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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.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.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.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.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.

Purpose The purpose of this paper is to assess nurse’s knowledge and practice regarding basic life support (BLS) skills while working with SARS-CoV-2 patients in Jordanian hospitals. Design/methodology/approach A cross-sectional survey was conducted among 386 nurses with direct contact with SARS-CoV-2 patients at Jordanian hospitals. A self-administered structured questionnaire was used based on the American Heart Association (AHA) guidelines. Findings A total of 386 participants were recruited. The mean years of experience were 7.89 (SD = 5.97). About three quarters of participants revealed they deal with SARS-CoV-2 patients directly (n = 284, 73.6%). The total mean score of nurse’s knowledge was 4.44 (SD = 1.22), while the total mean score of practice was 8.44 (SD = 2.05). Independent t-test was used, which revealed a statistically significant difference between educational level and total score of nurse’s knowledge [t(386) = 0.215 and p = 0.001] and between training to deal with SARS-CoV-2 during BLS and total score of practice [t(386) = 2.66 and p = 0.008]. Pearson correlation discloses a positive correlation between the total score of knowledge and practice (r = 0.343 and p = 0.001). Research limitations/implications In general, nurses revealed a moderate level of knowledge and practice of BLS skills. However, assessing nurse’s knowledge and practice during the outbreak of SARS-CoV-2 plays a key role in identifying the gap in nurse’s knowledge and practice, and therefore, it will have an impact on providing high-quality BLS to save infected patients while providing maximum safety according to AHA guidelines. Originality/value This study is the first study that examined the level of knowledge and practice of BLS skills during SARS-CoV-2 pandemic in Jordan.

Secondary prevention is a priority after coronary revascularization for effective long-term cardiovascular care. Coronary Heart Disease is a major health problem in Jordan, but little is known about the current provision of secondary prevention.The aim of this study was to evaluate risk factors and explore the current provision of secondary Coronary Heart Disease prevention among patients presenting with first-time Coronary Heart Disease at two time points: during hospitalization (Time 1) and 6 months later (Time 2), in multicentre settings in Jordan.A descriptive, repeated measures research study design was applied to a consecutive sample of 180 patients with first-time Coronary Heart Disease. Demographic and clinical details were recorded from medical files. Self-administered questionnaires developed by the researchers were used to measure secondary prevention information related to Coronary Heart Disease, including secondary prevention services, lifestyle advice received and medical advice topics. A short form of the International Physical Activity Questionnaire was used to measure physical activity. Participants were assessed at Times 1 and 2.Unstructured lifestyle advice given to the patients at Times 1 and 2 most frequently related to medications, smoking, diet and blood lipids control advice topics, with no statistically significant improvement in cardiovascular risk factors among patients between Times 1 and 2.Despite an extremely high prevalence of risk factors in this population, the provision of secondary prevention is poor in Jordan, which requires urgent improvement, and the contribution of nurses' to secondary prevention should be enhanced.

The decisional balance is related to the transtheoretical model, and involves weighting the pros and cons of performing a behavior. The study aimed to assess hypertensive patients’ decisional balances about smoking, weight control, and physical exercise. A cross-section descriptive correlation design was used, and 110 patients were recruited using convenience sampling in outpatient clinics. The decisional balance was measured using “Decisional Balance Scales,” which assess an individual’s decisional balance related to smoking, weight control, and physical exercise behaviors. The results predicted that Jordanian hypertensive patients with higher physical exercise decisional balance and higher weight decisional balance had lower smoking decisional behaviors. Nurses can foster health promotion and behavioral change by employing interventions that improve decisional balances. Improving the decisional balance of one behavior would have a positive impact on other behaviors. Thus, designing multidimensional interventions might be effective for modifying different types of health behaviors, and fostering health promotion practices.

Fibromyalgia (FM) is a chronic disorder characterised by chronic widespread pain, fatigue and sleep disturbances with higher prevalence in females. Psychological factors contribute largely to FM. Although women war refugees represent a fragile population that is prone to psychological distress, FM was not studied in this population.The current study had three objectives: (1) to screen FM and insomnia prevalence and severity, (2) to study the correlation between FM severity and insomnia and (3) to study FM treatment trends and their concordance with the guidelines among female Syrian refugees residing in Jordan.A cross-sectional study design was performed. Data from 384 Syrian female were analysed from four medical centres in Jordan. The Fibromyalgia Impact Questionnaire (FIQ) was used to study FM prevalence. Structured questions were designed to explore FM pharmacotherapeutic trend, and the Insomnia Severity Index (ISI) was used to screen insomnia.The prevalence of severe FM was about (30%), with a significant correlation with insomnia. Acetaminophen was used for FM relief in 60% of the study sample.Fibromyalgia prevalence is high among female refugees and is associated with insomnia. The treatment is suboptimal. The early screening and raising awareness of FM diagnosis and treatments are highly recommended. Key Points Fibromyalgia is an overlooked disorder especially among female war refugees The prevalence of severe fibromyalgia was about (30%), with a significant correlation with insomnia Fibromyalgia among the Syrian female refugees is mistreated perhaps due to lack of the proper diagnosis.

Background Identifying learning needs is an important component of care among patients with heart failure (HF). There is a discrepancy in the level of importance of information as perceived by patients, caregivers, and nurses. No studies have been conducted to identify learning needs among patients with HF in Jordan. Objective The aim of this study was to identify the learning needs of patients with HF in Jordan from the perspective of patients, family caregivers, and their nurses. Methods A descriptive comparative design using a convenience sample of 67 patients with HF, 67 family caregivers, and 67 nurses was used. The Heart Failure Learning Needs Inventory was used to identify the learning needs. The mean scores were compared among the 3 groups and ranked by importance for each item to determine the most important areas of perceived needs for each group. Results All groups had high total Heart Failure Learning Needs mean scores: patients, 4.12 ± 0.92; caregivers, 4.14 ± 0.65; and nurses, 4.08 ± 0.54. The top priority learning need for both patients and caregivers was "the recommended daily salt intake," whereas for nurses, it was "why I am taking each medication and its side effects"; nurses significantly perceived it as more important to learn than patients and caregivers did. Younger and employed patients requested more information than other patients. Conclusions Although some similarities exist, there are important differences among the 3 groups on perceived importance of information. Understanding these differences may be critical in developing a tailored educational program for patients and caregivers and improving nursing practice.

We studied whether mood and demographics are related to body mass index in a population of Syrian and Iraqi refugees residing in Jordan. Questionnaires and Brunel Mood Scale were used to collect demographical data. Data were analyzed using t-test and analysis of variance. A high prevalence of overweight and obesity was observed in this population (60.5%). Mood subscales were not associated with body mass index categories. However, body mass index as a continuous variable was associated with anger, depression, and fatigue scores. Linear regression revealed that age, ethnicity, unemployment, chronic illnesses, and physical activity level, but not mood, are associated with body mass index.

This research aimed to determine the depression level and its correlation experienced by post-coronary artery bypass graft patients after being discharged from cardiac intensive care units. A cross-sectional design was employed for assessing variables. The Self-rating Depression Scale, as proposed by Zung, was used by the researchers on a convenience sample of Jordanian patients ( N = 143) who were approached soon after their discharge from the targeted units. The results suggested that the level of depression among Jordanian patients was relatively high ( M = 62.7, SD = 5.6). Moreover, depression was significantly higher among female, unmarried and unemployed patients. Patients who received their information about coronary artery bypass graft surgery from nurses had a lower level of depression. Age, length of stay in the cardiac intensive care unit and hospital type significantly predicted the level of depression. The research concluded that the post-coronary artery bypass graft patients who experienced an early onset depression required more attention to highlight the importance of supportive interventions.

Purpose The purpose of this study was to examine the relationship between emotional intelligence and nurse-nurse collaboration among registered nurses in Jordan. Design This study used a cross-sectional, quantitative survey design to query 342 nurses who worked in two hospitals in Jordan. Methods We used Arabic versions of valid, reliable instruments to measure emotional intelligence and nurse-nurse communication. Findings A total of 311 questionnaires were returned (91% response rate). Nurses' emotional intelligence was positively and significantly correlated with the nurse-nurse collaboration subscales. The results also indicated a statistically significant mean difference in communication subscale scores by gender and nursing unit. Conclusions The present study demonstrated that nurse-nurse collaboration is linked to benefits for nurses in terms of improved job satisfaction, better nurse retention, improved quality of patient care, and enhanced healthcare efficiency and productivity. This suggests that improving nurse-nurse collaboration may have spillover effects of benefits, not only for nurses but for patients, organizations, and the overall healthcare system. Clinical relevance Building an environment that encourages collaboration among nurses can greatly impact the performance of nurses and its benefit to nurses. Encouraging employees to participate in activities and to collaborate in making this an integral part of their evaluation will contribute to improving the teamwork in patient care.

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

Background: Similar anticonvulsants, such as gabapentin and pregabalin are recommended in neuropathic pain management, however little is known about their clinical differences in cases of low back pain. This paper aims to highlight some of the possible clinical differences between gabapentin and pregabalin in low back pain. Methods: Patients with moderate to severe low back pain were recruited. Eligible patients were randomised to receive either pregabalin (300 mg/day)or gabapentin (800 mg/day) for six weeks. : The primary outcome measure was pain intensity according to the Visual Analogue Score (VAS) at baseline and at six weeks. The secondary outcome measures were: anxiety, insomnia, fatigue and the self-rated (GCI), measured at baseline, second, fourth, and the sixth week. Results: A total of 64 patients, pregabalin group (n=28), gabapentin group (n=36) completed the study. While pregabalin group showed a significantly lower pain score (p=0.039). The gabapentin group showed significant improvement in anxiety (p=0.001), insomnia (p=0.001), general fatigue (p=0.009), physical fatigue (p=0.001), reduce activity (p=0.001), and mental fatigue (p=0.014) higher than that of pregabalin. No difference in (GCI) was seen at six weeks. Conclusion: This is the first trial aimed at comparing gabapentin with pregabalin in NLBP. Although the results are preliminary, in our pilot study pregabalin was found to be superior in pain reduction, gabapentin demonstrated better effect on anxiety, insomnia and fatigue symptoms. The results are preliminary and studies with a larger sample size are still required.

The Hamilton Anxiety Rating Scale is an internationally used assessment tool for anxiety level however its acceptable factor structure remains fluid. The aim of this paper is to examine the psychometric properties and establish normative anxiety prevalence rates with a Persian randomized sample. A cross sectional survey was distributed to a randomised sample of adults (n = 1260) in the Middle East. A two-factor model was deemed the most statistically and theoretically appropriate measurement model. This represented a split between cognitive and physiological symptoms. Overall, 15.2% of respondents reported at least mild anxiety, with 2.3% experiencing severe anxiety. Lower anxiety scores on the scale were reported among males, the married, younger and higher educated people. The Hamilton Anxiety Scale continues to be a useful tool in the measurement of anxiety. The two factor model separates anxiety into two dimensions, cognitive and physiological aspects and both are highly correlated with each other suggesting a single overarching construct of anxiety. The two-factor model may help provide a better understanding of the effectiveness of different therapeutic techniques. The pooled prevalence of ADs in a non-clinical Persian sample was relatively lower than those of some other countries.

Background Promoting physical activity is a priority after coronary revascularisation for effective long-term cardiovascular care and to avoid further disease progression and complications. But little is known about the effect of different types of acute myocardial infarction (AMI) treatment modalities in changes in physical activity level post-AMI. Objective This study aimed to examine changes in physical activity among patients treated with different treatment modalities post-first AMI during early recovery phase at week 2 (time 1) and week 6 (Time 2) after hospitalization. Methods A descriptive study was done using a repeated-measures design. Physical activity was measured by a body-worn activity monitor (activPAL3 monitor) for 24 hours a day for full 7 consecutive days at time 1 and time 2 after hospitalization. Demographic and clinical data were collected from patients' records. The study was conducted in 1 setting in Jordan. Participants were met at time 1 and time 2. The study recruited a convenience sample of 94 patients with AMI. Participants did not have access to cardiac rehabilitation. The participants were categorized according to type of AMI treatment modalities into 3 groups: ST-elevation myocardial infarction treated by primary percutaneous coronary intervention, ST-elevation myocardial infarction treated by thrombolytic therapy, and non-ST-elevation myocardial infarction treated by medication. Results Patients treated by primary percutaneous coronary intervention had a statistically significant effect on changes in mean steps count and mean stepping time per day better than patients treated by other treatment modalities between weeks 2 and 6 after hospitalization. Conclusion The study showed that patients treated with primary percutaneous coronary intervention had better mean steps count and mean stepping time per day between weeks 2 and 6 after hospitalization in comparison with other treatment modalities. These findings could be used for development of effective intervention in the future. Further research using different research methods such as longitudinal studies among different cultures to confirm the finding of this study is recommended.

Background Little is known about changes in illness perception (IP) among patients treated with percutaneous coronary intervention (PCI). Objectives To examine changes in IP among patients undergoing PCI and examine the effects of demographics and clinical details on IP. Methods A descriptive repeated measures design was used. IP was evaluated at pre discharge time and six months’ later. Results Six months’ post PCI, patients perceived their illness as chronic, had more control over their condition, and better understanding of it. They experienced less symptoms, lower perceptions of consequences on their life and less emotional representation indicating positive changes. Receiving health education at follow-up time had a significant interaction effects on increased personal and treatment control. Having a family history of coronary heart disease associated with better understanding of illness. Conclusion Assessing patient' IP and providing health education at follow-up time should be incorporated in optimizing the care of PCI patients.

AIM To develop and test a scale that assesses the attitudes and practices of registered nurses toward physical examination (PE) in of (delete) the clinical settings. METHODS A cross-sectional methodological design with a convenience sample of 277 registered nurses was used. A Likert-type scale was constructed using 55 Likert-type items that were extracted from the relevant literature. Exploratory factor analyses were conducted using varimax rotation. Factor loading, eigenvalues, and screeplots were used to determine the best fit model. RESULTS The final version of the scale consisted of four factors. The determinant score was (0.001) and the total variance explained was 56.26%. All of those four factors had eigenvalue more than 1. The final version of the scale (the 20-item scale) was tested for reliability and was internally consistent (Cronbach's α = 0.833). The scale was supported for its validity. CONCLUSION The final version of the scale can be used to determine nurses' perspective and use of PE, and assist in bridging the gap between what is taught and what is practices regarding PE.

Assessing self-care is important aspects among patients with heart failure. However, few studies were conducted to assess self-care among patients with heart failure in Jordan. Therefore, this study aimed to assess the most and the least performed maintenance self-care behaviors and to examine the relationship between maintenance self-care behaviors and selected sociodemographics. A cross-sectional design utilizing a convenience sample of 226 patients with heart failure was used. The maintenance self-care mean was 53.89 and considered below the clinical target level (≥70). Asking for low salt item and performing physical exercises were the most performed self-care behaviors, while “trying to avoid getting sick” and “checking ankles for swelling” were the least performed self-care behaviors. Limited self-care behaviors indicated the need to implement cardiac education that may improve self-care behaviors. Cardiac education should target mainly patients with low income, low educational level, elderly, living alone, unemployed, and who are using traditional treatment.

This study examined the coping strategies used by Syrian refugees in Jordan in relation to their demographics. A cross-sectional correlational study was conducted with a convenient sample of 550 Syrian refugees. Out of all the study participants, 88% reported seeking social support, 64.5% reported using avoidance, and 39.5% reported using problem solving. Participants who were male, single, and younger, and who had a higher education and a higher total income were satisfied with their income, were employed and free of chronic illnesses, and had higher problem-solving scores. Higher social support-seeking scores were associated with being female, older, and widowed; having a lower education and lower total income; being dissatisfied with their income; being nonemployed; and having chronic illnesses. A number of significant predictors were identified for each coping strategy. The results of this study could be used to formulate programs and develop services regarding the stressors encountered by Syrian refugees and their coping strategies.

Background: Refugees and war survivors are at higher risk of developing mental health disorders. Anxiety and stress are caused by many factors, including a stressful environment that could cause fatigue and low quality of life. Despite the existence of many synthetic anxiolytic and antidepressant drugs, symptom management has still not been successful. Ginkgo biloba extract has been used as one of the potential herbal remedies to enhance cognitive functions. Psycho-education plays a significant role in alleviating psychological distress. However, the role of G. biloba in alleviating anxiety, stress and fatigue among refugees was not well studied previously. Objectives: In this study, we aimed to compare the effect of G. biloba and psycho-education with only psycho-education on refugees’ anxiety, stress and fatigue. Methods: A randomized controlled, pre-test–post-test design was used. Data were measured at baseline and 6 weeks later. Results: Providing psycho-education for the control group showed a non-significant improvement in outcome variables. However, adding G. biloba to psycho-education for the experimental group showed a significant reduction in mental, physical, activity fatigue and anxiety. Conclusion: The addition of G. biloba to the psycho-education proved superior to psycho-education alone. Therefore, combining the two approaches is beneficial in alleviating anxiety and fatigue.

Spirituality is an important factor that may mediate the detrimental impacts of hemodialysis on mental health. Lack of research examining spirituality and mental health in the Arab world in general and Jordan in particular encouraged this research. The study examined levels of spirituality, depression and anxiety and explored the association between them among patients receiving hemodialysis treatment in Jordan. A cross-sectional design was used to recruit 202 patients receiving hemodialysis treatment. Self-administered questionnaires including spiritual well-being scale, depression and anxiety and a demographic data sheet were used. The data were analyzed using SPSS and descriptive, inferential statistics and linear multivariate regression. The majority of respondents reported moderate mean levels of spirituality well-being (62.4%), while 60.9% and 80.2% scored low-to-moderate levels of depression, respectively. Only 22.3% reported moderate-to-severe anxiety levels. Increasing anxiety and number of co-morbid conditions were predictors of depression. No significant correlations were found between spirituality neither with the sample characteristics nor with depression and anxiety. It was found that depression and anxiety are common among respondents. Spirituality was of medium importance to them, yet it was not significantly associated with depression and anxiety. The implications of this study for holistic clinical practice are explored.

This study was conducted to identify the predictors, levels, and prevalence of anxiety and stress and to assess the relationship between these factors and quality of life in recently displaced Iraqis. A cross-sectional design was used. A convenience sample of 171 Iraqi refugees was recruited. The results indicated that more than half of the sample suffered from high anxiety levels, while 42.8% reported high stress. The regression model explained 46.3% of the variance in levels of quality of life. Unemployment, fewer than three family members, and high anxiety significantly predicted low-level quality of life. These three predictors need to be taken into consideration when developing health-related interventions to improve the quality of life of Iraqi refugees.

Background There is a distinct gap between theory and practice with respect to research use in clinical practice, particularly in critical care units, that could be related to the presence of a number of barriers that hinder the use of research findings. Aims The aims of the study were to identify barriers and facilitators to research use as perceived by Jordanian nurses in critical care units and to examine the predictors of research use among those nurses. Methods The study used a cross-sectional, correlational design. The self-administered "Barriers Scale" was introduced to 200 registered critical care nurses, using the drop-and-collect technique, between October and November 2015. Results The results revealed that "nurse does not have time to read research at work" was the top ranked barrier that hinders research use (mean [SD], 3.45 [0.79]). The first 7 ranked barriers were related to the organizational subscale. Managerial support was the top perceived facilitator for research use. Only "attending special training courses in nursing research" was the significant predictor of research use and explained 59.1% of the variance in research use, t(190) = -3.93, P = .003. The most identified barriers toward research use revealed by the qualitative data include dominant routine nursing tasks, existence of gap between theory and practice, shortage of nursing staff, and public negative image about nursing profession. Participants suggested the importance of increasing organizational support and creating an organizational research culture to further promote research use in clinical nursing practice. Conclusions Research use has not been widely implemented yet in Jordan because of various barriers. The organization-related barriers were the most influential. Factors hindering research use are multidimensional, and optimizing them should be a shared responsibility of nurse managers, researchers, clinicians, and academicians. Further initiatives are required to raise awareness of the importance of using evidence-based practice.

Insomnia, the inability to sleep and feel refreshed the next morning is a common problem reported as the most prevalent sleep disorder worldwide. Recently, special interest has focused on the use of herbal anxiolytics such as valerian root. In the Arab world, and particularly Jordan where it is prescribed by pharmacists, valerian root may be considered a relatively new non-prescription sleep aid. The objective of the current study was to assess pharmacists’ perception and knowledge of valerian pharmacology, explore their dispensing practice of sedatives/hypnotics and to investigate the Jordanian customers’ behaviour and preferences towards sedative/hypnotics. Data from 568 community pharmacists surveyed in Jordan was analysed. Almost one-third of the pharmacists admitted that they were unaware of the anxiolytic mechanism of valerian and half of them described valerian as a “hypnotic” instead of an “anxiolytic”. None knew that it could be hazardous to co-administer valerian with benzodiazepines. Additionally, diphenhydramine was preferred in general over valerian as a sleep aid. It was also found that pharmacists and customers thought valerian to be less effective than pharmaceutical medication in the treatment of insomnia. Our findings reflect a poor knowledge among pharmacists and the community about valerian. The authors suggest it would be beneficial to instigate measures to increase the awareness of herbal products amongst pharmacists.

The aim of this study was to conduct a systematic review that investigates the differences in illness perception with age and gender in patients diagnosed with coronary artery disease. Previous studies show some discrepancies regarding the influence of age and gender on the specific dimensions of coronary artery disease patients' illness perception. A systematic review using a narrative synthesis process included preliminary synthesis, exploration of relationships and assessment of the robustness of the synthesis and findings was conducted. Search terms were used to identify research studies published between 1996 and December 2014 across four key databases: CINAHL, Medline, PsycINFO and Web of Science. A total of 14 studies met the inclusion criteria of the review. The review found that men had a stronger perception that their own behaviour had caused their illness than women. In addition, older patients had lower perceptions of the consequences and chronicity of their illness. This analysis concludes that some dimensions of illness perception vary according to age and gender of patients with coronary artery disease. These differences should be taken into consideration, particularly when providing health education and cardiac rehabilitation.

At the time the study was conducted, Besher Gharaibeh, Byron Gajewski, and Diane Boyle were affiliated with School of Nursing University of Kansas, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA; Ahmed Al-smadi was affiliated with University of Ulster, Belfast, Newtownabbey Co. Antrim BT37 0QB, Jordandtown road, UK. The coexistence of diabetes and depression is associated with negative outcomes such as poor diabetes self-care management (DSCM). Complex relationships exist among diabetes knowledge, self-efficacy, self-care agency, depression and DSCM. No study has examined the relationships among all these factors at the same time. We aimed to examine relationships among depression, diabetes knowledge, self-care agency, self-efficacy and DSCM in insulin- treated people based on a modification of the DSCM model. A cross-sectional, correlational model testing design was used. Participants with type 1 ( n = 35) and type 2 ( n = 43) diabetes were recruited from both outpatient and community sites. Participants mean age was 46.6 years (standard deviation 13.7) and the majority were men (56.4%). Multiple regression analyses tested the hypothesised relationships. Depression was found to have a direct negative relationship with self-care agency and self-efficacy. The relationship between depression and DSCM was not direct. Self-care agency and self-efficacy completely mediated the effect of depression on DSCM. Self-efficacy completely mediated the effect of self-care agency on DSCM. We conclude that effective treatment programmes for persons managed with insulin should probably include not only screening and treatment of depression, but also skills training to enhance patient self-care agency and self-efficacy alongside DSCM.

Anxiety and stress are related to physiological changes in humans. Accumulating evidence suggests a cross-talk between psychiatric disorders and oxidative stress. The objective of this study was to compare oxidative stress and defensive antioxidant biomarkers in a group of refugees with acute anxiety and stress with a group of local Jordanians. The Hamilton Anxiety Rating Scale (HAM-A) and the Perceived Stress Scale (PSS) Arabic version were used to assess anxiety and stress respectively. Salivary nitric oxide concentration, glucose-6-phosphate dehydrogenase (G6PD) activity and total salivary protein were compared. As expected, refugees showed higher anxiety and stress scores compared with Jordanians. Also, we report a significant increase in salivary nitric oxide and G6PD activity in the refugee group while total protein concentration did not vary between the two groups. This is the first study that demonstrates an increase in nitric oxide and G6PD activity in the saliva of refugees, thus highlighting their potential role as possible biomarkers in anxiety and stress disorders. Copyright © 2015 John Wiley & Sons, Ltd.

To develop and test a scale that assesses the attitudes and practices of registered nurses toward physical examination (PE) in of (delete) the clinical settings.A cross-sectional methodological design with a convenience sample of 277 registered nurses was used. A Likert-type scale was constructed using 55 Likert-type items that were extracted from the relevant literature. Exploratory factor analyses were conducted using varimax rotation. Factor loading, eigenvalues, and screeplots were used to determine the best fit model.The final version of the scale consisted of four factors. The determinant score was (0.001) and the total variance explained was 56.26%. All of those four factors had eigenvalue more than 1. The final version of the scale (the 20-item scale) was tested for reliability and was internally consistent (Cronbach's α = 0.833). The scale was supported for its validity.The final version of the scale can be used to determine nurses' perspective and use of PE, and assist in bridging the gap between what is taught and what is practices regarding PE.

This study aimed to investigate the prevalence of insomnia and associated sociodemographic factors among refugees in Jordan. A cross-sectional survey was undertaken with a representative sample of 373 refugees. The majority of refugees had moderate to severe insomnia (

Objective: Assessing diabetes self care management is essential for nursing care for diabetes. There is a need to have valid and reliable scales that assess the actual performance of diabetes self management. The purpose of this study was to revise and conduct psychometric testing and analysis of the Diabetes Self Management Scale (DSMS). Methods: A cross-sectional methodological design was used. A convenience sample was used and 78 adults with diabetes and taking insulin from five sites in the Midwest area of the U.S participated in the study. Reliability analysis was done using Ferketich techniques to make decisions about whether any given item should be retained or deleted. Results: A descriptive analysis for the 60 items of the scale was conducted; several items had low variability compared to the other items on the scale. The correlation matrices showed that a total of 20 items had poor item characteristics. These 20 items were deleted resulting in developing 40- item version of the scale. The 40 - item scale had high level of internal consistency (Cronbach's α = 0.947). The validity testing of the 40 - item scale was guided by the Research Model for Diabetes Self Care Management; results were congruent with the model and showed strong correlation with self efficacy, moderate correlation with self care agency, and weak correlation with diabetes knowledge. Conclusion: The items and the scale (DSMS) have undergone careful psychometric testing. The 40-item DSMS is a reliable and valid instrument to measure diabetes self care management among people with diabetes.

Background Many sedatives and anxiolytics are used in single dose or chronically to aid sleep. Clinically important sedatives include valerian-hops and antihistamines as they are used over the counter and are highly accessible and safe agents. Objectives To evaluate and compare a single dose of chlorpheniramine versus valerian-hops combination in modulating subjective sleep measures in insomniac war refugees. Methods Insomnia among refugees was screened using the Insomnia Severity Index (ISI). Insomniac subjects were randomized to received a single dose valerian-hops (320/80 mg) (n = 65), or chlorpheneramine (4 mg) (n = 50) or placebo (n = 76) two hours prior sleeping. Participants were instructed to complete Leeds Sleep Evaluation Questionnaire (LSEQ), visual analogue scales of anxiety and sedation. Also sleep latency, total hours slept and self-rated improvement were obtained. Results Almost 75% of screened refugees had insomnia. Chlorpheneramine reduced sleep latency and anxiety significantly, however it resulted in poor sleep quality. Valerian-hops group showed marked anxiolysis one hour after dosing, a sleep quality similar to placebo and better than chlorpheneramine, and better alertness compared to placebo. Participants satisfaction was higher with chlorpheneramine and there was no difference in the total hours slept. Discussion Valerian-hops combination may provide better sleep quality than antihistamines.

Background: Simulation can produce highly qualified professionals, however, it can also be perceived as stressful and frustrating by the nursing students. Purposes: This study was to identify the attitudes and perceptions of Jordanian nursing students toward simulation as an educational strategy, to investigate whether certain students’ characteristics affect their attitudes and perceptions, to assess for differences in the attitudes and perceptions toward simulation between the different year levels of students, and to identify the important predictors of students’ attitudes and perceptions toward educational simulation. Method: A descriptive correlational design was used with a convenience sample of 413 Jordanian nursing students. The Arabic translated version of KidSIM ATTITUDES scale was used. Results: The total attitude score was encouraging with significant differences between first, second and third year students. Post hoc analyses showed the lowest attitude mean score occurring in the second year nursing students. Using linear regression analysis, prior experience in an ICU or CCU was the only significant predictor of the student’s attitudes and perceptions toward simulation. Conclusions and implication for practice: Reinforcing the teamwork approach during the students’ early phases of their course of study, and incorporating simulation into later phases can promote knowledge development, skill acquisition, and self-confidence.

This study was conducted to identify the predictors, levels, and prevalence of anxiety and stress and to assess the relationship between these factors and quality of life in recently displaced Iraqis. A cross-sectional design was used. A convenience sample of 171 Iraqi refugees was recruited. The results indicated that more than half of the sample suffered from high anxiety levels, while 42.8% reported high stress. The regression model explained 46.3% of the variance in levels of quality of life. Unemployment, fewer than three family members, and high anxiety significantly predicted low-level quality of life. These three predictors need to be taken into consideration when developing health-related interventions to improve the quality of life of Iraqi refugees.

The aim of this study was to conduct a systematic review that investigates the differences in illness perception with age and gender in patients diagnosed with coronary artery disease. Previous studies show some discrepancies regarding the influence of age and gender on the specific dimensions of coronary artery disease patients' illness perception. A systematic review using a narrative synthesis process included preliminary synthesis, exploration of relationships and assessment of the robustness of the synthesis and findings was conducted. Search terms were used to identify research studies published between 1996 and December 2014 across four key databases: CINAHL, Medline, PsycINFO and Web of Science. A total of 14 studies met the inclusion criteria of the review. The review found that men had a stronger perception that their own behaviour had caused their illness than women. In addition, older patients had lower perceptions of the consequences and chronicity of their illness. This analysis concludes that some dimensions of illness perception vary according to age and gender of patients with coronary artery disease. These differences should be taken into consideration, particularly when providing health education and cardiac rehabilitation.

Objective To investigate if salivary nitrate correlates to the daily psychological stress and anxiety in a group of human subjects. Methods The convenient sample recruitment method was employed; data from seventy three subjects were analyzed. The Perceived Stress Scale (PSS) and Hamilton Anxiety Rating Scale (HAM-A) inventories were used to determine stress and anxiety scores respectively. Salivary nitric oxide was measured through nitrate (NOx) levels using the Griess reaction method. Results Although stress and anxiety were correlated. No significant correlation exists between salivary nitrate and daily psychological stress and anxiety in the study's participants. Conclusion While all previous studies focused NOx levels in acute stress models. This is the first study to investigate the correlation between salivary nitrates and daily psychological stress and anxiety. Although stress and anxiety were correlated, there is no correlation between salivary nitrates and daily psychological stress and anxiety. Further studies are required to investigate this correlation using other biological samples such as plasma.