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Background: Many studies have shown increased levels of anxiety and depression during the COVID-19 pandemic. Purpose: This study assesses anxiety and depression among COVID-19 patients who received treatment in outpatient and inpatient settings in Jordan. Methods: This cross-sectional study involved 236 individuals tested positive for COVID19 and having received care at the hospital either as inpatients or outpatients at King Abdullah University Hospital (KAUH) in Jordan from April 9th to September 21st of 2021. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD7) were used as standardized assessments to evaluate these symptoms. Results: Our results indicated minimal anxiety and mild depression overall, with outpatients scoring significantly higher on both scales than inpatients (p-value= 0.011). Factors leading to higher depression and anxiety scores included chronic diseases, a family history of mentalhealth issues, COVID-19-related worries, experiences of social ostracism or bullying, inadequate government support, unemployment, daily following COVID-19 news, and being female. Participants aged 29-44 years and those who previously consulted a psychiatrist had higher anxiety scores. Conclusion: The findings suggest greater anxiety and depression among outpatients, linking these conditions to socio-demographic factors and COVID-19 experiences. The study underscores the need for healthcare systems to address the mental health of COVID-19 patients and combat misinformation's impact on emotional well-being. Implications for Nursing: Nurses play a pivotal role by integrating routine mental-health assessments, particularly for those with identified risk factors, and addressing both physical- and mental- health needs, emphasizing the necessity of a holistic approach to patient care. Keywords: Anxiety, Depression, Inpatient, Outpatient, COVID-19

Background: Nurses with valid and reliable clinical data documentation can make autonomous decisions about their patients' management or treatment options. Purpose: To examine the association of nurses' autonomy and perception toward electronic health records with decision-making. Methods: This cross-sectional study was conducted on a convenience sample size of 120 nurses with six months of clinical experience working in a medical/surgical unit in two hospitals in Amman, the capital of Jordan. Results: Nurses' perceived patient care autonomy scores correlated significantly and positively with their decision-making modes (p < 0.010). Similarly, nurses' perceived unit operation autonomy scores correlated significantly and positively with the nurses' decision-making modes (p < 0.010). Nurses with an analytical decision-making mode reported higher autonomy scores than those with an intuitive decision-making mode (p < 0.001). Conclusion: The study found significant differences in the nurses' levels of autonomy based on their decisionmaking modes. Also, there was a significant association between nurses' autonomy levels and their decision-making modes. Future research is recommended to improve nurses' levels of autonomy to empower and inform their clinical decisions, thus improving patients' clinical outcomes. Implications for Nursing: Future interventional research should be directed to improve the decision-making skills of Jordanian nurses by enhancing their autonomy and control over practice. Also, future qualitative research is recommended to examine perceived nurses' role ambiguity and conflict in Jordan. Keywords: Autonomy, Perception toward electronic health records, Decision-making, Nurses.

Background: The Jordanian health system was overwhelmed in the early phases of coronavirus pandemic, primarily due to the lack of workers, and the breakdown of several medical centers. Healthcare workers suffered tremendous physical and mental pressure due to this unprecedented situation. Purpose: This research aims at investigating the experiences of nurses caring for patients with COVID-19 in field hospitals. Methods: A qualitative phenomenology research aimed to explore the experiences of nurses in field hospitals in Jordan caring for COVID-19 patients. Intentional and snowballing sampling methods were conducted on twenty nurses from May to June 2022. Results: The study generated four main themes and ten sub-themes, (1) Sense of obligation and pride, (2) Stress, (3) Personal development, (4) Feelings of helplessness and betrayal. Physical, emotional, and mental changes of nurses were observed after caring for patients with severe illness resulting from COVID-19. Conclusion: The findings of the study acknowledged the participants' willingness to enrich their knowledge and expand their work expertise by being part of this experience. The analysis of the themes and sub-themes has shown that nurses experienced stress, anxiety, depression, as well as other psychological and mental challenges. Therefore, healthcare leaders should consider meeting the nurses' needs and resolving challenges that faced them. Implications for Nursing: Healthcare policymakers and leaders in the health sector should consider implementing programs that support nurses' well-being and productivity under crises. Also, additional pay allowance should be considered to compensate for the dangerous time that nurses spend in special situations, such as the COVID-19 pandemic. Keywords: Qualitative research, COVID-19, Nurses, Public health, Field hospitals.

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Background: COVID-19 vaccination has proven to be effective in controlling the spread of the pandemic. However, many parents remain unwilling to have their children vaccinated. Purpose: This study aims to investigate the willingness on the part of Jordanian parents to have their children receive COVID-19 vaccines and to examine the predictors of this parental willingness. These predictors/variables include parents' demographic variables, risk perception and trust in health authorities and healthcare professionals. Methods: In September 2020, an online survey was used to generate a sample made up of parents residing in every region of the country using a proportional cluster protocol. A selfreporting questionnaire was used to generate the data. Results: A total of 1,252 parents participated in this study. Analysis revealed that 25.5% of the parents were willing to have their children vaccinated and that 25%, approximately, trusted what the health authorities had to say about the pandemic. 31.4% trusted healthcare professionals for caring for COVID-19 infected people. Finally, the results of the study showed that parental risk perception, trust, gender and education were the significant predictors of the parents' willingness to have their children vaccinated. Conclusion: Among Jordanian parents, the high prevalence of opposition to children vaccination may be explained by factors, such as risk perception of COVID-19, trust in health authorities and healthcare professionals and demographics. Implications for Nursing: Health-promotion initiatives are needed to provide parents with clear, accurate and transparent information about the possible risks of COVID-19 infection among children and the vaccine's benefits for both children and communities. Keywords: Covid-19 pandemic, Vaccination, Parents' willingness, Children, Jordan

Background: Assessment of dietary practices for patients with diabetes is essential and should be conducted in an iterative process. Purpose: The aim of this study is to assess the dietary practices of Jordanian patients with type 1 and type 2 diabetes and to assess the effect of socio-demographic characteristics on these practices. Methods: A cross-sectional descriptive study was done using a sample of 310 participants. Data regarding the dietary practices was collected using items that were selected based on literature consensus and empirical works. Eligible patients were screened for inclusion criteria, then invited to participate in the study during their clinic's visit. Participants were instructed to complete and return filled questionnaires to the RAs. Descriptive statistics and regression analysis were done to assess for relationships between the study variables. Results: The majority of the sample did not receive sufficient training (n=181; 60%). 40.6%(n=126) reported following an unhealthy diet more often than a healthy diet. Regression analysis showed that the level of education significantly ((F=33.4; p<0.001) and positively impacted those practices (B=2.2; p<0.01). Females, younger patients and those using traditional therapy tend to do the wrong dietary practices more frequently than their counterparts (B= -7.322; -0.2; -7.8; p <0.01, respectively). Conclusion: Patients should be encouraged to seek proper diabetes training, as this training may boost their adherence to do the right dietary practices. Addressing dietary and nutritional behaviors might be beneficial over measuring a global adherence score, because patient's practices may vary over time. Implications for Nursing: Nurses should repetitively assess dietary practices, as these practices might not be consistent over time. Further research is needed to explore self-care agency governing decisions and actions that predispose unhealthy dietary practices. Keywords: Diabetes, Diet, Medical nutrition therapy, Practices.

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Background: Shaken Baby Syndrome (SBS) is a serious public health issue believed to result from non-accidental trauma by violently shaking the baby. Purpose: To evaluate the awareness about SBS among parents in Jordan. Risk factors associated with SBS including psychological distress and age were investigated. Methods: A descriptive questionnairebased study consisting of demographic characteristics, SBS knowledge, and parental selfreported psychological distress was conducted. The questionnaire was conducted online between September and October 2022. Descriptive analysis of frequency and percent distribution was used for demographic analysis. Contingency table (Cross Tabulation and Chi-square) along with frequency analysis was used to describe the associations among the frequency distributions of the categorical variables. Results: Over two-thirds (67.65%) of parents (a total of 306 participants) were unaware of SBS and 68.30% of them reported shaking their children. Aging was significantly associated with less SBS knowledge and more self-reported psychological distress. Self-reported psychological distress was significantly associated with increased shaking incidents (p<0.05). Most parents who had shaken their children and were unaware of the syndrome reported psychological distress at an ages of 30 and above. Conclusion: A serious lack of SBS awareness exists among parents in Jordan. Parents' characteristics including age and self-reported psychological distress are important factors to formulate a logical understanding of the SBS phenomenon. The triad of SBS knowledge, age and psychological distress should be essential components of successful educational programs. Implications for Nursing: The study supports the need for SBS interdisciplinary education and training programs for parents and professionals caring for babies in pediatrics units. Keywords: Shaken baby syndrome, Knowledge, Psychological distress, Abusive head trauma.

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Background: In recent years, Jordan has seen a rise in the prevalence of cancer cases. Many Jordanian cancer patients have reported a readiness to try to alleviate their symptoms, and thus improve their quality of life by adopting a blend of traditional, complementary and integrative (TCI) medicines. Currently, hospitals in Jordan offer no or limited complementary medicine (CM) services as part of oncology or palliative cancer care. Purpose: This study examines the perspectives of Jordanian cancer patients regarding the desirability of integrating a range of CM approaches with the conventional treatments offered by hospitals. Methods: In this descriptive study, 253 patients formed a convenient sample and were asked to complete the Questionnaire on Integrating Complementary Medicine in Oncology Treatment. Results: More than 40% of the patients were found to have used CM during chemo or radiotherapy. Different types of herbal medicine were the most used treatments. More than a half of the participants showed willingness to seek advice from healthcare professionals on the use of CM for cancer treatment if it was integrated into their oncology treatment. Participants expected CM to improve their symptoms of pain, nausea and vomiting, as well as changes in appetite. Conclusion: Since there can be some safety issues involved with CM approaches, training should be given to care providers on how to best help their cancer patients based on evidence-based culturally sensitive consultation. Implications for Nursing: More research is needed to be done into the perspectives of healthcare providers and care givers on CM use and its usefulness alongside the conventional medical treatments.

Background: The COVID-19 pandemic has had a significant negative impact on the mental health of students. Students have reported feelings of boredom, relaxation, and complications during remote learning, as well as missing social interactions and experiencing fear, sadness, and anxiety when hearing news about COVID-19. Purpose: The objective of this study is to investigate the level of anxiety and depression among the students who practiced online learning through COVID-19. Methods: A quantitative study was used. The study used a convenience sampling method to collect data. The total number of the sample reached 390 students. The students were selected from the University of Jordan and Applied Science University in Amman. The other part of the sample was collected from the governmental and private schools in Amman governorate. The questionnaire was used as a tool for data collection. Results: The results showed a wide variation of the conditions inside households that left a deep impact on the students in Tawjihi. The previous conditions and the difficulties that the families faced to save the internet with high criteria left high pressure on Tawjihi students. The results showed that the complete lockdown due to COVID-19 caused different levels of depression and anxiety. The results showed that the students were depressed from online learning due to the difficulties that they faced in reaching the online sessions and the difficulty in managing the online platforms. Conclusion: Online learning left different levels of depression and anxiety among the Tawjihi students as a result of the low experience of online learning. Implications for Nursing: By addressing anxiety and depression among students, nursing science can contribute to the development of effective interventions and support systems that enhance students' mental well-being and overall educational experience. Keywords: Online learning, High-school students, Depression, Anxiety.

Background: There are debates on the risk and harm of Hookah smoking among university students. There is a dearth of studies describing students' experiences, causative factors and consequences of Hookah smoking among female university students. Purpose: The purpose of this study was to describe the experience of adopting Hookah smoking among female university students. Methods: A descriptive qualitative design was used for this study. A purposive sample of 14 female university students participated through face-toface interviews. Results: The study results included six main themes: Hookah smoking is cool and entertaining; attracting factors for Hookah smoking; Hookah smoking versus cigarette smoking; socio-cultural acceptance of female Hookah smoking; imminent hazardous consequences of Hookah smoking; strategies to combat Hookah smoking among female students. Conclusion: Hookah smoking has become culturally accepted by female university students. Serious attention and initiatives should be considered to enhance female internal awareness to prevent peer pressure to start Hookah smoking. This habit started at home, became accepted by parents and is now accepted in public places. Therefore, it is crucial to implement culturally competent interventions to combat Hookah smoking in private and public places. Implications for Nursing: Nurses and policy makers should address the triggering factors for increased Hookah smoking among adults. Nurses should use effective approaches for combating Hookah smoking in different community settings. Also, they should conduct and implement culturally competent preventive programs to combat Hookah smoking in different settings and among all age groups, specifically university and school students, and enhance their awareness. Additionally, it is significant to enforce legislations and policies for the prevention of Hookah smoking among adults. Keywords: Hookah, Smoking, Female, University, Students, Cigarettes.

Background: In recent years, it has been discovered that complementary and traditional medicine (CTM) use among cancer patients has increased. In order to successfully integrate these treatments into cancer care, it is critical to assess the viewpoints, foreseen obstacles and recommendations for CTM use in cancer patients from the perspective of healthcare practitioners (HCPs). Purpose: This study aimed to explore the perspectives of HCPs on CTM integration in cancer care, as well as perceived barriers and suggested recommendations to CTM use in oncology settings. Methods: A descriptive cross-sectional design was used to collect data from a sample of 240 healthcare providers (HCPs) using the Complementary and Traditional Medicine in Supportive Cancer Care Questionnaire. Results: Findings revealed that 49.6% of the participating HCPs reported that 50% of cancer patients had used CTM in the past year. Approximately 75% of HCPs perceived that the greatest motives for cancer patients to use CTM are to improve their well-being and QoL, in addition to have lower chemotherapy side effects. According to HCPs, patients resorted to diet/nutrition therapy and herbs the most during chemotherapy or advanced cancer and they would first consult a folk healer (48.8%), then an oncologist (31.7%) about CTM used modalities. The findings also revealed that HCPs perceived inadequate communication between CTM and conventional practitioners and oncologist skepticism and rejection of CTM as barriers to CTM integration. Conclusion: HCPs saw a need to improve communication between integrative physicians and cancer patients by focusing on the patients' lifestyle and outlook, their well-being and their ability to function. Implications for Nursing: The findings showed that the majority of HCPs considered oncology nurses to have a crucial role in "participating in building CTM treatment plan". Therefore, nurses need to take a leading role towards reducing the barriers of CTM integration in cancer care settings and involve in planning educational training programs focusing on the benefits and risks of using CTM and the best methods towards integrating CTM modalities for cancer patients.

Background: Although patient education programs impart health-related knowledge that promotes the individual capacity to understand health-related information, there is a dearth of studies that examine the effect of cardiac educational programs on knowledge and satisfaction among patients with Coronary Artery Disease (CAD) in Jordan. Purpose: This study aimed to examine the effect of cardiac educational programs on knowledge and satisfaction among patients with CAD. Methods: A quasi-experimental design was used. Data was collected from 138 patients using the Coronary Artery Disease Education Questionnaire-Short Version and the Patient Satisfaction Scale. Participants were randomly allocated into an experimental group and a control group. Data was collected twice, before the intervention and one month after implementation. Results: There was a significant difference between the mean knowledge scores on the pre-test (M=10.3, SD= 3.80) and the post-test (M=12, SD=1.49) and a significant difference t (61) =-17.3 P< 0.001) between the mean satisfaction scores on the pre-test (M=3.5, SD= 0.38) and the post-test (M=4.41, SD=0.37). The results of paired t-test showed that there was a significant difference between the mean knowledge scores on the pre-test and the post-test for the experimental group. On the other hand, there was no significant difference t (64) = 1.01, P= 0.31 between the mean knowledge scores on the pre-test (M=10.8, SD=32.6) and the post-test (M=10.7, SD=2.96) for the control group. Conclusion: The used cardiac educational program enhanced the level of knowledge and satisfaction among CAD patients. Implications for Nursing: The findings of the current study support the significant effect of the cardiac educational program on the level of knowledge and satisfaction among patients with CAD, which encourages using such programs for CAD patients. Keywords: Cardiac educational program, Knowledge, Satisfaction, Patients, Coronary artery disease.

Background: The Acceptance and Commitment Therapy Model has gained empirical support, with limited evidence on the role of psychological flexibility in persons with heart failure. Objective: To examine the role of psychological flexibility in persons with heart failure. Methods: A total of 172 persons with heart failure from three major referral hospitals participated in the study. A proposed model based on the acceptance and commitment therapy was tested. Results: The results showed that the path between psychological flexibility and emotional outcomes is statistically significant. Psychological flexibility explained 52% of the variance. On the other hand, the path between psychological flexibility and behavioral outcomes was not significant. Conclusions: This study suggests that psychological flexibility plays a significant role in determining emotional outcomes in persons with heart failure. Implications to Nursing: Nurses need to assess persons with compromised psychological flexibility as a predictor of adverse emotional outcomes. Targeting psychological flexibility may improve stress and depression in persons with heart failure. Keywords: Psychological flexibility, Heart failure, Acceptance and commitment therapy, Depression, Stress.