Developing a Patient-Centred Management Program for People with Heart Failure in Jordan

Despite the medical advancement in heart failure (HF) management strategies, HF remains a condition that has significant physical, psychological, and social negative impacts on patients. Previous heart failure management programs have produced inconsistent results, and failed to determine an effective intervention that attains clinical stability. While the effectiveness of therapeutic options / elements for HF has been determined, a practice gap exists around how best to structure and deliver the therapeutic options. As a developing country Jordan has a limited health budget and infrastructure, as well as a lack of well-structured health care services for chronic diseases. In addition, there have been dramatic increases in prevalence of ischemic heart disease, diabetes, and hypertension, and other risk factors for heart failure (HF) attributed to sedentary lifestyles and dietary shifts. Therefore, an effective HF management program that is contextualised and feasible is needed. According to the literature, patient-centred care can be effective in improving HF knowledge, adherence to self-care, communication between patients and healthcare provider, and psychological status. Tailoring interventions is an important part of patient empowerment or patient centredness in which the interventions are specifically designed for patients based on careful assessments. This mixed methods study proposes a patient-centred HF management program that is tailored to the Jordanian context and patients’ needs. It involved two studies. The first study was a cross sectional survey. The second study comprised two components: a Delphi study of clinicians and focus groups for patients. The cross sectional study (survey) was conducted with a convenience sample of 300 Jordanian patients with HF. The outcomes that were measured included: (i) heart failure knowledge, (ii) self-care, (iii) treatment adherence, and (iv) quality of life (QOL). The Delphi study utilised seven clinicians and policy makers. The two focus groups included the same seven HF patients recruited from cardiac out-patient clinics. The main purpose for study two was to derive consensus from clinicians (using the Delphi method) and understand the perspectives of patients (using focus groups) on a more patient-centred model of HF management. Study I (quantitative study) showed that Jordanian HF patients had a moderate level of knowledge, a moderate self-care, poor adherence, and moderate quality of life. Males had higher knowledge than females. Only 3% of patients were informed to weigh themselves every day, and to watch the fluid status. Regarding self-care, most patients disagreed that they would contact their doctor or nurse if they gained 2 kg in one week (92%), and 83% disagreed with monitoring their weight every day. Unmarried and illiterate patients had poorer self-care than their counterparts. Activities with the lowest levels of adherence were: reducing or quitting smoking, and self-weighing. The predictors of quality of life were insomnia, marital status, previous hospitalisation, and employment. Regarding patients’ focus groups, eight themes emerged from the first focus group, including emotional impact of HF, Motivation to change lifestyle, Adjustment to treatment, Physical impact of HF, Loss of social interaction, and Impact of religion. Three themes emerged from the second focus group, involving the effectiveness of teaching sessions in cardiac clinic, suggestions for improving the educational program, and appropriateness of educational material. The Delphi study found consensus for the feasibility of different HF components: lifestyle brochure, nutrition card, and follow up phone call program, cardiac rehabilitation program, and group discussion session. The mixed methods study revealed that there were increased HF risk factors and sedentary behaviours for people with HF in Jordan, poor HF education, psychological distress, social isolation, and ineffective communication between patients and healthcare providers. The Jordanian healthcare system will need to implement a patient-centred heart failure management program that is tailored to Jordan context and patient’s needs. The proposed program from this study was determined to be feasible, appropriate, and applicable in Jordan, embracing three main elements that should be delivered to patients across the whole continuum of care process. These were targeted education, psychological support, and social support.Thesis (Ph.D.) -- University of Adelaide, Adelaide Nursing School, 202

Importance And Implementation Of Nursing Documentation: Review Study

This study was conducted to review the literature about nursing documentation. We presented the importance and implementation of nursing documentation. The importance of this topic has been realized here, in Jordan, and the Ministry of Health has recently started application of electronic documentation systems. Nursing documentation can be either paper based or electronic based documentation. Paper based documentation has been described not meet the required standards. We argued the standards of nursing documentation that should be met including completeness, clearing, and concision

Disparities in Obstetric, Neonatal, and Birth Outcomes Among Syrian Women Refugees and Jordanian Women

Objectives: To compare obstetric and neonatal characteristics and birth outcomes between Syrian refugees and native women in Jordan.Methods: We used the Jordan Stillbirths and Neonatal Deaths Surveillance System to extract sociodemographic and obstetric characteristics of the mothers and birth characteristics of newborns. Multivariate analysis was used to compare the characteristics of 26,139 Jordanian women (27,468 births) and 3,453 Syrian women refugees (3,638 births) who gave birth in five referral hospitals (May 2019 and December 2020).Results: The proportions of low birthweight (14.1% vs. 11.8%, p < 0.001) and small for gestational age (12.0% vs. 10.0%, p < 0.001) newborns were significantly higher for those born to Syrian women compared to those born to Jordanian women. The stillbirth rate (15.1 vs. 9.9 per 1,000 births, p = 0.003), the neonatal death rate (21.2 vs. 13.2 per 1,000 live births, p < 0.001), and perinatal death rate (21.2 vs. 13.2 per 1,000 births, p < 0.001) were significantly higher for the Syrian births. After adjusting for sociodemographic and obstetric characteristics of women, only perinatal death was statistically significantly higher among Syrian babies compared to Jordanian babies (OR = 1.3, 95% CI: 1.1–1.7, p = 0.035).Conclusion: Syrian refugee mothers had a significantly higher risk of adverse obstetric and neonatal outcomes including higher rate of perinatal death compared to Jordanian women

COVID-19 Fear and Anxiety among Patients with Chronic Heart Failure: A Cross Sectional Study

Although the current management of COVID-19 is mainly focused on efficacious vaccine and infection control, the most common psychological reactions (such as fear and anxiety) associated with the COVID-19 pandemic have not been investigated and even neglected in patients with heart failure who are at greater risk for morbidity and mortality. We assessed COVID-19 related fear and anxiety among patients with heart failure and determined their associated factors. A cross sectional survey was conducted among 300 consecutive patients with heart failure during the period of March 2021–June 2021. Almost 50.7% of patients had fear of COVID-19 and 36.3% had coronavirus anxiety. Age > 55 was significantly associated with increased odds of fear (OR = 2.6) and anxiety (OR = 4.3). Patients with angina were more likely to have fear (OR = 3.0) and anxiety (OR = 2.2) and patients with chronic lung disease were more likely to have fear (OR = 3.0) and anxiety (OR = 3.3). Increased age, having angina, and having chronic lung disease were associated with increased odds of fear of COVID-19 and coronavirus anxiety. Psychological support needs to be integrated in patient care with special attention to physiological risk factors that are associated with COVID-19 comorbidities

Development of a telemedicine group educational program for patients with heart failure: A delphi study

Aims: Evidence regarding the most effective and feasible videoconferencing group educational program for patients with heart failure is still equivocal. This study aimed to reach consensus about the structure, acceptability, and feasibility of videoconferencing for people with heart failure in Jordan that improves access to healthcare and clinical outcomes. Methods: There were two Delphi survey studies of three rounds each. Delphi one survey involved 32 healthcare staff, experienced in heart failure clinical practice and telehealth, to obtain a consensus of opinion on a proposed group videoconferencing program for patients with heart failure. Delphi two involved seven staff of the information technology center, experienced in videoconferencing and using supporting applications, to obtain their consensus on the current capabilities of the healthcare system and patients about information technology. Descriptive statistics were used for each item to determine whether consensus was achieved or not. Items that received 80% disagreement or 80% agreement of participants were not presented for re-rating in the third round, while the items that scored varying degrees of agreement were presented for experts for re-rating. Results: In Delphi one a group of items reached consensus regarding structure, factors influencing, and effectiveness of the videoconferencing program. In Delphi two, the findings indicated that videoconferencing modality is applicable and feasible in Jordan. Conclusion: This is the first study that addresses the equivocal evidence for the design and implementation of heart failure videoconferencing programs. The framework of the current proposed program can be utilized as a guideline to test or develop a future videoconference program