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الأبحاث

" 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

Women’s health concern in Jordan: knowledge, practice and barriers toward cervical cancer screening

Authors : Roqia Saleem Maabreh, Raya Yousef Al-Husban, Hekmat Yousef Al-Akash, and Noha Al-Shdayfat

Abstract : Purpose – Cervical cancer (CC) is one of the most important health issues faced by women worldwide. The purpose of this study is to identify Jordanian women’s knowledge, barriers and measures pertaining to risk factors and screening choices of CC (Pap smear tests). Design/methodology/approach – This study applied a cross sectional design by collecting data from a convenient sample of 200 women between 20 and 70 years of age in health and public centers in Jordan. Data was then analyzed using the descriptive statistical tools of SPSS, version 21. Findings – The findings revealed that 55.5% of the participants had no information about the Pap smear, and 75% did not know the risk factors. Moreover, 50% of the sample did not know where to take the test, and 50% reported a lack of encouragement from the husband to undertake the test. More than half of the participants (56.5%) expressed fear that cervical screening would be a painful examination even though they reported not having any previous experience with the test. Originality/value – Based on these findings, public education about CC screening is essential, including advertising and a campaign similar to the breast cancer awareness programs in Jordan, as a way of encouraging early screening to improve the health of women.

Keywords : Cervical cancer, Screening tests, Knowledge and barriers

Jordanian Patients’ Family Members Need Perceptions in the Critical Care Settings: Nurses’ Perspectives versus Family Members’ Perspectives in the Context of Health Informatics

Authors : Hekmat Al-Akash , Roqia Maabreh , Mohannad AbuRuz , Khaled Khader , and Abedalmajeed Shajrawi

Abstract : Background. An unexpected hospitalization in any of the Critical Care Units (CCUs) is a stressful condition, not only for patients but also for other family members. Research in this field in Jordan is not available. *e main objective of this study was to identify the most important needs as perceived by these family members in the light of this stressful event and compare them with the nurses’ perceptions of the importance of these needs and also to determine the perception of the needs’ importance with the sociodemographic characteristics of both family members and caring nurses. Methods: this was a cross-sectional study conducted in the period between February and August 2020 among adult family members of patients admitted to the CCUs in hospitals of Jordan from all sectors (public, private, and teaching). “Critical Care Family Needs Inventory (CCFNI)” questionnaire was administered to 82 family members and 99 CCU nurses to determine the importance of the needs on the inventory. The data were analyzed using descriptive statistics. Results. The most important need identified by the family members was relevant to the need for proximity (3.64 ± 0.45), followed by information (3.57 ± 0.58), assurance (3.44 ± 0.43), support (3.31 ± 0.62), and comfort (3.21 ± 0.56). Nurses identified the needs for assurance as the highest, followed by information, comfort, and support, whereas proximity was the least need perceived as very important. The top 10 important needs for both family members and nurses were identified. Family members and nurses were only common in 2 of the need statements on the scale. *ere was no significant association between the sociodemographic characteristics of the sample and the perception of the needs’ importance (p = 0.05). Conclusion. This study has shown that nurses and family members of patients admitted to CCUs have different perspectives relevant to needs’ importance. This should warn nurses to set the needs viewed by family members as a priority. Implications. In the CCU settings, in the context of advancing health informatics, families of patients in the ICUs have different needs other than those viewed by nurses. Their needs must be identified and considered.

Keywords :

Perceived control and length of stay post coronary artery bypass graft surgerybr/>

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

The effect of food safety training program on food safety knowledge and practices in hotels’ and hospitals’ food services

Authors : Hekmat Al-Akash, Abu Arrah Abdelhakeem, Bhatti Feyza, Maabreh Roqia, Abu Arrah Riham

Abstract : Food Safety Knowledge (FSK) among Food Handlers (FHS) in the food services in both hotels and hospitals has a crucial role in food protection and combating against foodborne diseases. The aim is to check the food safety (FS) training program upon FSK in the Jordanian hotels’ and hospitals’ food services. A pre-test-post-test design was used. A convenience sample of 412 food handlers from randomly selected hotels and hospitals were recruited. Data were collected using 118-questions Food Safety Knowledge Questionnaire (FSKQ); 40- questions tool for FS Practices. A significant improvement in FSK mean scores in the post-test (85.48±17.07/118 points corresponded to 72.44%) compared with the pretest (78.50±13.69/118 points, corresponding to 66.66%). The overall mean FSK score was considered to be “moderate” in pre and post-tests. FS Practice level mean was 26.86±4.38/40 points (67.14%), regarded as “moderate” in the pre-test and continued to be “moderate” after the training despite a significant increase in the post-test scores (27.92±4.45/40 point, corresponded to 69.80%, P=0.000). FHS worked in organizations where HACCP principles are implemented, possessed higher FSK and better FS practices. Although continued to be “moderate”, FSK and FS Practices among FHS in the Jordanian hotels and hospitals have been significantly improved after the FS Training Program

Keywords : Food Safety, Training Program, Jordan Hospitals, Jordan Hotels

Food Safety Knowledge among Food Handlers in Hospitals of Jordan

Authors : Abu Arrah Abdelhakeem, Bhatti Feyza, Al-Akash Hekmat

Abstract : Food safety knowledge (FSK) plays an important role in guiding food handlers (FHs) practices during food operations. The aim of this research was to investigate the level of FSK among FHs in hospitals' food services in Jordan. Up to 245 food handlers work in hospitals were purposefully selected from 6 public and private hospitals. A published FSK questionnaire included 120 items in 6 subscales was used to collect data. Most of the hospitals' FHs were male (91.84, n=225), of mean age 35.89 ± 9.26 years, with average experience of 12.55 ± 8.1 years, education of less than high school, and worked in public hospitals. The overall FSK was found to be "moderate" (71.20%). Food handlers were having the highest knowledge in the areas of "personal hygiene and hand washing" (80.87%), "health problems affecting FS" (86.10%), and "cross- contamination control and sanitation" (75.96%). FSK was "moderate" in "thawing, safe storage, transfer, catering, holding, heating, and re-heating" was (68.06%), "foodborne diseases and symptoms" (67.05%), and "poor" in "foodborne pathogens" (30.60%). Male FHs possessed higher FSK than female's counterparts (p=.036). There was a significant negative relationship between FSK and age (p=.044), positive relationship with previous exposure to FS training (p=.000), while there was no significant mean difference of FSK based on the years of experience or hospital sector (p=.090). One-way ANOVA with post-hoc revealed that FHs with higher educational qualification possessed higher FSK (p= .00). Food Safety Training is recommended for certain areas in food operations and foodborne pathogens.

Keywords : Food Safety, Food Hygiene, Food Safety Knowledge, Food Handlers, Hospitals, Jordan

Knowledge, Attitude and Practice about Evidence-Based Practice: A Jordanian Study

Authors : Mohannad Eid AbuRuz , Haneen Abu Hayeah , Ghadeer Al-Dweik, and Hekmat Yousef Al-Akash

Abstract : Background: Evidence-based practice has become a worldwide concern for healthcare staff and administrators as well as researchers. Evidence-based practice has been considered as critical element to improve quality of health services and achieving excellence in patient care. The implementation of Evidence-based practice in clinical environments has been challenging. One of the most important barriers to implement Evidence-based practice is knowledge deficit. Objective: The aim of this study was to describe Jordanian nurses' knowledge, attitudes, and practice regarding evidence-based practice. Methods: A descriptive cross-sectional correlational study was conducted in seven major hospitals in Amman/ Jordan. Five hundred nurses answered a self-reported questionnaire. Descriptive statistics and multiple linear regressions were used to analyze the data. Results: Attitudes toward Evidence –Based Practice had the highest mean followed by the knowledge/skills and finally the practice. Female nurses practice research less, have less positive attitude, and less knowledge about research compared to male nurses. Nurses with MSc degree, working in ICU and private hospitals have more positive attitude, reported higher levels of knowledge and skills compared to nurses with BSc, nurses working in other units, and nurses working in ministry of health and Royal Medical Service respectively. Conclusion: Ongoing education for nurses and minimizing barriers are recommended to promote the use of Evidence –Based Practice in Jordan

Keywords : Evidence-based Practice; Nurses; Attitudes; Knowledge

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

Authors : Mohannad Eid AbuRuz; Ghadeer Al-Dweik; Hekmat Yousef Al-Akash

Abstract : 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

Keywords : Depressive symptoms, perceived control, coronary artery bypass graft, length of stay

Perceived Stress in Nurses: A Comparative Study

Authors : Rami Masa’Deh , Fadwa Alhalaiqa , Mohannad Eid AbuRuz , Ghadeer Al-Dweik, & Hekmat Yousef Al-Akash

Abstract : 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

Keywords : department, Jordan, nurse, psychiatric, stress

Persistent (Anxiety and Depression) Affected Academic Achievement and Absenteeism in Nursing Students

Authors : Mohannad Eid Abu Ruz; Hekmat Yousef Al-Akash; and Samiha Jarrah

Abstract : Background: Anxiety and depression are common among nursing students due to different factors. When they are minimal and not persistent, they work as stimuli for good achievement. However, when they are high or persistent they have negative consequences (i.e. low academic achievement and higher absenteeism rates). Objective: The purpose of this study was to check the effect of persistent anxiety and depression on nursing student academic achievement and absenteeism rate. Methods: A prospective observational correlational design with a convenience sample of 170 students enrolled in the undergraduate and graduate programs-college of nursing at a private university in Amman, Jordan. Anxiety and depression were measured twice at the beginning of the semester and then two months later by Hospital Anxiety and Depression Scale. Data regarding grade point average, number of absenteeism and the gender of the students; were collected from the electronic system of the university. Results: Persistently anxious group has lower grade point average than persistently non-anxious group (mean [SD], 64.1 [13.8] vs. 73.1 [12.3], P< .001). Moreover, they have higher absenteeism rate than persistently non-anxious group (7.62 [5.7] vs. 4.0 [3.4], P< .001) and higher than transiently anxious group (7.62 [5.7] vs. 4.7 [4.6], P< .05). Persistently depressed group has lower grade point average than persistently non-depressed group (64.0 [13.8] vs. 73.2 [13.0], P< .001) and lower than transiently depressed (64.0 [13.8] vs. 71.7 [10.6], P< .01). Conclusion: Nursing administrators should search for the underlying causes for these negative emotions. Furthermore, setting strategies to control these negative emotions is highly recommended

Keywords : Anxiety, Depression, Academic achievement, Absenteeism, Collegial life, Education

The University of Jordan Students' Concerns and Awareness about Trans-Fatty Acids

Authors : AbdElhakeem Abu Arrah; Hekmat Yousef Al-Akash; Mohannad Eid Abu Ruz

Abstract : Total Trans Fatty Acids (TFAs) intake was associated with an increased risk of coronary and cardiovascular diseases and their mortalities. The World Health Organization highlighted the seriousness of TFAs intake and called to ban TFAs from foods or to limit their intake to less than 1% of the total amount of the energy intake. Fast foods are considered to have a high percentage of TFAs. University students spend most of their time outside home which makes them the suitable population to consume these kinds of food. The purpose of this descriptive study was to assess the University of Jordan students' concerns and awareness about TFAs. Four hundred and seventeen students answered a self-reported questionnaire about TFAs from October, 2015-January, 2016. Descriptive statistics, independent sample t test and multiple regression were used to analyze the data. Results showed that students at the University of Jordan were found to have moderate concern relevant to TFAs (Mean± 64 SD; 20.0 ± 5.1), and moderate awareness relevant to TFAs health risks (Mean± SD; 51.5± 15.2). Awareness was predicted from the faculty of students (health faculties), female gender, living status, and family income, which explained 30% of the variance. In conclusion, it is known that high levels of TFAs are associated with increased risk of cardiovascular diseases and obesity, especially in young adults. The results of this study showed that concern and awareness of the students about health risks and dietary sources of TFAs was insufficient to make decisions of healthier food selection

Keywords : Total Trans Fatty Acids, concerns, awareness, knowledge, University Students, Jordan

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

Research Title :“We do others’ Jobs”: a qualitative study of non-nursing task challenges and proposed solutions

Authors :Hekmat Al-Akash, Ayman Aldarawsheh, Rami Elshatarat, Murad Sawalha, Ahmad Saifan, Nezam Al-Nsair, Zyad Saleh, Wesam Almagharbeh, Dena Sobeh & Mudathir Eltayeb

Abstract :Introduction Non-nursing tasks (NNTs) have become a prevalent issue among healthcare professionals, affecting nurses globally. This study delves into the experiences of Jordanian nurses regarding NNTs, aiming to uncover challenges and propose solutions within the Jordanian healthcare context. Objectives Explore the impact of NNTs on Jordanian nurses’ roles, workload, and satisfaction. Additionally, the study aims to identify various types of NNTs performed by nurses, understand their impact, and propose solutions to mitigate challenges associated with these tasks. Methods A qualitative-exploratory research design was employed for this study. Semi-structured interviews were conducted with Jordanian nurses using a purposeful sampling approach to ensure a diverse representation of experiences and perspectives. Thematic analysis was used to identify recurring themes and patterns related to NNTs, their challenges, and potential solutions. Ethical guidelines were strictly followed to maintain participant confidentiality and ensure the integrity of the data collected. Results Analysis of the interviews revealed four major themes: challenges of NNTs, types of NNTs, impact of NNTs, and proposed solutions. Nurses faced significant difficulties due to task ambiguity, role confusion, and increased workload from NNTs, which included administrative duties, clerical work, and tasks typically performed by other healthcare professionals. These NNTs negatively impacted nurses’ effectiveness, productivity, and job satisfaction by diverting time and energy from primary nursing responsibilities, causing professional strain. To address these issues, participants suggested clearer job descriptions, stricter task assignment protocols, and systemic changes to tackle the root causes of NNTs. Conclusion This study sheds light on the pervasive challenges posed by NNTs among Jordanian nurses and emphasizes the importance of addressing these issues to enhance nursing care quality and nurse well-being. By proposing actionable solutions tailored to the Jordanian context, this research contributes to the global discourse on NNTs and underscores the need for organizational support and advocacy to optimize nurses’ roles and improve patient care outcomes

Keywords : Non-nursing tasks, Jordanian nurses, Qualitative research, Healthcare workload, Role ambiguity, Task assignment

Research Title :Impact of triage nurses' recognition of acute coronary syndrome on patients' clinical outcomes: A retrospective study.

Authors :Alsharawneh, Anas; Sawalha, Murad; Tabar, Nazih Abu; Elshatarat, Rami A; Almarwani, Abdulaziz Mofdy; Saleh, Zyad T; Almagharbeh, Wesam T; Al-Akash, Hekmat Y; Mohamed, Nermen A; Eltayeb, Mudathir M.

Abstract :Background: Triage nurses' pivotal role in initial assessment makes their competence crucial. However, the specific impact on Acute Coronary Syndrome (ACS) recognition and outcomes remains unclear in Jordanian healthcare. Understanding this relationship could enhance ACS management and patient outcomes in Jordanian Emergency Departments (EDs). Objective: To assess how triage nurses' recognition of ACS diagnosis affects patient outcomes in Jordan. Methods: This retrospective study examined records of 150 ACS patients admitted to the coronary care unit (CCU). Data extraction assessed triage nurses' accuracy in recognizing ACS symptoms and the timelines for diagnosis procedures (e.g., electrocardiogram [ECG]) and treatment provision (e.g., thrombolytic) based on triage decisions. It also evaluated the impact on treatment outcomes, including length of stay in the ED and hospital. Multiple linear regression analyses quantified the influence of under-triage on treatment outcomes. Results: The sample comprised 150 patients. Most were female (78.7%), aged 45-59.9 years (37.3%). ACS classifications: unstable angina (52.0%), STEMI (38.0%), NSTEMI (10.0%). The study included a cohort of ACS patients, with findings indicating varying degrees of under-triage by triage nurses. Analysis of timelines revealed significant delays in diagnosis and treatment initiation for patients subjected to under-triage. Multiple linear regression analyses demonstrated a robust association between under-triage and prolonged time to essential treatment outcomes, including delays in physician assessment, ECG performance, thrombolytic administration, and extended ED length of stay. Conclusion: Triage nurses' knowledge and competency are crucial determinants of accurate ACS recognition and subsequent clinical outcomes for patients presenting to the ED in Jordan. Investing in ongoing education and training programs for triage nurses may lead to improved ACS recognition rates and better patient outcomes in Jordanian healthcare settings.

Keywords :triage; Jordan; Myocardial infarction; Retrospective study; Triage nurses; Unstable angina.

Research Title :Effectiveness of Triage Professionals' Knowledge and Experience on Their Ability in Early Diagnosis and Consequent Treatment of Acute Coronary Syndrome: A Literature Review Study

Authors : Zyad T. Saleh, Aziz Aslanoglu, Riyad Al-Dgheim., Murad A. Sawalha, Rami A. Elshatarat, Hekmat Y. Al-Akash, Wesam T. Almagharbeh, Khaled M. Al-Sayaghi, Khadega A. Alhefnawy, Hala I. Zaiton, Osama Mohammad Abu Nassar, Dena Eltabey Sobeh, Mudathir M. Eltayeb, Mohammed Khalaf Alharbi

Abstract :Objective: To investigate the impact of triage professionals' knowledge, experience, and other key attributes on their ability to accurately diagnose and initiate early treatment for Acute Coronary Syndrome (ACS) through a review of existing literature. Methods: A literature review was conducted using established databases. Studies examining the relationship between triage professionals' expertise and their ability to manage suspected ACS cases were included. Results: The review uncovered several key themes regarding the role of triage professionals in managing suspected ACS cases: Triage professionals must possess multifaceted expertise, combining strong knowledge, clinical competency, effective communication, and sound decision-making skills to effectively manage potential ACS cases in high-pressure environments. Accurate ACS identification demands specific skills such as comprehensive knowledge, competent assessment, clear communication, and strong decision-making abilities. Experience plays a significant role in shaping triage professionals' abilities, enhancing intuitive skills and pattern recognition. However, it can also be susceptible to limitations such as fatigue-induced bias, highlighting the need for strategies to mitigate these challenges. Educational interventions emerge as effective tools for improving triage professionals' knowledge and confidence levels. Well-designed training programs have been shown to lead to quicker identification of high-risk patients, potentially resulting in improved patient outcomes. Despite these findings, the review identified several gaps and areas for improvement in current research. Limitations include a lack of emphasis on the direct link between interventions and patient outcomes, limited longitudinal studies, and variations in methodology and setting that hinder generalizability. Addressing these limitations is crucial for advancing our understanding of the effectiveness of educational interventions in improving the early management of ACS by triage professionals. Conclusion: Continuous learning, standardized practices, and ongoing research are crucial to optimize the role of triage professionals in early ACS management. Addressing the identified limitations in research methodology and implementing future studies as suggested can potentially improve patient outcomes and enhance the healthcare system's response to this time-sensitive condition.

Keywords : Triage Nurses Knowledge Experience Early Diagnosis Acute Coronary Syndrome Literature Review.

Research Title :Opportunistic Bacterial Infections and Control Measures in Saudi Arabian Healthcare Facilities: A Literature Review

Authors : Mohammad Alzaareer, Aziz Aslanoğlu, Rami A. Elshatarat, Wesam T. Almagharbeh, Amany A. Saleh, Hekmat Y. Al-Akash, Mudathir M. Eltayeb, Dena Eltabey Sobeh, Zyad T. Saleh, Noraznawati Ismail

Abstract : This study provides a comprehensive exploration of opportunistic bacterial strains in Saudi Arabian healthcare settings, offering insights derived from an extensive literature review. The analysis delves into the characteristics of these bacterial strains, emphasizing their prevalence and the challenges they pose to healthcare facilities. Additionally, the study examines infection control strategies employed within the Saudi Arabian healthcare landscape to mitigate the impact of opportunistic bacteria. The literature review covers a broad spectrum of research, encompassing studies that characterize opportunistic bacterial strains prevalent in various healthcare settings. It sheds light on the diversity of these strains, with a focus on their resistance patterns and virulence factors. The investigation incorporates molecular typing methods, such as pulsed-field gel electrophoresis and polymerase chain reaction, to elucidate the genetic diversity and clonal spread of these bacteria. Furthermore, the study provides an overview of infection control strategies implemented in Saudi Arabian healthcare settings. It explores the efficacy of measures such as strict hand hygiene practices, environmental surveillance, and antibiotic stewardship programs. The review underscores the importance of continuous education for healthcare personnel to enhance adherence to infection prevention protocols. This comprehensive overview not only contributes to the understanding of opportunistic bacterial strains prevalent in Saudi Arabian healthcare facilities but also offers valuable insights into evidence-based infection control strategies. The findings of this study have implications for healthcare practitioners, policymakers, and researchers striving to enhance patient safety and minimize the impact of healthcare-associated infections in the Saudi Arabian context.

Keywords :Opportunistic Bacteria Healthcare Settings Infection Control Saudi Arabia Literature Review.

Research Title :Predictors of Post-Percutaneous Coronary Intervention Chest Pain Among Coronary Heart Disease Patients

Authors :Mohammad Jamil Abdelhaq , Abedalmajeed Methqal Shajrawi , Samantha Ismaile , Ahmed Mohammad Al-Smadi , Hekmat Yousef Al-Akash, Ala Ashour , Anas Salah , Ahmad Mohammad Abu-Safia

Abstract : Patients who undergo percutaneous coronary intervention (PCI) procedure frequently suffer post-PCI chest pain (PPCP). This study aims to identify the changes in PPCP level and investigate the predictors of PPCP among patients with coronary heart disease at three measurement times: on admission (T1), 24 hours post-PCI (T2), and 30 days post-PCI (T3). A repeated-measure design was used. Significant differences were observed in PPCP levels between T1 and T2; between T2 and T3; and between T1 and T3. The predictors of PPCP are (1) high-intensity physical activities duration per week, (2) cardiac enzyme level upon admission, (3) increased ejection fraction, and (4) increased heart rate. The results highlight that identifying predictors of PPCP helps in determining high-risk patients, whereby evidence-based interventions can decrease readmission rates and reduce patient exposure to unnecessary investigations and procedures. More research is needed to explain the changes in PPCP level and to confirm these results.

Keywords : Jordan; chest pain; coronary heart disease; percutaneous coronary intervention; predictors; revascularization.

Research Title :Women’s health concern in Jordan: knowledge, practice and barriers toward cervical cancer screening

Authors : Roqia Saleem Maabreh; Raya Yousef Al-Husban; Hekmat Yousef Al-Akash; Al-Shdayfat, Noha

Abstract :Cervical cancer (CC) is one of the most important health issues faced by women worldwide. The purpose of this study is to identify Jordanian women’s knowledge, barriers and measures pertaining to risk factors and screening choices of CC (Pap smear tests. Design: study applied a cross sectional design by collecting data from a convenient sample of 200 women between 20 and 70 years of age in health and public centers in Jordan. Data was then analyzed using the descriptive statistical tools of SPSS, version 21. Findings: The findings revealed that 55.5% of the participants had no information about the Pap smear, and 75% did not know the risk factors. Moreover, 50% of the sample did not know where to take the test, and 50% reported a lack of encouragement from the husband to undertake the test. More than half of the participants (56.5%) expressed fear that cervical screening would be a painful examination even though they reported not having any previous experience with the test. Originality/value-Based on these findings, public education about CC screening is essential, including advertising and a campaign similar to the breast cancer awareness programs in Jordan, as a way of encouraging early screening to improve the health of women

Keywords : Pap smear; cervical cancer; women’s cancer.

Research Title :Guideline Implementation for Improved Asthma Management and Treatment Adherence in Children in Jordan

Authors :Roqia Maabreh Mahmoud H. Alrabab’a Madiha Amin Morsy Hekmat Yousef Al-Akash Ahmad Rajeh Saifan Nabeel Al-Yateem

Abstract : Asthma imposes a significant social burden on children, their families, and society at large. As a chronic health condition, effective management could greatly benefit from consistent adherence to guidelines. Despite this, minimal effort has been exerted to examine the impact of asthma management guidelines and adherence to treatment on children with asthma and the mothers caring for them. This study was designed to evaluate the influence of asthma management guidelines on the knowledge and treatment adherence among children with asthma and their mothers. A quasi-experimental design was utilized, and the study was conducted at two large hospitals in Jordan: Princess Rahma Hospital and King Hussein Medical Center. A purposive sample of children aged 6–12 years (n = 100) who were accompanied by their mothers (n = 100) were recruited for this study. Data were collected using a structured questionnaire and an observation checklist before and after the implementation of guidelines. Statistical analyses were performed using SPSS. The results revealed a statistically significant improvement in knowledge related to asthma among children and their mothers (p < 0.001). Additionally, a statistically significant difference was observed in the children’s adherence to their treatment regimen before and after the implementation of asthma management guidelines (p < 0.001). Moreover, the improvements in knowledge and practice related to asthma were sustained in the follow-up assessments. In conclusion, the guidelines had a beneficial effect on the children’s adherence to their treatment regimen both before and after their implementation. Thus, asthma patients should adhere to conventional guidelines at various health services to manage their condition effectively.

Keywords : asthma; management; adherence; experimental study; Jordan

Research Title :The Impact of Type of Acute Myocardial Infarction on Cardiac Patient Self-efficacy After Hospitalization

Authors :Abedalmajeed Methqal Shajrawi, Ahmed Mohammad Al-Smadi, Ala Ashour, Aaliyah Momani, Hekmat Yousef Al-Akash, Malcolm Granat, Ian Jones

Abstract :Background: Self-efficacy is an important psychological construct associated with patient adherence with healthy lifestyle choices. Few studies have focused on the impacts of the type of acute myocardial infarction (AMI), non-ST-elevation myocardial infarction (STEMI) and STEMI, and the different treatment modalities of AMI on changes in cardiac self-efficacy after hospitalization. Objective: This study examined the changes in cardiac self-efficacy based on the type of AMI and aimed to investigate the impact of different treatment modalities on changes in cardiac self-efficacy among post-AMI patients during hospitalization and at the 3- and 6-month follow-ups subsequent to hospitalization. Methods: A repeated-measures design was used with a convenient sample of 210 patients diagnosed with first AMI. Patients completed the Cardiac Self-efficacy Questionnaire at the 3 time points. The study was implemented in 3 major hospitals in Jordan. Patients did not have access to cardiac rehabilitation. Results: There was a statistically significant impact of AMI type on changes in cardiac self-efficacy measured between T1 and T2, between T2 and T3, and subsequently between T1 and T3. Nevertheless, there was no statistically significant impact of treatment modalities of AMI on changes in cardiac self-efficacy measured at the 3 time points. Conclusions: Assessment of self-efficacy for post-AMI patients is recommended. Moreover, post-non-STEMI patients need more attention when implementing an intervention to enhance self-efficacy after hospitalization. Health decision makers have to consider establishing cardiac rehabilitation to improve self-efficacy in Jordan. Further research is needed to confirm the study results and to investigate other contributing factors that could influence self-efficacy after hospitalization.

Keywords :Cardiac self-efficacy, myocardial infarction, treatment modalities, cardiac rehabilitation.

Research Title :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 : Aaliyah Muntaser Momani , Peter Callery , Yin-Ling Lin , Raghad Hussein Abduelkader , Hekmat Y Al Akash

Abstract :Background: Type 1 diabetes is the most common endocrine condition among adolescents. Diabetes self-management can be challenging during adolescence. Objective: The objective of this study is to understand how adolescents and their parents manage type 1 diabetes in Jordan. Methods: 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. Results: 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. Conclusion: 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 : Adolescents; Jordan; culture; diabetes management; parents; qualitative; type 1 diabetes.

Research Title :Perceived control and length of stay post coronary artery bypass graft surgery

Authors :Mohannad Aburuz Nisreen Dahger Aaliyah M M Momani Fatma Refaat Ahmed Hekmat Al-Akash

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 : coronary artery bypasses length of stay perceived control

Research Title :Food Safety Knowledge among Food Handlers in Hospitals of Jordan

Authors :Abu Arrah Abdelhakeem 1, Bhatti Feyza 1, Al-Akash Hekmat

Abstract :Food safety knowledge (FSK) plays an important role in guiding food handlers (FHs) practices during food operations. The aim of this research was to investigate the level of FSK among FHs in hospitals' food services in Jordan. Up to 245 food handlers work in hospitals were purposefully selected from 6 public and private hospitals. A published FSK questionnaire included 120 items in 6 subscales was used to collect data. Most of the hospitals' FHs were male (91.84, n=225), of mean age 35.89 ± 9.26 years, with average experience of 12.55 ± 8.1 years, education of less than high school, and worked in public hospitals. The overall FSK was found to be "moderate" (71.20%). Food handlers were having the highest knowledge in the areas of "personal hygiene and hand washing" (80.87%), "health problems affecting FS" (86.10%), and "cross- contamination control and sanitation" (75.96%). FSK was "moderate" in "thawing, safe storage, transfer, catering, holding, heating, and re-heating" was (68.06%), "foodborne diseases and symptoms" (67.05%), and "poor" in "foodborne pathogens" (30.60%). Male FHs possessed higher FSK than female's counterparts (p=.036). There was a significant negative relationship between FSK and age (p=.044), positive relationship with previous exposure to FS training (p=.000), while there was no significant mean difference of FSK based on the years of experience or hospital sector (p=.090). One-way ANOVA with post-hoc revealed that FHs with higher educational qualification possessed higher FSK (p= .00). Food Safety Training is recommended for certain areas in food operations and foodborne pathogens.

Keywords :Food Safety, Food Hygiene, Food Safety Knowledge, Food Handlers, Hospitals, Jordan

Research Title :Job Satisfaction, Anxiety and Depressive Symptoms among Nurses Working at Critical Care Settings

Authors :Yousef Hekmat Al Akash; Mohannad Aburuz Ghadeer Al Dweik Raghad Hussien Abdelkader Rami Masa'Deh

Abstract :The relationship between nurses' job satisfaction and stress is well documented. However, there is a lack of studies about the relationship between job satisfaction, anxiety, and depression among nurses. The general purpose of this study was to identify the effect of job satisfaction on anxiety and depressive symptoms among critical care nurses. This was a cross-sectional study with a convenience sample of 220 critical care nurses from one hospital from three sectors, governmental, private, and teaching in Amman, Jordan. Job satisfaction, anxiety, and depressive symptoms were measured by self-reported questionnaires. The whole sample was ambivalently satisfied, and having mild anxiety symptoms, and moderate-severe depressive symptoms. Nurses who were working in the intensive care units were the least in their level of anxiety and depressive symptoms and highly satisfied compared to other groups. Nurses who were working in the governmental hospital had higher levels of depressive symptoms than nurses who were working in a private hospital, and they were less satisfied. Working in the intensive care units decreased anxiety symptoms by 0.18 score, and every score increased in job satisfaction, decreased anxiety symptoms by 0.19 score. Being married increased depressive symptoms by 0.26 score and working in governmental hospitals increased depressive symptoms by 0.19 score. Every score increased in job satisfaction, decreased depressive symptoms by 0.27 score. Job dissatisfaction increased levels of anxiety and depressive symptoms among nurses. This might increase rates of burn out and intention to leave workplace areas ending with shortage and impairment of quality of care. The implementation of different strategies to improve job satisfaction among critical care nurses is necessary

Keywords : Job satisfaction, anxiety symptoms, depressive symptoms, critical care, nurses, Jordan

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

Authors : Mohannad Eid AbuRuz , Ghadeer Al-Dweik , Hekmat Yousef Al-Akash

Abstract : 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

Keywords : anxiety; coronary artery bypass graft; length of stay; perceived control.

Research Title :Knowledge, Attitudes, and Practice about Evidence-Based Practice: A Jordanian Study

Authors :AbuRuz, Mohannad Eid; Hayeah, Haneen Abu; Al-Dweik, Ghadeer; Al-Akash, Hekmat Yousef.

Abstract :Background: Evidence-based practice has become a worldwide concern for healthcare staff and administrators as well as researchers. Evidence-based practice has been considered as critical element to improve quality of health services and achieving excellence in patient care. The implementation of Evidence-based practice in clinical environments has been challenging. One of the most important barriers to implement Evidence-based practice is knowledge deficit. Objective: The aim of this study was to describe Jordanian nurses' knowledge, attitudes, and practice regarding evidence-based practice. Methods: A descriptive cross-sectional correlational study was conducted in seven major hospitals in Amman/ Jordan. Five hundred nurses answered a self-reported questionnaire. Descriptive statistics and multiple linear regressions were used to analyze the data. Results: Attitudes toward Evidence -Based Practice had the highest mean followed by the knowledge/skills and finally the practice. Female nurses practice research less, have less positive attitude, and less knowledge about research compared to male nurses. Nurses with MSc degree, working in ICU and private hospitals have more positive attitude, reported higher levels of knowledge and skills compared to nurses with BSc, nurses working in other units, and nurses working in ministry of health and Royal Medical Service respectively. Conclusion: Ongoing education for nurses and minimizing barriers are recommended to promote the use of Evidence -Based Practice in Jordan.

Keywords : Evidence-based practice; Nurses; Attitudes; Knowledg

Research Title :Perceived Stress in Nurses: A Comparative Study

Authors : Rami Masa'Deh Fadwa Alhalaiqa Mohannad Eid AbuRuz Ghadeer Al-Dweik Hekmat Al-Akash

Abstract :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 altogether. 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.

Keywords :department, Jordan, nurse, psychiatric, stress

Research Title :The university of Jordan students' concerns and awareness about trans-fatty acids

Authors : H. Al-Akash, M. Aburuz, AbdElhakeem Abu Arrah

Abstract :Total Trans Fatty Acids (TFAs) intake was associated with an increased risk of coronary and cardiovascular diseases and their mortalities. The World Health Organization highlighted the seriousness of TFAs intake and called to ban TFAs from foods or to limit their intake to less than 1% of the total amount of the energy intake. Fast foods are considered to have a high percentage of TFAs. University students spend most of their time outside home which makes them the suitable population to consume these kinds of food. The purpose of this descriptive study was to assess the University of Jordan students' concerns and awareness about TFAs. Four hundred and seventeen students answered a self-reported questionnaire about TFAs from October, 2015-January, 2016. Descriptive statistics, independent sample t test and multiple regression were used to analyze the data. Results showed that students at the University of Jordan were found to have moderate concern relevant to TFAs (Mean± 64; SD; 20.0 ± 5.1), and moderate awareness relevant to TFAs health risks (Mean± SD; 51.5± 15.2). Awareness was predicted from the faculty of students (health faculties), female gender, living status, and family income, which explained 30% of the variance. In conclusion, it is known that high levels of TFAs are associated with increased risk of cardiovascular diseases and obesity, especially in young adults. The results of this study showed that concern and awareness of the students about health risks and dietary sources of TFAs was insufficient to make decisions of healthier food selection

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