring behaviours among each specific group of nurses. Future research is needed using qualitative methods to understand what the perception of intensive care unit nurses is about caring.

Open visitation policy in intensive care units in Jordan: cross-sectional study of nurses' perceptions

INTRODUCTION

Intensive care unit patients and families experience significant stress. It creates frustrations, nervousness, irritability, social isolation for patients, anxiety, and depression for families. An open visitation policy with no time or duration limits may assist in reducing these negative experiences. However, most Jordanian and regional hospitals within the Middle-East and Northern Africa (MENA) have not implemented this strategy.

PURPOSE

To evaluate nurse managers' and nurses' perspectives on the effects of an open visitation policy at intensive care units (ICUs) on patients, families, and nurses' care.

METHOD

A cross-sectional, descriptive, and comparative survey design was used.

RESULTS

A total of 234 nurses participated in the study; 59.4% were males, and 40.6% were females. The mean of their age was 28.6 years, with a mean of 4.1 years of experience. Nurses generally had negative perceptions and attitudes toward the open visitation policy and its consequences on the patient, family, and nursing care.

CONCLUSIONS

ICU managers and staff nurses did not favor implementing an open visitation in their units despite its known benefits, international recommendations, and relevance and compatibility with the local religious and cultural context. A serious discussion regarding this hesitation from the side of the healthcare professionals should be started to find a suitable solutions that consider the benefits of the open visitation policy and the challenges that prevent its implementation in the Jordanian and Arabic cultures.

Listening to the minority: A qualitative study exploring male students' perceptions of the nursing profession and reasons for choosing nursing as a career

INTRODUCTION

Nursing is a rapidly growing profession that has traditionally been dominated by women. Research has highlighted various challenges associated with increasing the number of male nurses, such as cultural challenges and stigma related to nursing. The United Arab Emirates (UAE) has experienced an increase in male students enrolling in nursing programs. To ensure this is sustainable, it is important to understand how male students perceive nursing and clarify factors that influence their decision to choose nursing as a career.

OBJECTIVES

To explore male nursing students' perspectives of the nursing profession and understand why they chose nursing as a career.

METHODS

Participants in this qualitative analysis were 30 male students that were selected using purposive sampling. Semi-structured interviews were used to collect data about participants' experiences. We used a qualitative content analysis to guide the data analysis.

RESULTS

Three main themes were identified that described male students' perspectives of and reasons for choosing nursing: (1) perceptions of nurses and nursing profession; (2) individuals as facilitators or role models in choosing the nursing profession; and (3) barriers to choosing the nursing profession.

DISCUSSION AND CONCLUSION

Our results regarding barriers and facilitators for male students in choosing to study nursing may be useful to help improve the recruitment of and learning opportunities for male nursing students. Highlighting the male presence in the nursing profession and positive male role models may encourage males to enter the profession. Therefore, understanding the experiences of male nursing students in choosing nursing as a career has important implications for nursing practice and education.

Morphine Use Did Not Eliminate the Effect of Pain on Complications After Acute Myocardial Infarction

Background:

Patients with Acute Myocardial Infarction (AMI) are usually present complaining of severe chest pain. This pain results from an imbalance between oxygen supply and demand, leading to severe complications. Different guidelines recommend using Morphine as a drug of choice for treating this pain.

Objective:

This study aimed to check the effect of chest pain and Morphine use on complications rate after AMI.

Methods:

This was a prospective observational study with a consecutive sample of 300 patients with AMI. Data were collected by direct patients interview and medical records review in the emergency departments & Intensive Care Units (ICU). Any complication developed within the hospital stay and after AMI was recorded. All correlated variables were analyzed using the binary logistic regression model.

Results:

The sample included 176 (58.7%) men and 124 (41.3%) women with a mean age of 56.92±12.13 years. A total of 83 patients (27.7%) developed one or more in-hospital complications. Acute recurrent ischemia was the most frequent complication; 70 (23.3%). Severe chest pain (≥ 7), duration of chest pain (more than 5 minutes), history of previous MI, and history of hypertension increased the occurrence of complications by 13%, 7%, 63%, and 25%, respectively. However, the use of Morphine did not have any protective effect against the development of these complications.

Conclusion:

The severity and duration of chest pain increased the occurrence of complications. Morphine administration did not have any protective effect against the development of these complications. Thus, it is recommended to update different policies and guidelines to use other types of chest pain relief methods, e.g., treating the underlying cause of chest pain and addressing the imbalance between oxygen supply and demand.

Depressive symptoms, perceived control and quality of life among patients undergoing coronary artery bypass graft: a prospective cohort study

BACKGROUND

Coronary artery bypass graft surgery (CABG) is an intervention directed toward improving the Quality of Life (QoL) for patients with coronary artery disease. Depression can affect QoL negatively among this population. Perceived control (PC) decreased the effect of anxiety on QoL, however, this effect has not been well-studies regarding depression. Therefore, the purpose of this study was to check the effect of depression on QoL among CABG patients and to determine if preoperative PC moderates this effect.

METHODS

This was a prospective observational cohort study conducted on a consecutive sample of 200 patients from three hospitals in Amman, Jordan. Depression Anxiety and Stress Scale, Short-Form Health Survey-36, and Arabic version of the Control Attitude Scale-Revised were used to measure depressive symptoms, QoL and PC respectively. Data were analyzed using t test and step wise multiple regression followed by simple slope analysis.

RESULTS

Postoperative Physical Component Summary (PCS) was better than preoperative PCS (mean ± SD: 38.2 ± 9.4 vs. 36.6 ± 9.5, P < 0.001). Postoperative Mental Component Summary (MCS) was better than preoperative MCS (mean ± SD: 44.3 ± 11.5 vs. 41.4 ± 11.4, P < 0.001). Preoperative depression was higher than postoperative depression; (mean ± SD: 12.8 ± 6.8 vs.11.1 ± 6.7, P < 0.01). Simple slope analysis was significant (simple slope = 0.41, t = 6.1, P < 0.001), indicating the moderating effect of PC.

CONCLUSION

Patients undergoing CABG surgery had poor QoL and high levels of depression. Perceived control moderated this relationship and improve QoL. Assessing depression levels and implantation of interventions to enhance perceived control levels prior to operation might improve QoL.

Psychological distress among the nursing workforce in the United Arab Emirates: Comparing levels before and during the COVID-19 pandemic

BACKGROUND

Nurses make up the majority of the healthcare workforce. They contribute to the development of healthcare systems and the provision of high-quality, effective, and patient-centered healthcare services. However, nurses need good mental and emotional well-being to provide adequate care and the necessary physical and mental health support for their clients. This study aimed to determine the level of generalized psychological distress among nurses in the United Arab Emirates. As this study was initiated before the coronavirus disease 2019 (COVID-19) pandemic, we were able to compare data gathered before and during the pandemic.

METHOD

This study used a cross-sectional correlational design. The Kessler Psychological Distress Scale (K10) was used to measure generalized psychological distress. Nurses' distress levels were measured and compared before and during the COVID-19 pandemic.

RESULTS

In total, 988 participants completed the questionnaire. The majority (n = 629, 63.7%) were employed in hospitals and the remainder worked in primary healthcare settings (n = 359, 36.3%). The mean distress score was 27.1 ± 13.7; 42.1% (n = 416) of participants had a severe level of distress, and only 36.4% (n = 360) reported no distress. More participants had severe stress levels before COVID-19 (59.5%, n = 386) compared with during COVID-19 (10.9%, n = 30).

CONCLUSIONS

Participants' K10 scores suggest that nurses experience significant distress, which may compromise their ability to care for their clients. This study emphasizes the importance of supporting nurses as a preliminary step to improving patient care. Despite the pressure of working during the COVID-19 pandemic, participants' general distress scores were lower during than before the pandemic. Organizational, governmental, and global support and appreciation may have contributed to relieving the distress nurses experienced. This may be a useful ongoing approach for enhancing healthcare systems.

Undergraduate Nursing Student Perspectives About Challenges in Clinical Education in Jordan: A Cross-Sectional Descriptive Study

Introduction:

Clinical education is an essential element in a baccalaureate nursing program, providing nursing students with the required knowledge, skills, abilities, and attitudes that are required to deliver professional nursing care after graduation.

Objective:

The purpose of this study was to identify the student perceived challenges associated with nursing instruction in the clinical environment.

Methods:

A cross-sectional descriptive design was used to identify the challenges associated with clinical instruction from the nursing students’ perspective. Convenience sampling was used to recruit 187 nursing students from three universities in Jordan, including one public and two private.

Results:

The major challenges to clinical education were fear of committing mistakes; lack of facilities for students; lack of knowledge among community and patients about the nursing profession; fear of infection; lack of availability of equipment in the clinical setting; students’ lack of preparedness and skills in planning care; and lack of collaboration from clinical staff.

Conclusion:

Identifying the challenges is necessary to formulate strategies to address them, to improve curriculum designed and clinical education for nursing students accordingly.

The effect of persistent anxiety and depressive symptoms on quality of life among patients with heart failure

BACKGROUND

Anxiety and depressive symptoms interfere with physical and psychological status, worsening symptoms and quality of life (QoL) among patients with heart failure (HF). This study assesses the impact of persistent anxiety and depressive symptoms on QoL among patients with HF in Jordan.

METHODS

This was a prospective observational study of a consecutive sample with a confirmed diagnosis of HF, recruited from four hospitals in Jordan during the period 1-31 March 2020. QoL was measured using the Arabic version of the Short Form 36 Health Survey, while anxiety and depressive symptoms were measured using the Hospital Anxiety and Depression Scale. Data were analyzed using descriptive statistics and stepwise multiple regression.

RESULTS

Of 127 patients who participated in the study, 72 (56.7%) were persistently anxious and 60 (47.3%) were persistently depressed. In multiple regression models, persistent anxiety, persistent depression, and higher levels of New York Heart Association functional class were independent predictors for both Physical Component Summary (of which history of DM was another predictor) and Mental Component Summary. The model explained 78.4% of the variance for PCS, P < 0.05. These predictors reduced QoL/(PCS) by 0.261, 0.398, 0.09, and 0.325 units respectively. Mental Component Summary (MCS) regression model explained 76.1% of the variance, P < 0.001. These predictors reduced QoL/(MCS) by 0.286, 0.346, and 0.359 units respectively.

CONCLUSIONS

Persistent anxiety and depressive symptoms were associated with poor QoL among patients with HF. It is highly recommended to assess psychological health for the patients with HF, especially anxiety and depression, and to include this dimension in treatment protocols.

Efficacy of Benson's Relaxation Technique on Anxiety and Depression among Patients Undergoing Hemodialysis: A Systematic Review

This study aimed to evaluate the efficacy of Benson's relaxation technique on anxiety and depression among patients undergoing hemodialysis. A systematic review of randomized controlled trials was conducted. Searching databases included EBSCO Host, PubMed, ProQuest, Science Direct, Sage Journals, Ovid, and Google Scholar from January 2000 to September 2020. Five randomized controlled trials were identified. Findings revealed a statistically significant decrease in anxiety score. Concerning depression; one RCT showed a statistically significant decrease and two RCTs revealed a non-significant difference in depression level. The overall quality of the RCTs was not high. Despite that the RCTs showed benefits of BRT in managing anxiety. However, this is not the same for depression. The lack of high-quality scientific evidence supporting its retinue use indicates that additional well designed randomized controlled trials in multiple countries are warranted to support the efficacy of Benson's relaxation technique on anxiety and depression among patients undergoing hemodialysis.

The Association Between Depressive Symptoms and Length of Hospital Stay Following Coronary Artery Bypass Graft is Moderated by Perceived Control

PURPOSE

Depressive symptoms can negatively influence patient outcomes after coronary artery bypass graft surgery (CABG). Preoperative depressive symptoms can be associated with a longer hospitalization. Perceived control moderates the effect of anxiety on length of stay (LOS) among CABG patients, but its effect on depressive symptoms and LOS is not well studied. This study tests whether perceived control moderates the relationship between depressive symptoms and LOS among patients following CABG.

PATIENTS AND METHODS

This prospective cohort study was conducted on 220 participants recruited from three hospitals in Jordan. Participants' depressive symptom levels were measured using the depression subscale of the Hospital Anxiety and Depression Scale. Perceived control was measured by the Arabic version of the Control Attitude Scale-Revised. Length of stay was obtained from medical records. Data were analyzed using multiple regression and simple slope analysis.

RESULTS

Females had higher levels of depressive symptoms (mean [SD]: 16.7 [5.2] vs 11.6 [5.6], P<0.05), and longer LOS (mean [SD]: 17.5 [12.7] vs 10.3 [9.0], P<0.001) compared to male patients. Being female increased the length of stay by 0.18 days. Every one-unit increase in preoperative depressive symptoms increased LOS by 0.37 days. Perceived control has a protective effect; every one unit increase in perceived control decreased LOS by 0.28 days. Moreover, perceived control moderates the relationship between depressive symptoms and LOS.

CONCLUSION

This study suggests that depressive symptoms and perceived control play an important role in the recovery among post-CABG patients. Application of policies to assess depressive symptoms and improve perceived control prior to CABG by health care providers might decrease morbidity and mortality.

Validation of the Arabic Version of the Brief Symptom Inventory to Measure Anxiety in Patients With Acute Myocardial Infarction

BACKGROUND AND PURPOSE

Anxiety after acute myocardial infarction is well-known phenomenon. This study aimed to examine the psychometric properties of the Arabic version of the Brief Symptom Inventory to measure anxiety in this population.

METHODS

This was a prospective observational study among 460 patients. Patients answered the Brief Symptom Inventory and the Hospital Anxiety and Depression Scale to measure anxiety. Complications and other clinical variables abstracted from medical records.

RESULTS

Cronbach's α was .86, indicating adequate internal consistency. The item-total correlations and all interitem correlations were all acceptable. Anxiety was independent predictor for complication after acute myocardial infarction and higher in females supporting the construct validity.

CONCLUSION

Arabic version of the Brief Symptom Inventory is a valid and reliable instrument to measure anxiety after acute myocardial infarction.

Correlation of selected stress associated factors with vitamin D deficiency in Jordanian men and women

Background: To identify stress associated factors for vitamin D deficiency (VDD) in healthy Jordanian people based on serum 25(OH)D levels.

Design: Prospective cohort study.

Methods: Three hundred and seventy-one Jordanian men and women aged 17–52 years, who were identified as VD deficient 25(OH)D <30 ng/mL, were eligible to participate in the study. Serum vitamin 25(OH) D was measured using chemiluminescent immunoassay. Cortisol, parathyroid hormone, calcium, phosphate, fasting lipid profile, and blood glucose were also analyzed. Questionnaires were used to collect lifestyles parameters. Anthropometric parameters including: body mass index (BMI), waist (W) and hip (H) circumferences, W/H ratio (WHR) were also calculated.

Results: The vast majority (91%) of the participants had vitamin D deficiency (25- (OH) D <30 ng/mL). Positive correlations were observed between vitamin D deficiency and the following anthropometric parameters in all study sample; gender (P=0.010), height (P=0.22), height/hip ratio (P=0.015) and waist/hip ratio (P=0.013). Lifestyle parameters that indicated very weak positive correlations with VDD were number of family members (P=0.011) and insufficient exposure to sunlight (P=0.023). The following clinical parameters showed weak or very weak correlations with VDD; serum cortisol (r=0.318), low density lipoprotein (r=0.246) and total cholesterol (r=0.133). Skin color and water pipe tobacco smoking were added to the multivariable stepwise regression analyses as they have been weakly correlated with VDD. These predictors together explained only 12.2% of the variance in serum cortisol levels in the VDD study sample.

Conclusion: A weak positive association between VDD and elevated serum cortisol was observed in this study. Subcutaneous changes may be involved in that association but further studies are needed to clarify a potential role for adrenocorticotropic hormone (ACTH).

Incidence and predictors of groin complications early after coronary artery intervention: a prospective observational study

Background

Coronary artery disease remains the most common single cause of death worldwide. Percutaneous coronary intervention is an appropriate management for coronary artery disease which is not free from its potential complications. The purpose of this study was to determine the incidence rate and the predictors of groin complications post percutaneous coronary intervention in cardiac catheterization laboratories in Jordan.

Methods

This was a prospective observational study with a consecutive sample of 300 patients post percutaneous coronary intervention procedure. Data were collected from the cardiac health care center using a pre-structured observational sheet. Any groin complication developed within the first 24 h post procedure was recorded. All correlated variables were analyzed using logistic regression.

Results

The sample included 237 (79%) men and 63 (21%) women with a mean age of 57.46 ± 10.51 years. A total of 114 patients (38%) developed one or more groin complications. Ecchymosis was the most frequent groin complication; 102 (34%). Females and participants greater than 65 years were nearly two times more likely to develop groin complications (OR = 2.13, P = .024, 95% CI: 1.11-4.01) and (OR = 2.14, P = .023, 95% CI: 1.11-4.13) compared to other groups. Patients with a systolic blood pressure before sheath removal greater than 180 mmHg were about ten times more likely to develop groin complications (OR = 9.82, P = .001, 95% CI: 2.58-37.37).

Conclusions

Different factors can increase the risk of groin complications post percutaneous coronary intervention. Therefore, identification of high risk groups (i.e. females) might help in the application of different methods to control these complications.

Patients with ST segment elevation myocardial infarction: moderating effect of perceived control on the relationship between depression and in-hospital complications

BACKGROUND

Cardiovascular diseases remain the top global killer, with nearly 80% of related mortalities occurring in developing countries. Over half of cardiovascular diseases' mortality is due to coronary heart disease, which is commonly linked to acute myocardial infarction. Psychological factors (i.e., depression and anxiety) after acute myocardial infarction are associated with higher levels of complications and mortality. Perceived control moderated the effect of anxiety on complications in different cardiac populations, but impacts on depression and complications after acute myocardial infarction are not well studied. This study explores the moderating effect of perceived control on the relationship between depression and complications after ST segment elevation myocardial infarction.

METHODS

Three hundred patients with a confirmed diagnosis of ST segment elevation myocardial infarction participated in this prospective observational study. Patients answered socio-demographic data, the depression subscale of the Hospital Anxiety and Depression Scale (HADS), and the Control Attitude Scale-Revised (CAS-R) questionnaires. In-hospital complications and all other necessary data were extracted from medical records after discharge. Data were analyzed using logistic regression.

RESULTS

24% developed at least one complication. Patients with high depression scores (8-21) were more likely to develop complications (χ² = 34.15, p < .001) than those with low depression scores (0-7). Patients with high levels of perceived control had lower levels of depression than those with low perceived control (mean [SD], 9.47 [6.43] vs. 12.31 [6.66], p < .001). The results of logistic regression showed that perceived control moderated the association between depression and complications, since depression scores, perceived control scores, and the interaction between depression and perceived control were significant predictors of complications. Participants with high depression and low perceived control had the highest rate of complications (31.5% vs. 15.4%, P < .001).

CONCLUSIONS

Depression increased complications after ST segment elevation myocardial infarction. Perceived control moderated this relationship. Assessment of depression and enhancement of perceived control in patients with acute myocardial infarction can decrease complications and improve outcomes.

Pre-operative depression predicted longer hospital length of stay among patients undergoing coronary artery bypass graft surgery

Purpose: Coronary artery bypass graft surgery (CABG) is a common and remarkably effective treatment for coronary heart disease, improving health status and enhancing quality of life. However, some outcomes after surgery remain unexplained, including psychological factors such as depression. The prevalence rates of pre- and post-operative depression among CABG patients are high, which is associated with negative short- and long-term outcomes. This study explores the impacts of pre-operative depressive symptoms on post-operative hospital length of stay (LOS) among patients undergoing CABG in Jordan. Patients and methods: This was a non-experimental, prospective observational study among 227 CABG patients recruited from 5 hospitals in Amman, Jordan. Depression was measured within an average of two weeks prior and one month after the operation using the Hospital Anxiety and Depression Scale. Length of stay was abstracted from medical records after discharge. Results: The average post-operative LOS was 11.40±10.41 days. The average pre-operative depression level was moderate; 12.76±6.80 and 42.47% complained of varying levels of depressive symptoms. The average post-operative depression level was moderate; 11.11±6.78 and 40.53% complained of varying levels of depressive symptoms. In stepwise regression models, depression scores and female gender were independent predictors that increased post-operative LOS. On the other hand, high income (≥1501$/month) and use of statins had protective effects and decreased post-operative LOS. The model explained 22.4% of the total variance regarding LOS. Conclusion: Pre-operative depressive symptoms increased post CABG LOS. Application of policies and depression assessment protocols prior to CABG by health care providers can identify high-risk groups (eg, females), so appropriate interventions can be designed and implemented to decrease morbidity and mortality.

Checking the moderating effect of perceived control on the relationship between anxiety and postoperative hospital length of stay among coronary artery bypass graft patients

Background

Coronary artery disease (CAD) is the most common cardiovascular disease (CVD). Coronary artery bypass graft (CABG) surgery is the most common treatment used for CAD. Patients undergoing this surgery are always anxious, which might increase complications in the postoperative period, especially prolongation of postoperative length of stay (LOS). It has been shown that perceived control (PC) moderated the relationship between anxiety and complications in a cardiac population, but its effect has not been studied in post-CABG.

Aim

The aim of this study was to check if there is a moderating effect for the PC on the relationship between anxiety and LOS post-CABG.

Patients and methods

A non-experimental, prospective, observational study was conducted with a consecutive sample of 250 patients who underwent elective CABG from four hospitals in Amman, Jordan. PC was measured by the Arabic version of the Control Attitude Scale-Revised (CAS-R), and anxiety was measured by the Arabic version of the anxiety subscale of Hospital Anxiety and Depression Scale. LOS and other needed information were obtained from patients’ medical records.

Results

Preoperative anxiety was significantly higher than postoperative anxiety (mean [SD]: 12.80 [6.70] vs 11.01 [6.74], P<0.001). Female patients were more anxious and had longer LOS compared to male patients. In stepwise regression, anxiety and PC scores were independent predictors for LOS. Every unit increase in preoperative anxiety increased LOS by 0.381 days, and every unit increase in PC decreased the postoperative LOS by 0.210 days. Moderating effect was checked by simple slope analysis for high (+1 SD) and low (−1 SD) levels of PC. Patients with high anxiety and low PC had the longest LOS, and patients with low anxiety and high PC had the shortest LOS, indicating the moderating effect of PC on the relationship between anxiety and LOS.

Conclusion

High levels of anxiety were associated with longer LOS after CABG. PC moderates this relationship. Enhancing PC in this population can improve outcomes and decrease LOS and morbidity.

Evaluation of public awareness, knowledge and attitudes towards basic life support: a cross-sectional study

BACKGROUND

Out-of-hospital cardiac arrest is a major cause of mortality worldwide. When basic life support techniques are implemented quickly, the chance of survival is doubled. Therefore, this study evaluated public awareness, knowledge and attitudes towards basic life support in Jordan.

METHODS

A descriptive, cross-sectional design with a convenience sample of 300 Jordanian adults aged over 18 years, recruited from three metropolitan areas in the northern, middle and southern regions.

RESULTS

A total of 87 participants (29%) stated that they have received training about cardiopulmonary resuscitation (CPR). Among them, 20 participants (23%) received their training through the media. The highest response rate for cardiac arrest signs was chest pain (n = 129, 43%). Participants who received training had greater knowledge of the three signs of consciousness evaluation. The numbers of participants who received training and performed chest compression, mouth-to-mouth ventilation, and both compression and ventilation were higher than those who did not receive training. Overall, 256 participants (88.3%) reported that they would perform CPR on someone from their family without hesitation. The most important concern about performing CPR was making a mistake.

CONCLUSIONS

Improving knowledge about cardiopulmonary resuscitation is an important topic, which can be achieved by training the general population. Media can play an important role in this issue.

Depressive Symptoms and Complications Early after Acute Myocardial Infarction: Gender Differences

Background:

Cardiovascular disease is the first leading cause of death worldwide. Coronary heart disease is the most common manifestation of cardiovascular disease. Acute myocardial infarction is the primary manifestation of coronary heart disease. Depression is a common and predicted complication after acute myocardial infarction. Limited studies evaluated gender differences in depressive symptoms after acute myocardial infarction especially in developing countries.

Objective:

The study aimed to determine whether there was a difference in depression levels and rate of complications based on gender early after acute myocardial infarction.

Method:

This was a prospective comparative study on 230 patients (150 men and 80 women) with a confirmed diagnosis of acute myocardial infarction. All participants signed an informed consent, filled sociodemographic and clinical questionnaire and the Depression Subscale of the Hospital Anxiety and Depression Scale. Clinical data were abstracted from the participants’ medical record after discharge.

Results:

Eighty-six participants (37.4%), 54 men and 32 women, developed 1 or more complications during hospitalization. Female patients were more depressed (14.4±3.5 vs. 8.3 ± 2.6) and developed more complications (1.9 ± 0.9 vs. 0.8 ± 0.5) than male patients did. Depressive symptoms increased the occurrence of complication by 40% and 33% for female and male patients respectively after controlling for sociodemographic and clinical variables.

Conclusion:

Depressive symptoms independently predicted complications after acute myocardial infarction in both men and women. The inclusion of depression assessment tools in acute myocardial infarction treatment protocols is highly recommended.

Anxiety and depression predicted quality of life among patients with heart failure

Purpose

Anxiety and depression are prevalent among patients with heart failure. However, their effect on the quality of life (QoL) is not well investigated in developing countries. Therefore, the purpose of this study was to test the effect of anxiety and depression on QoL among Jordanian patients with heart failure.

Patients and methods

Two hundred patients with a confirmed diagnosis of heart failure from 1 governmental and 1 private hospital in Amman, Jordan, were recruited between March and August, 2017. A descriptive, cross-sectional design was used. Anxiety and depression were measured using the Arabic version of the Hospital Anxiety and Depression Scale. QoL was measured using the Arabic version of the Short Form-36.

Results

Patients reported poor QoL in both physical component summary (M ± SD; 35.8±9.6) and mental component summary (M ± SD; 41.5±11.3). Prevalence rates for anxiety and depression were 62% and 65%, respectively. In stepwise regression analysis, anxiety and depression were independent predictors for poor QoL in both summaries, p<0.001.

Conclusion

Patients with heart failure have poor QoL and high anxiety and high depression prevalence rates. Inclusion of routine assessment and management of anxiety and depression in heart failure protocols is highly recommended.

Perceived control moderates the relationship between anxiety and in-hospital complications after ST segment elevation myocardial infarction

Purpose

Anxiety is a common psychological response after acute myocardial infarction and might be associated with higher levels of in-hospital complications. Perceived control might moderate this relationship, but the effect of this method has not been checked in developing countries. Therefore, the objectives of this study were as follows: 1) to check if anxiety was an independent predictor of in-hospital complications after acute myocardial infarction; and 2) to check if perceived control moderates the relationship between anxiety and in-hospital complications after acute myocardial infarction.

Patients and methods

This was a prospective observational study among 500 patients with a confirmed diagnosis of ST segment elevation myocardial infarction recruited from three private hospitals in Amman, Jordan. Anxiety was measured by the Anxiety subscale of Hospital Anxiety and Depression Scale, and perceived control was measured by the Arabic version of the Control Attitude Scale-Revised.

Results

One hundred and forty patients (28%) developed at least one complication during hospitalization. Two hundred and fifty-five patients had low anxiety scores (≤7), and 245 patients had high anxiety scores (≥8). Patients with high levels of perceived control had lower levels of anxiety (mean [SD]; 5.3 [3.6] vs 14.1 [6.3], P<0.001) than those with low perceived control. In logistic regression, anxiety was an independent predictor of in-hospital complications after controlling for sociodemographic and clinical variables (odds ratio: 1.24, 95% CI, 1.08–1.41, P<0.01). Moreover, the interaction of anxiety and perceived control was a significant predictor of complications.

Conclusion

Anxiety was associated with increased risk of in-hospital complications after acute myocardial infarction independent of sociodemographic and clinical variables. Perceived control had a moderating effect for this association since the combination of low perceived control and high anxiety scores was associated with the greatest risk for complications. Supporting patients’ levels of perceived control can decrease complications, morbidities, and mortality after acute myocardial infarction.

Comparison of Quality of Life Between Jordanian and Saudi Patients With Heart Failure

INTRODUCTION: Heart failure can influence all aspects of patients' health despite the improvement in its treatment. Different factors might affect the quality of life for patients with heart failure. These factors include but are not limited to: age, gender, ejection fraction, culture, and social support. Therefore, the purpose of this study was to examine differences in quality of life and perceived social support in patients with heart failure from Jordan and Saudi Arabia.MATERIALS & METHODS: A cross-sectional correlational design was used to test the objective of this study. A total of 202 patients were recruited from outpatient clinics of three hospitals in Jordan and Saudi Arabia. Data were collected through the SF-36 and the MOS-SSS questionnaires.RESULTS: The results of this study demonstrated that Jordanian patients with heart failure reported significantly greater social support in all MOS-SSS subscales than the Saudi patients except for the tangible support. The Saudi patients reported significantly more mental impairment (p ˂ .01) and lower level of fatigue (p ˂ .01) than the Jordanian patients.CONCLUSIONS: It is important to assess and identify physical and psychological resources available for patients at home and in the community to improve their quality of life.

Persistent anxiety and in-hospital complications after acute coronary syndrome

OBJECTIVES

To investigate the effects of pre-event persistent anxiety on in-hospital complications and length of stay (LOS) in patients who experienced acute coronary syndrome (ACS).

METHODS

This was a prospective study with patients seeking treatment for ACS events. Anxiety was measured 2 times before the event in 600 patients with pre-existing coronary heart disease (CHD). Patients were followed for 2 years or until they developed an ACS event. 120 patients developed ACS events (rate 20%). Complications and LOS were abstracted from medical records.

RESULTS

Persistently non-anxious patients have lower anxiety scores at 3 months follow-up than baseline (mean [standard deviation (SD)], 6.1 [0.24] vs. 3.9 [0.95], P <0.01). Patients with persistent anxiety had significantly higher complication rates than non-anxious patients (mean [SD], 0.71 [0.12] vs. 0.15 [0.11], P <0.05). In a multiple logistic regression, persistent anxiety was an independent predictor of complications. Patients who were persistently anxious were at 5 times higher risk for developing complications (odds ratio = 5.0, 95% confidence interval: 1.27-38.8, P < 0.05).

CONCLUSION

Anxiety measured up to 2 years before an ACS event was predictive of in-hospital complications. Clinicians caring for patients with CHD need to be as equally aware of the importance of assessing and treating persistent anxiety as clinicians caring for patients hospitalized for an ACS.

Perceived Stress in Nurses: A Comparative Study

PURPOSE: The purpose of this study is to assess the perceived stress in nurses working in various departments including mental health and psychiatric nurses in Jordan and compare the all together.METHODS: Using a non-random convenience sample, 310 nurses working in various departments in Jordan representing five different hospitals were included. Nurses answered the Arabic Version of Perceived Stress Scale 10-Items Questionnaire (PSS10) and a Characteristic Checklist.RESULTS: This study showed that nurses working in psychiatric departments perceived the highest stress levels followed by oncology nurses (ONs), ICU/CCU, and ER nurses respectively. Medical and surgical nurses reported the lowest level of stress.CONCLUSIONS: This study showed that psychiatric nurses have the highest levels of stress among all participated nurses. This might lead to dissatisfaction with the work and high rates of burn out and turn over. All these factors can easily affect patients care and safety issue, especially psychiatric patients. It is highly recommended that nurse managers and policy makers pay a particular attention to this phenomenon and looking for causes of such high level of stress is important.

Jordanian Intensive Care Unit Nurses’ Knowledge of Delirium Recognition

<p><strong>INTRODUCTION:</strong> Delirium is a clinical syndrome that negatively affects the outcomes of the intensive care units patients if undetected early and treated well. However, this condition remains under recognized and poorly managed by health care providers including nurses. The objective of this study was to check nurses' knowledge level about delirium recognition.</p><p><strong>MATERIALS </strong><strong>&amp; METHODS: </strong>This was a cross-sectional study on 176 intensive care units nurses working in four major hospitals in Amman, Jordan. Data were collected using a self-reported likert scale questionnaire.</p><p><strong>RESULTS: </strong>Nurses lack the basic knowledge about delirium recognition; the mean was (52.65 ± 4.99). Older nurses (aged 31 years and above) have significantly higher levels of knowledge regarding delirium recognition compared to younger nurses (mean ± SD, 56.02 ± 18.1 vs. 49.28 ± 12.65, <em>P </em>&lt; .005). Moreover, nurses with longer experience in intensive care units were more knowledgeable about delirium recognition (r=0.73, p &lt;.001).Graduate studies have a positive effect on the knowledge level. Nurses holding master degree have significantly higher levels of knowledge regarding delirium recognition compared to those with Baccalaureate degree; (mean ± SD, 60.28 ± 16.86 vs. 53.0 ± 12.18, P &lt; .005).<strong></strong></p><p><strong>CONCLUSION: </strong>Delirium is a widespread disorder in the intensive care units. Jordanian nurses lack the basic knowledge regarding essential characteristics of delirium and its recognition. Education of nurses in all care settings is vital and necessary.<strong>     </strong></p>

Quality of Life for Saudi Patients With Heart Failure: A Cross-Sectional Correlational Study

Introduction:

Heart failure is a major public health issue and a growing concern in developing countries, including Saudi Arabia. Most related research was conducted in Western cultures and may have limited applicability for individuals in Saudi Arabia. Thus, this study assesses the quality of life of Saudi patients with heart failure.

Materials and Methods:

A cross-sectional correlational design was used on a convenient sample of 103 patients with heart failure. Data were collected using the Short Form-36 and the Medical Outcomes Study-Social Support Survey.

Results:

Overall, the patients’ scores were low for all domains of Quality of Life. The Physical Component Summary and Mental Component Summary mean scores and SDs were (36.7±12.4, 48.8±6.5) respectively, indicating poor Quality of Life. Left ventricular ejection fraction was the strongest predictor of both physical and mental summaries.

Conclusion:

Identifying factors that impact quality of life for Saudi heart failure patients is important in identifying and meeting their physical and psychosocial needs.