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Background: Poor medication adherence is a concern among patients with hypertension. However, few studies have assessed the effect of health literacy on medication adherence among refugee patients. Aim: The aim was to examine the effect of health literacy and associated factors in explaining medication adherence among Syrian refugee patients with hypertension. Methods: A cross‐sectional study was used, recruiting 150 Syrian refugees with hypertension in February 2020. The Hill‐Bone scale and the Health Literacy Questionnaire were used to collect data, which were analysed using descriptive and inferential statistics. Results: Participants had low levels of medication adherence and had low mean scores in eight of nine subscales of the health literacy scale, except in the appraisal of health information subscale. Factors including patient's age, marital status, the number of medications and co‐morbid diseases were significantly associated with medication adherence. Age, understanding written health information and ability to engage with healthcare providers were predictive of medication adherence. Conclusion: To increase medication adherence among refugee patients with hypertension, nurses need to improve patients' health literacy and understanding of health information about their disease. Summary statement: What is already known about this topic? Refugees report a higher prevalence of chronic diseases than non‐refugees due to a lack of available medications and limited access to health‐care services.Adherence to antihypertensive drugs is the cornerstone for accomplishing hypertension control.Health literacy is closely associated with better adherence to medications. What this paper adds? Syrian refugees diagnosed with hypertension showed low medication adherence.Age and level of understanding of health information were found to be factors that explained the level of medication adherence.Medication adherence was associated with the number of prescribed medications, the presence of other medical problems and marital status. The implications of this paper: To enhance medication adherence, healthcare providers, including nurses, should educate their patients about their diseases and medical regimes to enhance their health and health literacy.Further research is required to explain other personal factors, including patients' beliefs about their health and medications.Nurses, nurse managers and other healthcare professionals should develop and implement programs that address the individual needs of refugees to increase patients' levels of health literacy and medication adherence. [ABSTRACT FROM AUTHOR]

Aims: We examined the predictive factors of COVID‐19 vaccine hesitancy among Jordanian older adults. Background: Vaccine hesitancy among older adults is influenced by several factors. Design: This study employed a cross‐sectional design. Methods: Online surveys were conducted between November 2021 and April 2022. The surveys included socio‐demographic variables, COVID‐19 vaccine‐related information, the Vaccine Attitude Examination Scale and the Fear of COVID‐19 Scale. Results: Participants were 350 older adults (aged 68.1 ± 7.21 years; 62.9% females). Linear regression analyses were performed to assess the impact of correlated variables on the explanation of anti‐vaccination attitudes. Participants reported a moderate level of fear of COVID‐19 and a moderate level of hesitancy towards receiving the COVID‐19 vaccine. The linear regression model revealed that several chronic illnesses, fear of COVID‐19 and number of family incidences of COVID‐19 explained vaccine hesitancy. Conclusions: Raising awareness among older adults about the desired effect of the COVID‐19 vaccine in terms of minimizing hospitalization, disease consequences and mortality rate is required. Well‐tailored interventions are essential to reduce vaccine hesitancy among older adults and reinforce the importance of receiving the vaccine for those with multi‐morbidities. Summary statement: What is already known about this topic? COVID‐19 vaccines are effective in minimizing the undesirable consequences of COVID‐19 and decreasing the mortality rate.Fear of COVID‐19 and misconceptions about the vaccination contribute to vaccine hesitancy.New COVID strains, new policies and new vaccine risk factors increase vaccine hesitancy. What this paper adds? There is a moderate level of COVID‐19 vaccine hesitancy among the Jordanian older adult population.Vaccine hesitancy among older adults is attributed to multi‐morbidities, negative attitudes towards the vaccine, fear of COVID‐19 and number of family incidences of COVID‐19.Factors that influence the attitudes of Jordanian older adults towards anti‐vaccination include having had COVID‐19, number of chronic illnesses, fear of COVID‐19 and number of family incidences. The implications of this paper: Health‐care providers should use evidence‐based strategies to motivate and encourage Jordanian older adults to get vaccinated by disseminating factual and transparent information about the efficacy and safety of COVID‐19 vaccines, thereby reducing associated fears and promoting trust among older adults.Health‐care providers should tailor educational campaigns and communication strategies that address the gap in health literacy levels among older adults to achieve the desired vaccination rate.The results inform policymakers and other stakeholders to commence proactive vaccination campaigns that use population‐specific strategies to increase vaccine uptake and acceptance. [ABSTRACT FROM AUTHOR]

Aim: To explore the validity and reliability of the Missed Nursing Care Survey after translating it into the Arabic language. Methods: We employed a cross‐sectional design. We recruited 260 Jordanian nurses, and data were collected between May and July 2020. Translation, acceptability, construct, convergent, discriminant validity and reliability were investigated. Results: The factor analysis showed an adequate fit (three subscales) between the proposed missing care survey model and the observed data. This model reflected the survey's construct, convergent and discriminant validity, explaining 58.88% of the variance collectively. Confirmatory factor analyses showed adequate goodness‐of‐fit results (goodness of fit index = 0.91, comparative fit index = 0.94, increment fit index = 0.94, Tucker Lewis index = 0.92 and root mean square error of approximation = 0.06). The total Cronbach alpha and composite reliability achieved the criterion for all constructs in this survey. Conclusion: This Arabic version of the Missed Nursing Care Survey achieved the required level of validity and reliability. Measuring missed care and its reasons may help to improve quality of health services and assist nurse managers in designing appropriate interventions to reduce it. Adoption of culturally acceptable instruments by health‐care policymakers may support patient safety. Summary statement: What is already known about this topic? The Missed Nursing Care Survey was designed to identify reasons for missed nursing care.The Missed Nursing Care Survey has been shown to be a reliable and valid measure among various populations and different languages. What this paper adds? The Arabic version of the Missed Nursing Care Survey was shown to be a valid and reliable tool.Measuring the quality and procedures of nursing care in the Arabic region will aid in understanding the differences between countries. The implications of this paper: Adoption of culturally acceptable instruments by health‐care policymakers may support patient safety.Measuring missed care and its reasons may help to improve the quality of health services and assist nurse managers in designing appropriate interventions to reduce it. [ABSTRACT FROM AUTHOR]

Background: Although many studies have discussed nurses' caring performance, few have focussed on critical care nurses. Also, none have studied this among newly graduated nurses despite their very different circumstances. Aim: The purpose of this study was to examine factors affecting the caring performance of newly graduated nurses in critical care units. Method: A descriptive cross‐sectional design, using self‐reported questionnaires, was used among a sample of 209 nurses interviewed in Jordanian hospitals. The Mental Health Professionals Stress Scale was used for measuring work‐related stress and the Caring Behaviours Assessment tool to assess caring performance. Data collection was conducted from March to May 2018. Results: The participants had moderate levels of caring performance (M = 182.6/315, SD = 15.46). The highest score was reported for 'Supportive/Protective/Corrective Environment' subscale, while the lowest for 'Teaching/Learning' subscale. Many significant differences were noticed in caring performance based on participants' demographics. Only working in private hospitals was a significant predictor for caring performance (P <.05) predicting 14% of variance. Conclusion: Caring performance of newly graduated nurses in critical care units was affected by many factors including workload, self‐doubt, income and area of working. The significance was flagged of developing nursing policies concerned with stress relief and improvement of caring performance. Summary statement: What is already known about this topic? Newly graduated nurses are known to have more work‐related stress compared to experienced nurses, which may lead to lower commitment toward work requirements and lower quality of nursing care.Nurses' caring performance is known to be affected by several factors which lead to impaired nursing performance and overall organizational productivity and quality of care. What this paper adds? This study explored the predictors of caring performance of newly graduated nurses' working in critical care units, which provides baseline data for future research.Lower levels of caring performance by newly graduated nurses was found to be associated with higher levels of work‐related stress.Working conditions seem to affect the caring performance of newly graduated nurses. The implications of this paper: More attention is needed regarding newly graduated nurses' caring performance by nursing management, which might influence their ability to provide higher quality nursing care.Policy makers and nursing managers should consider establishing specific interventional programmes directed toward reducing factors that affect newly graduated nurses' caring performance in critical care units. [ABSTRACT FROM AUTHOR]

Background: Job demand and job satisfaction in nursing profession have been identified as significant indicators of quality of nursing care. Job demand is the most influential job stressor and has been connected to negative consequences on nurses' ability to function. Purpose The purpose of this study was to examine the moderating effect of work locus of control on the relationship between job demand and job satisfaction among nurses working at public hospitals. Methods: A quantitative, cross‐sectional, correlational design was utilized to randomly recruit 427 registered nurses working at two major public hospitals. Data were collected using a self‐administered questionnaire regarding job demand, job satisfaction and work locus of control. Results: Work locus of control had a significant moderating effect on the relationship between job demand and satisfaction. External locus of control had a negative effect on the job demand and job satisfaction relationship, whereas internal locus of control positively buffered this correlation. Conclusion: This study adds a novel contribution to the body of knowledge that buffering effect of job demand among nurses is much dependent on appropriately enhancing internal locus of control, consequently improving job satisfaction. SUMMARY STATEMENT: What is already known about this topic? Nurses' job satisfaction is associated with nurses' job demand.Job demand is a multifaceted factor and interferes with quality of nursing care. What this paper adds? Enhancing locus of control will contribute to increase nurses' job satisfaction and buffer effects of job demand.External locus of control has negative effects whereas internal locus of control has positive effects on the relationship between job demand and job satisfaction among nurses.The domains of job demand vary in their influence on job satisfaction among nurses depending on its internal or external effect. The implications of this paper: Nurse managers and decision makers are required to focus largely on the external forces that influence nurses' job satisfaction.Domains of job demand need to be addressed by nurse managers in terms of how to effectively enhance internal locus of control and suppress external locus of control factors to improve nurses' job satisfaction.To improve quality of nursing care and practice, internal locus of control has to be sustained and external locus of control has to be managed. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate the compliance of Jordanian nurses with ventilator‐associated pneumonia prevention guidelines and the barriers to compliance. Method: A descriptive, cross‐sectional design was used. A convenience sample of 294 nurses from nine hospitals in Jordan completed a self‐reported questionnaire. Results: According to the study compliance categories, 45.6% of the participants reported 'insufficient compliance,' 24.8% 'weak compliance' and 29.6% 'sufficient compliance.' Nurses with more experience and previous education on ventilator‐associated pneumonia reported higher compliance scores than their counterparts with less experience and no previous education. Nurses reported several barriers that limited their own compliance, such as lack of education, lack of policies and protocols, lack of resources and the shortage of staff. Conclusion: The compliance of nursing staff with the prevention guidelines was poor. Applying tailored educational programs may help improve their level of compliance. These programs must target new graduate nurses and be conducted in those hospitals with limited resources. SUMMARY STATEMENT: What is known about this topic? Assessment of nurses' compliance with ventilator‐associated pneumonia (VAP) prevention guidelines is essential.Identifying barriers to compliance with VAP guidelines is the first step to improve the practice. What this paper adds? Compliance with VAP prevention guidelines in developing countries, such as Jordan, is still modest.Educational programs on VAP prevention improve the nurses' practice.Incidence of VAP rate should be linked to compliance rate with the prevention guidelines.Several barriers such as lack of resources and policies and shortage of staff interfere with nurses' compliance.Education and training of nurses would help to improve compliance and overcome barriers. The implications of this paper: Educating nurses in the clinical settings is imperative in order to prevent the occurrence of VAP.Providing human resources and supplies would help to prevent VAP. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Fibromyalgia (FM) is a syndrome of chronic widespread pain, typically associated with fatigue, sleep, cognitive dysfunction and disordered mood.FM may limit an individual's ability to participate in everyday work and social activities, thereby making it difficult to maintain normal relationships with other individuals.While it has been studied in different populations and settings, the impact of FM and associated psychological factors has not been previously studied among female war refugees. What does the paper add to existing knowledge?: The study showed the high impact of FM on female refugees in Jordan; approximately three quarters of the participants had a moderate to severe FM impact.Refugees settled in Irbid city, Iraq, showed increased age, anxiety and post‐traumatic stress disorder correlated with a higher FM impact. What are the implications for practice?: The study recommends evaluation of the impact of FM among all female refugees living in Jordan, along with its neighbouring countries hosting refugees.Healthcare providers, including mental health nurses, should be aware of the role of PTSD and anxiety on the impact of FM. Accordingly, healthcare workers should design appropriate mental health treatment plans to help to decrease the impact of FM.Mental health nurses should evaluate FM impact among all refugees worldwide. Nurses in Jordan are recommended to share their experience with nurses outside of Jordan as this may help with funds being obtained and the implementation of advanced psychological interventions. Introduction: Fibromyalgia (FM) is a syndrome of chronic widespread pain. While it has been studied in different populations and settings, the impact of FM and its associated psychological factors has not been previously studied among female war refugees. Aim: To assess the impact of FM and its associated factors in female refugees. Methods: A cross‐sectional study was conducted. The impact of FM, anxiety, post‐traumatic stress (PTSD) and insomnia was investigated. Results: 288 refugees previously diagnosed with FM were recruited. The results showed that 73.62% of the participants had a moderate to severe FM impact. Refugees settled in Irbid city were six times more likely to have a higher FM impact than refugees settled in Zarqa, and Iraqi refugees were more likely to have a higher impact than Syrian. Increased age, anxiety and PTSD were correlated with a greater impact. Conclusion: Mental health nursing services should be directed towards female refugees, particularly those with increased age, anxiety and PTSD. Implications for practice: Mental health nurses should evaluate the FM impact among all refugees worldwide. Furthermore, nurses in Jordan are recommended to share their experiences with nurses outside of Jordan, as this may help to raise funds and implement advanced psychological interventions. [ABSTRACT FROM AUTHOR]

Background: Nurses working in emergency units are in direct contact with traumatic events. Trauma effects do not solely affect patients and their caregivers and, rather, extend to secondarily influence nurses themselves. Secondary exposure to trauma may result in symptoms similar to symptoms experienced by the patient themselves. No previous study investigated the secondary traumatic stress among emergency nurses in Jordan. Purpose To identify prevalence, predictors, and consequences of secondary traumatic stress among nurses working in emergency departments. Method: A descriptive correlation design was utilized to collect data using self‐report questionnaires from 202 nurses working at eight emergency departments in Jordan. Findings The study revealed that almost half of the sample reported high to severe levels of secondary traumatic stress. The analyses showed that nurses who demonstrated lower empathy (P =.016) and greater coping capacity (P <.001) tended to develop more secondary traumatic stress. Organizational factors were not significant predictors of secondary traumatic stress. Conclusion: A significant proportion of emergency nurses suffer secondary traumatic stress that is found also to be associated with psychical factors. Emergency nurses need to consider the consequences of secondary traumatic stress on their health and quality of care provided. SUMMARY STATEMENT: What is already known about this topic? Emergency nurses are susceptible to develop secondary traumatic stress due to nature of their work and being repetitively exposed to traumatic patients.No studies have examined existence of secondary traumatic stress among nurses in Jordan and in the Arab countries.The literature has contradicting findings on factors that can enhance or attenuate development of secondary traumatic stress symptoms. What this paper adds? More than half of the participants reported high to severe levels of secondary traumatic stress indicating that secondary traumatic stress is apparent among ER nurses in Jordan.Coping and empathy are important predictors of secondary traumatic stress among emergency nurses.Nurses who reported higher level of secondary traumatic stress symptoms tended to have more work‐related absenteeism and more sick days. The implications of this paper: There is a need to raise awareness of both nurses and health care leaders to existence of secondary traumatic stress among emergency nurses and to establish screening tools and referral procedures for risky nurses.Theory of secondary traumatic stress has to be revised to provide more robust view about the process by which secondary traumatic stress develops among helping professionals.Future studies have to examine factors that may contribute to secondary traumatic stress other than factors addressed in previous studies. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence and identify the predictors of breakfast skipping among 14‐ to 16‐year‐old adolescents in Jordan, focusing on mother‐related variables. Background: Breakfast is an essential meal across one's entire lifespan and especially important during the adolescent years. The practice of skipping breakfast has become so prevalent among adolescents that it is now a well‐documented nutritional problem. Design A descriptive cross‐sectional correlational design. Methods: A proportional cluster stratified sampling protocol was used to select 1896 adolescents and their mothers (1013) during the period of March to June 2016. A self‐reported questionnaire was used to collect data on breakfast‐skipping rates, the perceived reasons for this behavior, the perceived importance of consuming breakfast, and maternal encouragement of breakfast consumption. Results: The prevalence of breakfast skipping was 34.3% among adolescents and 21.5% among their mothers. A significant association was found between breakfast skipping among adolescents and their mothers (χ2 [1, n = 998] = 37.90, P =.001). Maternal encouragement of breakfast consumption, gender, and adolescent perception of the importance of this meal were found to be significant predictors of adolescent breakfast skipping. Conclusion: The findings highlight the importance of involving mothers in developing nutritional health plans aimed at promoting regular breakfast consumption among adolescents. SUMMARY STATEMENT: What is known about the topic? Regular breakfast intake has been linked to positive benefits for adolescent health, including lower risk for obesity and fewer biomarkers of chronic illness.The practice of skipping breakfast is highly prevalent among adolescents, both in Jordan and across the globe.Parental eating habits and attitudes influence adolescent eating behaviors and attitudes. What the paper adds? Female adolescents in Jordan skipped breakfast more often than male adolescents and to a significant degree. For both groups, lack of appetite was reported as the main reason (39%) for skipping breakfast.The interrelationships found between maternal and adolescent variables related to breakfast consumption highlight the pivotal role of mothers in promoting this practice. When mothers valued eating breakfast, so did their adolescent children, a relation that translated into lower rates of breakfast skipping among the adolescents.Maternal encouragement of breakfast consumption, the adolescents' perceived value of this practice, and their gender proved significant predictors of breakfast skipping behavior. The implications of this paper: Health interventions to promote breakfast consumption among adolescents are likely to be more effective if based on a better understanding of the role of mothers in this regard.Nurses should involve mothers in developing nutritional health plans to promote regular breakfast consumptions among adolescents.Nurses should educate mothers and adolescents about the health costs for adolescents associated with skipping breakfast. [ABSTRACT FROM AUTHOR]

Aims and Objectives: This study aimed to assess the perceived caregiver burden among parents of chronically ill children in Jordan. Background: Although there are few studies on the accurate prevalence of chronic diseases among Jordanian children, there are a few on the burden of caregiving, which is important because most children with chronic illness rely on their caregivers to perform their daily tasks. In Jordan, little is known about the caregiver burden associated with caring for children with chronic diseases. Design: A cross‐sectional design was reported in line with the STROBE guidelines. Methods: The Katz Index of Independence was used to determine the children's level of dependence, and the Burden Scale for Family Caregivers was used to measure the caregivers' level of burden. Results: Nearly, 49.3% of caregivers had a very severe burden, 31.2% of children had a severe functional impairment, 19.6% had a moderate impairment, and 49.3% had full functionality. Based on their children's dependency, caregivers' subjective burden varied greatly (p <.001). Fully functional children had a far lower disease burden than severely and moderately disabled children (p <.001). The caregiver burden score differed significantly across chronic disease categories (p <.001). Unemployed caregivers had a far higher subjective burden than working caregivers (p =.009), and single (divorced/widowed) caregivers had higher burdens than married caregivers. Conclusions: Various factors can increase caregiver burden. Therefore, healthcare providers must plan holistic and family‐centred interventions to reduce the caregiving burden. Relevance to Clinical Practice: There is a need to establish support programs to help reduce the level of burden among caregivers of children with chronic diseases. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to examine the impact of demographic variables, organizational commitment levels, perception of health and quality of work on turnover intentions. A self-reported cross-sectional survey design was used to collect data from Jordanian registered nurses who were working between June 2011 and November 2011. The findings showed strong effects of the quality of work, perception of health and normative organizational commitments on turnover intentions. This study sheds the light on the important work outcomes in health-care organizations. Increasing nursing quality of work and normative organizational commitment are good strategies for reducing turnover intentions. [ABSTRACT FROM AUTHOR]

Background: Disordered eating attitudes and behaviours are linked to poor physical and psychological outcomes. Aim: To examine the individual, psychological, and socio‐cultural factors associated with disordered eating attitudes among Jordanian adolescents. Methods: A stratified sampling method was used to select school students aged 15 to 18 years from three governates in Jordan in 2013/2014. Participants filled out questionnaires on socio‐demographic variables, the Eating Attitudes Test (EAT‐26; to discriminate adolescents with disordered eating); the Body Shape Questionnaire (BSQ; used to measure psychological factors associated with disordered eating); Body Mass Index was calculated and obesity evaluated according to international cut off points (to categorize normal weight, overweight, and obese adolescents, and these categories were used as individual factors associated with disordered eating). Results: A total of 963 (460 boys and 503 girls) participated in the study. Disordered eating (EAT score ≥ 20) was present in 389 (40.4%); body shape dissatisfaction (BSQ scores ≥110) was present in 161 (16.8%). Overweight and obesity were found in 332 (34.5%) participants. Unhealthy weight loss behaviours (such as self‐induced vomiting, substance abuse, and smoking) were very common. Multivariate logistic regression analysis demonstrated that female sex, urban residence, distorted perceptions of weight, BMI (excess weight), body dissatisfaction, and socio‐cultural variables (parents, peers and mass media) were significantly associated with disordered eating. Conclusion: Jordanian urban adolescents seem to embrace Western norms to fit in with the demands of Western culture. Socio‐cultural factors, particularly mass media, play a significant role in changing adolescents' norms. Prevention and intervention programs are needed to control these disorders. SUMMARY STATEMENT: What is already known about this topic? Worldwide, disordered eating among adolescents is a significant health issue with serious physical, psychological, and social consequences.Studies on the factors that lead to the development of disordered eating in Jordanian adolescents are limited What this paper adds? The rate of disordered eating in this study indicated that adolescents are being exposed to greater pressures to fit in with "Western" norms more than previously.Sociocultural factors appear to play a significant role in changing adolescents' norms.Adolescents who engage in dieting or weight loss behaviours might not necessarily be overweight and may in fact even be normal weight. The implications of this paper: School nurses have multiple opportunities to facilitate early detection, initiate prevention programmes, and develop culturally sensitive interventions.Offering school nurses an effective assessment tool like EAT‐26 will allow them to accurately assess students, identify those at risk, and develop appropriate prevention strategies. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study that examined the use of complementary and alternative medicine therapies among children with cancer in Jordan. Background. Complementary and alternative medicine use by oncology patients has been gaining acceptance in the developed countries and developing countries. Healthcare professionals are becoming increasingly aware that patients use complementary and alternative medicine either covertly or overtly. Methods. A descriptive cross-sectional design was used with parents of children with cancer under treatment and follow-up in a paediatric oncology department in Jordan between August 2007 and April 2008. Results. Parents of 69 children with cancer in Jordan were surveyed for their use of complementary and alternative medicine with their children. A total of 65.2% of the sample had used at least one type of complementary and alternative medicine during the course of their child's treatment. The use of biological and nutritional complementary and alternative medicine was 70.5% among the users. Use of body and soul complementary and alternative medicine strategies was reported for 22.2% of the children using complementary and alternative medicine. Twenty per cent of the sample used body movement complementary and alternative medicine for their children. A total of 45.5% of complementary and alternative medicine users perceived benefits in using complementary and alternative medicine for their children with cancer. However, 40% of complementary and alternative medicine users had stopped using complementary and alternative medicine for multiple reasons. Conclusion. Parents used complementary and alternative medicine to support their children's medical treatment and to use all possible methods to cure their children. The reason for parents not using complementary and alternative medicine included not being aware of complementary and alternative medicine. Most of the patients have not discussed the issue of using complementary and alternative medicine with the medical staff. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to analyse nurses' perceptions of clinical leadership needs and compare their differences based on the sample's characteristics. Also, it aimed to compare nurses' perceptions of clinical leadership needs between nurses and nurse managers. Background: Various professional organisations have identified the need to develop clinical leaders. Clinical leadership is about having clinical expertise in specialised fields and having professionals involved in clinical care. However, worldwide, little emphasis is placed on the clinical leadership needs of nurses. Methods: Using STROBE (https://www.strobe‐statement.org/index.php?id=available‐checklists), a cross‐sectional study was conducted in 2020 using a purposive sample of 349 Jordanian nurses who were surveyed using the CLeeNA instrument. Different descriptive and inferential statistics were used to analyse the data. The response rate in the current study was 69.8%. Results: The 7‐point CleeNa scale was reduced into 3 categories 1 = "not important (1–3)," 2 = "Neutral (4)" and 3 = "highly important (5–7)." The total mean score of perceived CleeNa was 2.61(SD = 0.50) indicating "very important." The highest perceived mean score of the subscales was for "leadership and clinical practice." In contrast, the lowest perceived mean score of the subscales was "financial and service management." The total mean scores of perceived CleeNa were higher among married nurses, nurse managers, those who have a master degree or more, aged 35 years or more, had more than 4 years of nursing experience or/and more than 4 years of leadership experience, supervised more than 10 employees and were working in teaching hospitals. The total mean scores of perceived CleeNa scale and subscales of staff and team development, patient safety and risk management, and perceived standards of care were higher among nurse managers when compared with nurses. Conclusion and relevance to clinical practice: Results indicated that innovative clinical leaders are needed. A paucity of research identifies the extent to which clinical leadership is enacted in clinical nursing practice. Developing a clinical leadership programme is warranted to contribute positively to nurses' leadership roles and outcomes, patients' outcomes, and in turn, organisational outcomes. [ABSTRACT FROM AUTHOR]

Aim and Objective: This study investigated the effects of social support, parenting stress and maternal self‐efficacy on postpartum depression among adolescent mothers in Jordan. Background: Adolescent pregnancy may have serious health, social and economic consequences for young women, families and communities. In Jordan, the incidence of adolescent pregnancy has increased from 5% in 2012 to 15% in 2018. Little attention has been given to postpartum depression among adolescent mothers in Arab and Middle Eastern countries. Method: In a cross‐sectional design using convenience sampling, 200 women aged less than 20 years, six to eight weeks postpartum and who could speak and read Arabic were interviewed in a participating health clinic. The interview occurred before or after a woman's scheduled clinic appointment and included socio‐demographic data, Edinburgh Postnatal Depression Scale (EPDS), Maternity Social Support Scale (MSSS), Parenting Stress Scale (PSS) and Perceived Self‐efficacy Scale (PSES). Data collection took place between December of 2018 and April of 2019. Reporting followed the STROBE guidelines. Results: Results revealed that 28.5% of adolescent mothers had probable postpartum depression. Mothers who reported high social support, high parenting stress, low self‐efficacy, financial stress and marital conflict had significantly higher EPDS scores than those who did not report these stressors. Conclusion: Prevalence of postpartum depression reported in this study warrants immediate action on early assessment, detection and intervention. High levels of social support may feel overwhelming for young mothers and contribute to high parenting stress, low maternal self‐efficacy and marital conflict. Relevance to clinical practice: Adolescent mothers are at increased risk of PPD compared to mothers over 20 years of age. Perceived quality rather than availability of social support needs to be considered. Young mothers require education and early intervention prevention strategies to better prepared them for motherhood and manage stressors associated with their changing social role. [ABSTRACT FROM AUTHOR]

Kamel AA, Bond AE, Sivarajan Froelicher E. International Journal of Nursing Practice 2012; 18: 147-154 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. [ABSTRACT FROM AUTHOR]

Eshah NF. International Journal of Nursing Practice 2011; : 27-35 Modern styles of living and the accelerated pace of life could direct people to adopt unhealthy lifestyles. Globally, literature indicates that the percentages of people who adopt healthy lifestyle behaviour (HLB) are disappointing. This study aimed to identify the level of adoption of HLB in Jordanian subjects and to compare the sociodemographic and self-reported clinical history based on the HLB adoption level. Cross-section descriptive study was conducted and Health Promotion Lifestyle Profile-II was used to reflect subjects' adoption of HLB. Through convenience sampling 260 subjects were enrolled; 50% had excess weight, 30% were current smokers, 53% had never had their cholesterol assessed. Findings revealed that subjects were not adopting HLB regularly. Women, married, educated, young subjects and having higher income subjects had higher HLB adoption level. Health-promotion programmes are urgently needed for this community and sociodemographic variables have to be considered throughout preparation, implementation and evaluation phases of such programmes. [ABSTRACT FROM AUTHOR]

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Aims and objectives To identify the links between self-esteem, fatigue and health-related quality of life for children and young people during and following treatment for cancer. Background Measures to minimise adverse outcomes for survivors of childhood cancer have been developed, but the crucial periods of returning to school and transition to adult life and adult services are not addressed so well. Screening of quality of life, fatigue and self-esteem in childhood cancer patients during and after treatment is important for optimising the nursing response and improving outcomes for children. Design A cross-sectional, descriptive, correlational, comparative survey was designed. Methods Validated measures of the attributes being studied were used. This study was conducted in private rooms on the ward and in the outpatient clinic of a major oncology hospital in Jordan in 2015. Seventy children aged 5-16 years were included. Ethical approval was secured. Results The age range of the children was 5-16 years (Mean 10·17, SD 3·4 years). Thirty were girls and 40 were boys. The total quality of life scores ranged from 21-100 ( M = 65·5; SD = 17·6). The total scores of fatigue range from 12·5-100 ( M = 65·79; SD = 22·20). Children with a high level of fatigue experienced lower quality of life. Conclusion Continuing education centres at hospitals may find the results of this study helpful to provide professional updates and training events to enhance nurses' understanding of psychosocial distress responses and ability to intervene effectively within the multiprofessional effort. Relevance to clinical practice The outcomes of this study may enhance the development of guidelines for routine assessment by nurses and others of these factors among children with cancer. The nursing role in ensuring holistic care and attention to the problems of most concern to patients could be strengthened. [ABSTRACT FROM AUTHOR]

Aims and objectives This study develops a new instrument, the Spiritual Care Intervention-Provision Scale, and assesses its psychometric properties in an Arab Muslim nurse sample. The Spiritual Care Intervention-Provision Scale was developed to measure the frequency with which nurses provided aspects of spiritual care. Background Most of the available spiritual care instruments were developed in the West and reflect a predominantly Christian tradition. A review of the literature on spiritual care in nursing revealed that no instrument exists for measuring spiritual care interventions provided by nurses to Arab Muslim patients. Design A cross-sectional descriptive and correlational design. Methods Following an extensive literature search, review by an expert panel and a pilot study which included patients' views regarding aspects of spiritual care provided by nurses, the final version of the Spiritual Care Intervention-Provision Scale was tested in a convenience sample of 360 Jordanian Arab Muslim nurses. Correlational and factor analysis were used. Results The internal consistency of the Spiritual Care Intervention-Provision Scale was high, with α coefficient of 0·85. The exploratory factor analysis supported a two-factor structure for the Spiritual Care Intervention-Provision Scale as hypothesised. A significant positive correlation between the Spiritual Care Intervention-Provision Scale and religiosity was in the expected direction though small in magnitude. Conclusions This study initiates the development of an instrument for the provision of spiritual care intervention by nurses that balances the religious and existential dimensions of spirituality. The Spiritual Care Intervention-Provision Scale exhibited acceptable evidence of internal consistency and validity among Jordanian Arab Muslim nurses. Further work was suggested to firmly establish all aspects of this new scale. Relevance to clinical practice This culturally specific instrument contributes to the evaluation of the provision of spiritual care by Jordanian Muslim nurses to their patients, to guide them in providing a comprehensive and appropriate spiritual care interventions and to examine the effect of spiritual care on various aspects of patient's quality of life. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore the symptom management strategies utilized by post coronary artery bypass graft (CABG) patients and its associations with demographic variables. A clear understanding of the use of symptom management strategies following CABG surgery may help nurses in developing educational program and interventions that help patients and their families during recovery period after discharge. A cross-sectional, descriptive design was utilized. A convenience sample of 100 Jordanian patients post CABG surgery selected from five hospitals was surveyed between November 2012 and June 2013 using the Cardiac Symptom Survey. Chi squared analyses were used to examine the associations between the symptoms management strategies and selected demographic variables. Frequency of symptom management strategies utilized by post CABG patients revealed that most frequently employed strategies were use of medications (79%), repositioning (54%) and the rest (45%). Symptom management strategies utilized for poor appetite, sleeping problem and fatigue had significant associations with demographic variables. By providing information about the symptoms expected after surgery and possible ways to manage them, will strengthen the patients psychologically and will make CABG experience within the realm of self-management and coping. [ABSTRACT FROM AUTHOR]

Aims and objectives To assess the epidemiology and correlates of urinary incontinence and its perceived impact on the emotional and social well-being of Jordanian women. Background Diabetes is a chronic disease with rising prevalence in women worldwide. Although urinary incontinence is a complication of diabetes, it is not commonly assessed with limited nurses' knowledge available on its prevalence, correlates and its perceived impact on lives of women. Design A cross-sectional survey design using probability sampling approach was used to collect information on incontinence. Methods A total of 1011 adult women, 20-65 years old, attending primary healthcare centres in Jordan were interviewed using a standardised incontinence questionnaire. Questionnaire included items to assess the perceived impact of incontinence on social and emotional well-being of women. The study outcome included weekly or more any, stress and urge incontinence. Results Of 435 (43%) diabetic and 576 (57%) nondiabetic women, a total of 676 (66·8%) women reported incontinence. The prevalence of weekly or more any, urge and stress incontinence was significantly higher in diabetic than in nondiabetic women, 31·5, 13·8 and 20% versus 18·2, 5·9 and 14·2%, respectively. After adjusting for age, body mass index, parity and history of urinary tract infections, in multiple logistic regression analyses, diabetes was significantly associated with any ( OR: 1·99; 95% CI: 1·44-2·74) urge ( OR: 2·23; 95% CI: 1·38-3·61) and stress incontinence ( OR: 1·54; CI: 1·07-2·22). Obesity and age were found to be significant correlates for urge incontinence in diabetics. Women with incontinence perceived incontinence as bothersome condition with negative impact on social well-being. Conclusions Incontinence is a common and distressing problem in diabetic women, especially for those who are older and obese. Prospective cohort studies are needed to assess how nurse-led interventions may impact the negative consequences of incontinence on women well-being. Relevance to clinical practice Nurses are in the right position to assess urinary incontinence in diabetic women. Proper communications, culturally sensitive screening and tailored interventions may assist nurses in providing care and support to alleviate the impact of incontinence on women well-being. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe the quality of life and anticipatory grieving among Jordanian parents living with a child with cerebral palsy. A cross-sectional, descriptive, correlational design was used with 204 Jordanian parents. Both mothers and fathers were recruited from health-care centres that provided comprehensive care for children with cerebral palsy in Jordan and from schools for special education. Structured interviews were conducted using the Marwit and Meuser Caregiver Grief Inventory Cerebral Palsy and Quality of Life Index. The majority of the parents reported that providing care for a child with cerebral palsy is requiring more emotional energy and determination than ever expected. There was a significant negative correlation between total anticipatory grief score and total quality of life score and all subscales. This indicates that parents with high level of intensity of anticipatory grief had lower quality of life. No statistically significant differences were found in anticipatory grief and quality of life responses between mothers and fathers. The outcomes of this study have important implications for encouraging family-centred care and inform policy to improve the lives of children with cerebral palsy and their parents. [ABSTRACT FROM AUTHOR]

Aims and objectives To describe Jordanian mothers' perceptions of nursing support provided during hospitalisation of their children and identify socio-demographic characteristic of mothers and children associated with mothers' perceptions of nursing support. Background Nursing support is crucial to mothers to ease and relieve pain and stress experience during hospitalisation of their children. Design A cross-sectional design. Method A total of 235 mothers who stayed with their children during their hospitalisations for medical or surgical health problems were recruited for the purpose of the study. Mothers of children of one month to two years old from two governmental hospitals in Amman- Jordan were interviewed over a period of two months. Data were collected using Nursing Parent Support Tool and demographic data questionnaire. Results This study showed that the perception of Jordanian mothers to nursing support was moderate ( M = 3·23, SD = 0·95). Stepwise multiple regression analysis showed that mothers' satisfaction to nursing support and mothers' education explained (0·332) of the variance in the mother's perception of nursing support. Conclusion Satisfaction with nursing care and level of education are important factors in Jordanian mothers' perception of nursing support. Nurses need to understand the importance of these factors when providing support and holistic care. Relevance to clinical practice To enhance high level of satisfaction of nursing care, paediatric nurses in the practice settings should establish parent support groups and provide educational materials that are beneficial for educated and uneducated parents. [ABSTRACT FROM AUTHOR]

Aims and objectives. The purpose of this study is to provide insight into the relationship between dietary and fluid non-adherence, depressive symptoms, quality of life, perceived barriers and benefits of exercise, and perceived social support among Jordanian patients with end-stage renal disease receiving haemodialysis using Pender's health promotion model. Background. Non-adherence to dietary and fluid restrictions is a leading cause of treatment failure and poor outcomes in end-stage renal disease. Yet, factors that interfere with the patients' ability to follow their dietary restrictions are unknown. Design. A descriptive, correlational, cross-sectional design was used. Methods. Jordanian patients ( n = 190) with end-stage renal disease receiving haemodialysis from three main Jordanian cities were included. The dialysis diet and fluid nonadherence questionnaire, Beck Depression Inventory-II, Quality Of Life Index, Dialysis Patient-Perceived Exercise Benefits and Barriers Scale, and the Multidimensional Perceived Social Support were employed to measure the key variables. Results. Patients were more likely men with mean age of 48·2 ± 14·9. Only 27% of the patients showed full commitment to diet guidelines and 23% to fluid guidelines during the last 14 days. Depression ( M = 18·8 ± 11·4) had significant negative association with quality of life (importance and satisfaction) ( r = −0·60, r = −0·32, p = 0·001, respectively). Multiple hierarchal regressions revealed a predictive model of only two variables: age ( B = −0·22, p = 0·05) and residual renal function ( B = −0·23, p = 0·012) for dietary non-adherence. Conclusions. Non-adherence to diet and fluid guidelines association with individual characteristics, health perception and psychosocial variables should be investigated in a longitudinal design. Relationship of non-adherence with culture-related factors should deeply be assessed among Jordanian patients with end-stage renal disease receiving haemodialysis. Relevance to clinical practice. Identification of the factors that may worsen dietary and fluid non-adherence may lead to improved therapeutic interventions within the mainstream of medical practice for Jordanian patients with end-stage renal disease receiving haemodialysis. [ABSTRACT FROM AUTHOR]

Jarrah SS, Kamel AA. International Journal of Nursing Practice 2012; 18: 308-315 Attitudes and practices of school-aged girls towards menstruation The purpose of this study was to (i) investigate attitude and menstruation-related practices in Jordanian school-aged girls; (ii) identify the influence of premenstrual preparation on girls' attitude and menstruation-related practices. A descriptive cross-sectional design was used. Data was collected from a convenience sample of 490 school-age girls (12-18 years) from different districts in Jordan. Self-report instruments [Menstrual Attitude Questionnaire (MAQ), and Menstrual Practices Questionnaires (MPQ)] were used to assess the study variables. Descriptive statistics, correlation and chi-square tests were used to analyze the data. It was found that menstrual attitude and practices were positively correlated. Poor attitude toward menstruation and low menstrual practices were significantly associated with inadequate premenstrual preparation. There is a need to prepare girls for menstruation before menarche. The role of the schools and teachers should be reinforced through formal and well planned reproductive health educators for girls and their mothers. [ABSTRACT FROM AUTHOR]

Merrill RM, Madanat H, Kelley AT. International Journal of Nursing Practice 2010; : 624-632 This study assesses smoking prevalence, attitudes, and perceived patient counselling responsibilities among practicing nurses in Amman, Jordan. It also identifies whether their smoking status or training in counselling patients about smoking is associated with their smoking-related attitudes and counselling practices. Data were collected through a cross-sectional survey of 266 ( n = 266) nurses at four public and private hospitals in Amman. Smoking prevalence was 42% for male nurses and 13% for female nurses. Nurses strongly favoured enforcement of anti-smoking policy, but did not strongly agree that nurses should be involved in counselling patients about smoking. Approximately 41% of nurses indicated that they had received training on counselling patients about smoking. Nurse training with respect to counselling patients about smoking was positively associated with the nurses' belief that their counselling could help patients stop or never start smoking. In addition, nurses with counselling training about smoking felt significantly better prepared to assist patients to quit smoking. Nurses who smoked were significantly less likely to believe their counselling of patients about smoking could be effective. Finally, smoking status was not significantly associated with how well prepared the nurses felt to assist patients to quit smoking. These findings identify a need for more extensive and better-tailored training programmes for nurses on patient counselling about smoking. [ABSTRACT FROM AUTHOR]