" It [Diabetes] is From God and I Need to Take Care of Myself": Type 1 Diabetes Self-Management Among Adolescents and Their Parents in Jordan
Authors : Momani, A.M., Callery, P., Lin, Y.L., Abduelkader, R.H. and Al Akash, H.Y
Abstract : Type 1 diabetes is the most common endocrine condition among adolescents. Diabetes self-management can be challenging during adolescence. The objective of this study is to understand how adolescents and their parents manage type 1 diabetes in Jordan. Constructivist grounded theory methodology principles were used to achieve the study aim. A total of 48 participants were recruited using purposive and theoretical sampling techniques, including adolescents and their parents. Data were collected (October 2016 - April 2017) using 38 semi-structured, audio-recorded interviews (one-to-one or joint interviews based on participants' preferences). Data were collected and analyzed concurrently using different levels of coding, constant comparative analysis, and memo writing. This study was approved by relevant ethics committees from the University of Manchester and Jordan University Hospital. The theme of living with diabetes is presented and discussed in this article. Culture emerged as the central theme; two aspects of culture are presented in this article: collectivism and cultural beliefs. This study identified that diabetes self-management could be influenced by the culture in which Jordanian adolescents live in as well as being shaped by their religious beliefs. These findings are potentially transferable to other Arab and non-Arab countries that share similar cultural aspects and religious beliefs.
Keywords : Type 1 diabetes, adolescents, qualitative, grounded theory, Jordan
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The Effect of Anxiety and Depressive Symptoms on Quality of Life among Patients with Heart Failure: An integrative literature review
Authors : AbuRuz, M., Alemoush, R.A. and Momani, A
Abstract : Background: Anxiety and depressive symptoms interfere with physical and psychological status, worsening symptoms and quality of life (QoL) among patients with heart failure (HF). Objective: The purpose of this review was to explore the effect of anxiety and depressive symptoms on the QoL among patients with HF. Methods: The research strategy was done using the following search engines: PubMed, CINAHL, ProQuest, Science Direct, and Google Scholar. The key words used in this research included: Heart failure, QoL, Anxiety & depression/ depressive symptoms, and the combination of these words. The research targeted articles in English language during the period from 2009 to 2020. The inclusion criteria included all study types. Results: The results of this search ended up with 150 articles. After reviewing the abstract of these articles, irrelevant articles were excluded. When the full text articles were reviewed, 129 articles were excluded ending with 21 articles which constitute the base of this literature review. Conclusion: Patients with HF usually suffer from poor QoL. Anxiety and depressive symptoms negatively affect the QoL for this population.
Keywords : Anxiety, Depressive symptoms, Heart failure, Quality of Life
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“I Like People to Treat Me Normally”: Barriers to Type 1 Diabetes Self-Management Among Adolescents
Authors : Momani, A.M., Callery, P., Lin, Y.L., Abduelkader, R.H. and Khalil, H
Abstract : Adolescents with type 1 diabetes face barriers that can have a negative influence on self-management behaviors. This study was an analysis of semi-structured interviews with adolescents, parents, and health-care providers to better understand these barriers among adolescents in Jordan. Adolescents with type 1 diabetes reported individual-level barriers including feeling labeled, pitied, and stigmatized for having type 1 diabetes. They also discussed the system-level barrier of an education system that does not adapt to meet their needs. Individual- and system-level barriers are interrelated and could influence adolescents’ decisions regarding whether to disclose their condition to others
Keywords : Type 1 diabetes, adolescents, qualitative, grounded theory, Jordan
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Perceived control and length of stay post coronary artery bypass graft surgery
Authors : Ruz, MEA., Dahger, N., Al-Akash, HY., Momani, A., Ahmed, FR
Abstract : Background & Aim: Patients undergoing CABG might have increased complications postoperatively, especially prolonging postoperative Length of Stay (LOS). Perceived Control (PC) affects LOS post CABG and complications among different cardiac populations. However, this relation is not well-studied post CABG. This study aimed to determine whether PC was an independent predictor of LOS among patients post CABG.
Methods & Materials: A prospective observational design was used. A consecutive sample consisted of 220 patients from four hospitals in Amman, Jordan, who underwent elective CABG between July 2020 and January 2021. PC was assessed using the Arabic Version of the Control Attitude Scale-Revised. LOS and other necessary information were retrieved from the patients' medical records. Data were analyzed using stepwise multiple regression.
Results: 169 males and 51 females participated in this study. Age, female gender, as well as PC were found to be independent predictors for the hospital LOS. On the one hand, advanced age and female gender increased the hospital LOS, while higher levels of PC were protective. A one-year increase in age increased hospital LOS by 0.16 days, being female increased hospital LOS by 0.17 days, and a one-point increase in PC levels decreased LOS by 0.33 days. On the other hand, only female gender and PC were independent predictors for the ICU LOS. Similarly to hospital LOS, the female gender increased ICU LOS by 0.18 days while the one-point increase in PC decreased the ICU LOS by 0.21 days.
Conclusion: PC was an independent predictor that affects LOS after CABG. Increasing PC among this population, especially females and the elderly, might improve outcomes of their CABG surgery decrease hospital's LOS, and the resultant morbidity
Keywords : Perceived control, length of stay, post coronary artery bypass graft surgery
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Effect of Epidural versus Parenteral Opioid Analgesia on Labor Pain and Maternal and Neonatal Outcomes among Jordanian Women: A Retrospective Study
Authors : Khalil, H., Shajrawi, A., Momani, A., Khalil, D. and Abdelkader, R
Abstract : Introduction: Pain is a major concern during labor. Opioids commonly used to reduce pain during childbirth. However, the most effective route for opioid administration remains controversial. Thus, this study aimed to compare the effect of epidural and parenteral opioid analgesia on pain relief, opioid consumption, opioid-related side effects, and maternal and neonatal outcomes during labor. Methods: This was a retrospective chart review of Jordanian Arab pregnant women admitted for an uncomplicated normal vaginal birth. Data extracted from patients’ medical records and analyzed with t-test for parametric variables and chi-square and fisher’s exact tests for non-parametric variables.
Results: Women with epidural analgesia had less pain (t = -32.96, p ≤ .001), consumed less opioids (t = -5.23, p ≤.001) and complained of fewer opioid side effects (t = -10.35, p ≤ .001) compared to those with parenteral analgesia. However, they had a longer duration of labor (t = 2.05, p ≤ .05) and hospital stay (t = 6.13, p ≤ .001). Induced labor (χ2= 10.93, p ≤ .001) and cesarean section (χ2 = 19.09, p ≤ .001) were higher in women with epidural analgesia and their neonates had lower Apgar scores at 1 minute (t = -2.75, p ≤ .05) and 5 minutes (t = -2.47, p ≤ .05) after birth and higher incidence of fetal heart rate abnormalities (χ2= 5.95, ≤ .05). Conclusion: The use of epidural analgesia is more effective in relieving labor pain compared with parenteral analgesia. However, it is associated with negative maternal and neonatal outcomes.
Keywords : Epidural analgesia, Labor, Opioids, Pain, Parenteral analgesia
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The Effect of Anger Management Program on Perceived Stress of Healthcare Professionals: A Quasi-experimental Study
Authors : Masa'deh, R., Masadeh, O.M., Momani, A., Jarrah, S., AL Shabatat, S.H. and Hamaideh, S.H
Abstract : Background & Aim: Healthcare professionals working in Intensive Care Units and Emergency Rooms are at higher risk of violence from patients and their families compared to healthcare professionals working in other units. Healthcare professionals skilled in anger management may de-escalate the situation and stop violence from happening in the first place. This study aims to determine the effect of an aggression management program on perceived stress levels of physicians and nurses working in Intensive Care Units and Emergency Rooms. Methods & Materials: A quasi-experimental design with 158 physicians and 172 nurses recruited from nine hospitals in the three major cities in Jordan was used to assess perceived stress levels with the Arabic Version of Perceived Stress Scale (10-Items). Participants answered the questionnaires twice, before and after attending an aggression management program. Results: Results showed that female healthcare professionals had significantly higher stress levels than males (M=27.33±4.11, M=24.20±3.13; t (328)=2.11, p<0.001). Furthermore, healthcare professionals working in Emergency Rooms reported significantly higher stress levels than those working in Intensive Care Units (M=27.93±4.10, M=24.94±3.03; t (328)=2.04, p<0.001). Additionally, nurses reported significantly higher stress levels compared to physicians (M=28.17±3.92, M=25.20±3.13; t (328)=2.09, p<0.001). There was a strong significant positive relationship between increased stress levels and the number of violent attacks (r=0.73, p<0.001). Most importantly, perceived stress decreased significantly from the pre-intervention level (28.94±3.21) to the post-intervention level (24.20±3.01) (t (229)=2.03, p<0.001). Conclusion: Policymakers may need to consider offering aggression management programs for all healthcare professionals, especially those working in the Emergency Room. This program should decrease their perceived stress levels reflecting improved patient care, outcomes, and satisfaction.
Keywords : Aggression, violence, nurses, intensive care units, physician, Jordan
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The Association Between Depressive Symptoms and Hospital Length of Stay Following Coronary Artery Bypass Graft is Moderated by Perceived Control
Authors : Ruz, M.E.A., Momani, A. and Shajrawi, A.A
Abstract : 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.
Keywords : Depressive symptoms, perceived control, coronary artery bypass graft, length of stay
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Vitamin D Mediates the Relationship Between Depressive Symptoms and Quality of Life Among Patients With Heart Failure
Authors : Ruz, M.E.A., Momani, A. and Shajrawi, A.A
Abstract : Background: Depressive symptoms are common among patients with heart failure and are associated with poor quality of life. Vitamin D plays a role in the regulation of mood and depressive symptoms levels. Patients with heart failure can have lower levels of vitamin D. Objective: The aim of this study was to explore the relationship between vitamin D deficiency, depressive symptoms, and quality of life among patients with heart failure in Jordan. Methods: A cross-sectional correlational comparative design was used in this study. Depressive symptoms were measured by the Arabic subscale of the Hospital Anxiety and Depression Scale, quality of life was measured by the 36-item Short Form Health Survey questionnaire, and vitamin D was measured in plasma. Data were analyzed by independent-sample t test and multiple regression. Results: A total of 220 patients participated in this study, 70.5% of whom were men, and 57.3% had vitamin D deficiency (<30 ng/mL). Patients with vitamin D deficiency had higher levels of depressive symptoms compared with those with normal levels (mean [SD], 16.2 [4.3] vs 6.3 [2.3]; P ≤ .001). In multiple regression, according to the Baron and Kenny approach, depressive symptoms predicted quality of life and vitamin D levels. Vitamin D deficiency and higher levels of depressive symptoms were associated with poor quality of life. Conclusions: Vitamin D levels partially mediated the relationship between depressive symptoms and quality of life. Therefore, further research is needed to better understand the nature of the relationship between vitamin D deficiency, depressive symptoms, and quality of life among patients with heart failure.
Keywords : Vitamin D, depressive symptoms, quality of life, heart failure
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Transition to Motherhood after Childbirth Complications and ICU Admission
Authors : Al-Akash, H.Y., Safadi, R., Swigart, V., Maabreh R. and Momani, A
Abstract : Childbirth complications and admission to the intensive care units in the immediate postpartum period have the potential to impact transition to motherhood. Mothers in the intensive care units have special needs other than monitoring and resuscitation. This study aims to explore the subjective experience of transition into motherhood among Jordanian mothers who suffered childbirth complications that required postpartum hospitalization into the intensive care units. A descriptive phenomenological approach has been conducted to underpin this study among purposive seven mothers who developed childbirth complications and were admitted to the intensive care units at any of the Royal Medical Services Hospitals in Jordan. Data were generated through semi-structured qualitative interviews. The interviews were conducted at two points of time, within the first month and four to six months after birth. The results showed five major themes in relation to transition to motherhood after childbirth complications and admission to the intensive care units: Early Separation and Delayed Bonding, Unmet Needs of the Mothers by the Intensive Care Unit Environment and Healthcare Professionals, Devastation: Physical and Emotional and the Role of Spirituality and Sociocultural Influences. This study provided insight into risks of the childbirth complications upon mothers’ physical and psychological well-being, and maternal- infant relationship, it also highlighted the needs of mothers during their stay in the Intensive Care Unit
Keywords : Childbirth Complications, Intensive Care Unit, Motherhood, Phenomenology, Qualitative Approach, Transition to Motherhood
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