Psychiatric nurses' experiences and the emotional and psychological sequelae after being psychologically or physically assaulted in psychiatric units: A phenomenological study

AIM

This study aimed to describe psychiatric nurses' experiences and the emotional and psychological sequelae after being psychologically or physically assaulted in inpatient psychiatric units.

METHOD

The study employed a descriptive, phenomenological research approach. A purposive sample of 27 psychiatric nurses participated in in-depth one-on-one interviews. The collected data were transcribed and analyzed using ​Colaizzi's (1978) seven-step method.

RESULTS

Three themes and ten sub-themes emerged: A Fertile Environment for Physical and Psychological Workplace Violence, Psycho-Emotional Sequelae Aftermath of Assault, and Proactive Strategies for Combating Violence.

DISCUSSION

A thorough understanding of workplace violence aids in the development of strategies for preventing and addressing this phenomenon and its psychological and emotional consequences.

IMPLICATIONS FOR PRACTICE

The current study provides new insights on the importance of offering mental health and emotional support to assaulted nurses, especially those with accumulated exposure to violence.

COVID-19 related stigma, empathy and intention for testing in Jordan

Stigmatization of COVID-19 disease has been speculated due to misinformation about the disease, fearing of contracting the infection, absence of available cure, and holding responsibility for infecting others. We aimed to establish the prevalence of COVID-19 related stigma and its association with empathic responding, in addition to exploring predictors of stigma and testing intention among Jordanian people. A quantitative, descriptive and predictive design was used and data were collected using a web-based survey from 1074 adults. Findings showed that participants had high stigmatization against COVID-19 infection. Higher empathic responding (both cognitive and affective), being a female participant, and older age resulted in higher stigmatization. Only stigmatization of COVID-19 negatively predicted individuals’ intention for testing. These findings warrant intensive efforts from the Jordanian government on a local and national level to provide ongoing public education related to several aspects of COVID-19 disease, in order to reduce or prevent the associated stigma and increase people’s intention for testing.

Barriers to the use of mental health services by Syrian refugees in Jordan: a qualitative study

Background: More than 650 000 Syrian refugees are hosted in Jordan. Refugees are at high risk of mental health problems. Aims: To explore the perspectives of Syrian refugees and their host communities and community leaders in Jordan on barriers and facilitators to the use of mental health services by Syrian refugees. Methods: A qualitative descriptive design was used to collect data through individual, semistructured interviews conducted between May and December 2019 in Jordan. A purposive sample was recruited from different sites. Results: Twenty-four individual interviews were conducted: 16 for the clients and 8 for the community leaders. Three themes emerged as barriers to accessing mental health services: (1) lack of awareness of mental illness and available services; (2) availability, accessibility and affordability of mental health services; and (3) stigma and social discrimination. Findings show that respondents had low mental health literacy levels. Conclusion: Policy-makers, care providers and decision-makers should take the findings of this study into consideration by facilitating the use of mental health services through awareness-raising about mental illness and the provision of services at primary health care centres. Making the service available near to the people who require it and incorporating mental health services into a broad-based community environment such as schools, primary health centres, or case management system are recommended as a common strategy that could help address refugee needs.

Anxiety and coping strategies among nursing students returning to university during the COVID-19 pandemic

BACKGROUND

Despite the continued expand of the coronavirus disease 2019 (COVID-19) pandemic, nursing students are returning to on-campus learning and training in clinical settings. The COVID-19 pandemic might constitute a new source of anxiety that increases the already high anxiety levels of nursing students. This study aimed to assess the COVID-19 infection-related anxiety and coping strategies among nursing students returning to university campuses during the COVID-19 pandemic in Jordan.

METHODS

A cross-sectional study was conducted on a sample of 282 nursing students who returned to campus during the summer semester of the academic year 2019/2020. The returning students were invited to complete an online questionnaire consisting of three parts: 1) sociodemographic variables and infection-related information, 2) the Generalized Anxiety Disorder 7 (GAD-7) Scale, and 3) the Brief-Coping Behavior Questionnaire (Brief-COPE).

RESULTS

Of the participating students, 70.6% reported mild to severe anxiety levels. Female students and students who had fears of becoming infected with COVID-19 were found to be at higher risk of anxiety than were other students. A positive correlation was found between students' anxiety levels and their dysfunctional coping strategies, which included denial, behavioral disengagement, venting, and self-blame. Students who had chosen to study nursing willingly used coping planning. Further, other sociodemographic variables and infection-related information were associated with dysfunctional and emotion-focused coping strategies.

CONCLUSIONS

The participating nursing students showed significant COVID-19-related anxiety upon returning to on-campus learning. Unfortunately, the students were found to use some dysfunctional coping strategies which were associated with increased levels of anxiety. The results highlight the important role of universities and nursing faculty members in supporting students emotionally and ensuring their personal safety inside the classroom and in clinical settings.

Knowledge of Jordanian nurses and attitudes toward patients with suicidal attempt

Nurses' attitudes toward attempted suicide may affect the quality of care provided to those patients. There is a significant relationship between suicide literacy level and stigmatizing attitudes toward suicide. This study aimed to examine nurses' knowledge and attitudes toward patients with suicidal attempts. A cross-sectional correlational design was used to guide this study, and data were collected using an online survey. The Stigma of Suicide Scale-short form (SOSS-SF) was used to measure stigmatizing attitudes toward suicide, while the Literacy of Suicide Scale (LOSS) was used to measure suicide literacy level. The sample consisted of 343 Jordanian nurses, and their mean age was approximately 31 years old. Only 58 (16.9%) nurses reported having suicide training. Nurses had low stigmatizing attitudes toward suicidal patients. Nurses showed low suicide literacy levels. Only 46% of nurses had scores equal to or higher than the passing score of the LOSS. Linear multiple regression was used to predict nurses' level of stigma toward suicidal patients. Among the four predictors entered in this analysis, only LOSS showed a significant and negative effect. This study highlighted the importance of suicide training and education for nurses because it may improve their attitudes, self-confidence, and professional practices when providing care for patients.

Suicide literacy, suicide stigma, and psychological help seeking attitudes among Arab youth

To date, very little is known about the current situation of suicide and its effects on psychological help-seeking attitudes in Arab countries. Therefore, this study aimed to assess the levels of suicide literacy and suicide stigma and their relationships with attitudes towards seeking psychological help among a sample of Arab youth in Jordan. A descriptive, correlational, cross-sectional study was conducted using an anonymous online self-report survey to collect data. This study included a total of 707 Arab youth aged 16-24 years (mean = 18.60, SD = 1.95). Most of the participants were male (n = 398, 56.3%). The participants were found to have very low suicide literacy levels, relatively high suicide stigma levels, and negative attitudes towards seeking psychological help. Family members, relatives, and friends were the most frequently reported sources of psychological help, while mental healthcare professionals were the least frequently reported sources. A significant negative correlation was found between attitudes towards seeking psychological help and both stigmatization and glorification subscales of suicide stigma. While a significant positive correlation was found between attitudes towards seeking psychological help and suicide literacy. The predictors of attitudes towards seeking psychological help were gender, suicide literacy, and glorification of suicide stigma among Arab youth. The results of this study confirm the presence of an urgent need for designing and implementing educational programs and awareness campaigns on suicide and mental health among youth in schools and universities. Such interventions may increase knowledge, decrease stigma, change psychological help-seeking attitudes, and hence improve the use of mental health services and may prevent suicide among this age group.

Informative title: Effects of social support, parenting stress and self-efficacy on postpartum depression among adolescent mothers in Jordan

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.

Depression, coping skills, and quality of life among Jordanian adults during the initial outbreak of COVID-19 pandemic: cross sectional study

Little is known about the immediate psychological impacts of the national lockdown implemented during the COVID-19 pandemic on the general population in Arab countries like Jordan. The aim of this study was to assess the levels of depression, coping skills, and quality of life and their correlates among a sample of Jordanian adults aged ≥18 years during the COVID-19 lockdown implemented in Jordan. A quantitative, descriptive, correlational, cross-sectional design was conducted using an anonymous online self-report survey to collect data on participants’ demographics, depression, coping skills, and quality of life. This study included a total of 511 participants aged 18–65 years (mean = 30, SD = 10.6), most of whom were female (n = 333, 65.2%). About 65% (n = 332) of the participants were found to be suffering from depressive symptoms and 32% (n = 163) of them had moderate to severe depression levels. Religion, acceptance, and planning were the most frequently reported coping skills. The mean total quality of life score among all of the participants was 73.21 (SD = 16.17). Female participants had significantly higher levels of depression and lower levels of quality of life than male participants. Further, age was not found to be significantly correlated with depression, coping skills, or total quality of life scores. Depression scores were significantly positively correlated with coping skills and negatively correlated with total quality of life scores. No significant correlation was found between coping skills scores and total quality of life scores in this study. Being employed, holding an undergraduate degree, having chronic physical problems, and having mental health problems were found to be significantly associated with higher levels of depression. Holding a graduate degree, being a student, having military health insurance, not having mental health problems, and being a non-smoker were found to be significantly associated with lower coping skills scores. Being female, being educated to high school level or below, having mental health problems, and having family history of chronic physical problems were found to be significantly associated with lower total quality of life scores. This study provides valuable information on the psychological impacts of the national lockdown during the initial outbreak of the COVID-19 pandemic on Jordanian adults. This information may help in the development of appropriate psychological interventions aimed at improving mental health and quality of life among at-risk groups during the COVID-19 pandemic.

The relationship between social networking sites usage and psychological distress among undergraduate students during COVID-19 lockdown

During the outbreak of the COVID-19 pandemic, interpersonal interactions are restricted to social networks. Undergraduate students are isolated in their homes and dorms. Loneliness is closely related to psychological distress. Fear of contracting the disease will worsen psychological distress. The purpose of this study was to assess the severity of depression, anxiety, and stress symptoms among undergraduate students and their relationships with social networking sites usage during the COVID-19 lockdown. An online survey was used to recruit 456 participants for this cross-sectional descriptive study. Self-reported questionnaires were used to collect data on students' demographics, depression, anxiety, stress, and social networking usage. The results revealed that the majority of students had symptoms of depression (74.1%), anxiety (59.6%), and stress (61.2%). Female students had higher depression and anxiety symptoms than males. Senior-level students' psychological distress symptoms were significantly different from those of junior level. The largest percentage of students (91.9%) used social networking sites for entertainment. The academic usage of social networking sites was negatively (p < .05) correlated with depression and stress scores, while entertainment usage was positively correlated with anxiety. Age was not found to be significantly correlated with psychological distress. Academic and entertainment use of social networking sites were successfully associated with psychological distress symptoms after controlling for demographics. During this unprecedented time of undergraduate students' course of study, they were experiencing higher than average distress symptoms. These symptoms could be mitigated by continuing the regular academic activities and delivering the most accurate up-to-date information on the COVID-19 through social networking sites.

Exploring the potential of acceptance and commitment therapy model in self-care behaviour in persons with heart failure

Aim

This study examined the interaction among cognitive fusion, mindfulness and committed action on the self-care behaviour in person with heart failure as guided by the acceptance and commitment therapy model.

Design

An exploratory cross-sectional design was used.

Method

Participants with heart failure from in-patients setting (N = 165) were recruited from two major regional hospitals. Data were collected using self-report questionnaires of the study variables and demographic characteristics. Data were analysed using Hayes SPSS process macros.

Results

Based on the acceptance and commitment therapy model propositions, all main and interaction effects, except for cognitive fusion, were significant. The current study showed that the main effect of the study variables on self-care behaviour was insufficient and adding complex interactions between these variables improved the model fit, as it was suggested by the acceptance and commitment therapy model.

Personal, professional and workplace factors associated with burnout in Jordanian midwives: A national study

OBJECTIVE

To investigate the prevalence of burnout and explore associated socio-demographic and work-related factors among Jordanian midwives.

DESIGN

A cross-sectional survey design. The survey tool included the Copenhagen Burnout Inventory (CBI) and socio-demographic and work-related data forms.

SETTING

All government-funded hospitals in Jordan (18 hospitals) that provide antenatal, labour and birth, or postnatal care for women.

PARTICIPANTS

A sample of 321 midwives participated.

DATA ANALYSIS

Frequencies, means, and standard deviations were calculated as appropriate on the demographic variables and scale scores. The CBI was assessed for internal consistency using Cronbach's alpha. Multiple regression analyses using backward elimination were undertaken to determine associations between variables and CBI subscales. An alpha level of 0.05 was used for all statistical tests.

FINDINGS

Over three-quarters of midwives reported personal (78.1%), work-related (82.2%), and client-related (71.3%) burnout (scored >50 on CBI). Compared to midwives aged between 21 - 30 years, those between 31 - 40 years of age scored on average a 11.75 (95% CI = 7.05 - 16.45) points lower personal burnout score. Married midwives had on average a 6.44 (95% CI = 1.57 - 11.31) points higher personal burnout score compared to single midwives. Midwives with ≥ 10 years' experience had on average a 4.29 (95% CI = 1.93 - 6.64), 5.27 (95% CI = 3.17 - 7.36), and 7.31 (95% CI = 4.84 - 9.78) points lower personal, work-related, and client-related burnout scores respectively compared to midwives with < 10 years' experience.Compared to midwives providing care for 1 - 5 women per shift, those providing care for > 10 women per shift reported 9.98 (95% CI = 6.06 - 13.90) and 5.35 (95% CI = 0.71 - 9.99) points higher work-related and client-related burnout scores respectively. Midwives who rotated between shifts had on average a 5.87 (95% CI = 1.27 - 10.48) and 11.2 (95% CI = 5.78 - 16.66) points higher work-related and client-related burnout scores respectively than those who did not rotate.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The high prevalence of burnout identifies the urgent need for a national plan to address midwives' psychological health in Jordan. Midwives should be appropriately trained to recognize the signs and symptoms of burnout in a timely way, and for support services to be offered. The government could consider implementing continuity of midwifery care models, reducing the administrative burden on midwives, and empowering them to work to their full scope of practice.

Psychometric properties of two Arabic Suicide Scales: stigma and literacy

Suicide is one of the leading causes of death. Suicide stigma and literacy may affect the rate of suicide and help-seeking behaviors. This study examined the psychometric properties of the Arabic version of the Stigma of Suicide Scale-short form (SOSS-SF) and Literacy of Suicide Scale (LOSS). The sample included 160 Jordanian university students. Reliability analysis showed acceptable Cronbach's alpha levels of the three SOSS-SF subscales (stigmatization, isolation, and glorification subscales). Factor analysis supported the construct validity of the SOSS-SF by showing three factor structure similar to the three original subscales. LOSS scores showed low literacy level about suicide with a passing rate of 55% and a mean score of 5.63 out 12. Students had more difficulty in answering questions related to signs/symptoms and risk factors of suicide. This study will enable Arabic clinicians to use these tools which assess important aspects about suicide.

Does a novel teaching approach work? A Students' perspective

BACKGROUND

There is always a call for educational reform and further research to improve educational programs. The continuous development of new educational approaches is a work in progress. Educational strategies like team-based learning, flipped classroom, and lottery-based token economy, were used to develop a novel teaching approach.

AIM

This study had two major goals. The first goal was to introduce a novel teaching approach in professional healthcare academies. The second goal was to get an in-depth understanding, from the students' perspective, about the benefits and limitations of this new teaching approach.

METHOD

The study was conducted using a qualitative, phenomenological research design. Third and fourth-year nursing students completed reflective journals to describe their personal experience with the new teaching approach at the end of the semester. The students' responses were analyzed and coded using Kember's four-category coding schema for reflective writing, to extract themes using thematic analysis.

FINDINGS

Seventy-five students completed and returned their reflective journals. The analysis showed various challenges and facilitators/benefits of the students' experiences. The themes that emerged from the analysis were: lack of exposure vs. a sense of achievement; lack of teamwork skills vs. role fulfillment; working with new people vs. conflict resolution; variation vs. collaboration/creativity; time management vs. constructive competition; wasting resources vs. flexibility, and proactivity/active engagement. These themes summarized why the new teaching approach worked and what barriers students faced with the new assembly.

CONCLUSION

Results from the current study demonstrated the great potential of the new teaching approach. Recommendations for future research were also discussed.

Health literacy: exploring disparities among college students

BACKGROUND

Health literacy is a multidimensional concept that is considered a primary public health concern. This concept is often neglected in research, and the evidence regarding health literacy in college students is limited. The aim of this study was two-fold: to determine the needs and limitations of health literacy among college students and to explore the relationships among the nine dimensions of health literacy and sociodemographic factors, including age, gender, nationality, year of study, field of study, smoking status, history of chronic diseases, use of on-campus gym, and the intention to exercise on-campus.

METHODS

This study was conducted using a cross-sectional approach. A total of 520 college students participated in this study. The average age was 21.03 years (SD = 2.29), with 47.5% males and 52.5% females. Data were collected using a demographics questionnaire and the Health Literacy Questionnaire (HLQ). In addition to descriptive statistics, multivariate analysis of variance (MANOVA) and follow-up analyses were performed to explore any statistically significant mean differences among levels of health literacy and sociodemographic factors.

RESULTS

The levels of health literacy on the nine HLQ scales were lower than the levels reported in the literature. Multivariate analysis showed a significant effect of age, gender, smoking status, year of study, and field of study on the level of health literacy. Follow-up analyses revealed that female students, students from the health-related faculties, and those who do not smoke have higher levels of health literacy compared to their counterparts. A detailed comparison between the levels of the HLQ scales was made based on students' demographic characteristics. The field of study had the most prominent effect on the level of college students' health literacy; mean differences were statistically significant (p < .001), and effect sizes were large (ranging from .66 to 1.35 for the nine scales of the HLQ).

CONCLUSION

College students' health literacy is influenced by demographic characteristics. Such variations could amplify some of the existing health disparities. The implications of the findings on health, health promotion, and interprofessional education are discussed.

Responding to Varying Levels of Certainty about Pain in People with Dementia after Initial Pain Assessment

Introduction

Pain is still inadequately treated in people with dementia (PWD) due to the complexity of assessing it. Pain assessment in PWD is still challenging because of patient-related or nurse-related factors. The patient-related factors have been studied extensively. However, the nurse-related factors, e.g., nurses' certainty regarding suspected pain in PWD, have been given little attention by researchers.

Purpose

This study aims to investigate how the degree of nurses' certainty is compromised after pain assessment and how this affects levels of pain and agitation in PWD.

Method

A descriptive, correlational design was used, and a convenience sample of 104 nursing home residents with dementia were recruited.

Results

This study found that nurses' certainty after the pain assessment mediates the relationship between the type of pain assessment and patient outcomes when the nurses had a high initial certainty. When nurses had a low initial certainty, their certainty after the assessment and the type of assessment predicted the levels of pain and agitation in PWD.

Conclusion

Understanding how nurses' certainty can be compromising after pain assessment and how this relates to pain management in PWD is crucial.