Community Mental Health Nursing

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Anxiety and Depression Symptoms among Pregnant Women via In Vitro Fertilization Compared with Naturally Pregnant Women Referred to Antenatal Clinics: A Comparative Study
(An-Najah National University, 2019-01-09) Qalalwi, Ala
Introduction: Pregnancy is considered a critical period in a woman’s life. During this period, the woman experiences massive hormonal fluctuations, thus affecting her life physically, socially and psychologically. Aim: The aim of this study was to assess levels of anxiety and depression among pregnant women via In Vitro Fertilization (IVF) in infertility centers during the three trimesters of pregnancy and compare them with naturally pregnant women referred to the antenatal clinics. Method: A descriptive comparative design was used to collect data from the pregnant women who visited all private infertility centers and all Palestinian Ministry of Health (MOH)’s antenatal clinics in the West Bank. Result: The findings have showed that pregnant women via IVF were more likely to experience anxiety and depression symptoms than naturally pregnant women (11 and 4.2 times, respectively) with significant differences (P: 0.00 and P: 0.021, respectively). In addition, the findings have also showed that pregnant women via IVF were 14 times more likely to have anxiety or depression symptoms than naturally pregnant women with significant differences (P: 0.000).
Anxiety and Depression, and their Associated Factors among pregnant women in Palestinian refugee camps - west bank
(An-Najah National University, 2017-08-24) Abu- Iznait, Alaa; Al -Tell, Mariam
Pregnancy is a time of physical and mental health changes that can include feelings of joy and hope. However, pregnancy can also be a stressful period featuring increase prevalence of anxiety and depression. The aim of the study : is to find out the prevalence rate of depression and anxiety among pregnant women and the related associated factors during the period of study Method: A Quantitative descriptive approach was adopted to conduct the study and data was collected during two months from end of April until end of June in (2016) from antenatal clinics in 9 refugee camps in the West Bank. The sample consisted of (327) pregnant women, who were selected through random sampling, (GAD-7) used to measure the level of anxiety, and depression (PHQ-9) Depression Scale. Results: Results showed that prevalence of depression among pregnant women was high (59.5%) (n=194) of pregnant women reported various degree of depression as follows: (34%) (n=111) of women reporting mild depression, (17.2%) (n=56) moderate depression, (6.1%) (n=20) moderate to severe depression, and (2.1%) (n=7) severe depression. The prevalence of anxiety was also high in comparison to a global result, (60.1 %)(n=196) of pregnant women had different degree of anxiety as follows : mild anxiety according to scales was (30.7%) (n=100), moderate anxiety (17.5%) (n=57), and severe anxiety was (12%) (n=39). Conclusion: Anxiety and depression during pregnancy are major health problems among reproductive aged women. Findings suggest the need for assessment of the risk for prenatal anxiety and symptoms of depression during each antenatal visit and to take measures immediately to prevent and manage them. The findings also suggest a need to study depression and anxiety in more detail by qualitative research.
ASSESSMENT OF THE PALLIATIVE CARE AND DEPRESSION SYMPTOMS AMONG CANCER PATIENTS: A CROSS-SECTIONAL STUDY
(جامعة النجاح الوطنية, 2022-02-24) Battat, Maher
Background: Palliative care is critical for redundancy in cancer patients looking for quality of life improvement; symptom assessment should be incorporated in clinical practice routines at all stages of cancer. The Edmonton Symptom Assessment System (ESAS) used to rate the intensity of ten symptom assessment that has been designed and validated for cancer patients in a variety of languages and cultures. On the other hand, Beck’s Depression Inventory (BDI II) used to assess depression symptoms and depression severity, which is one of the palliative care symptoms among cancer patients that can be assessed by ESAS. Therefore, the study aims to assess cancer patients reported symptoms focusing on depression using ESAS scores and the BDI II scale to identify patients who would benefit from palliative care that can improve the integration of palliative care into standard oncology care at An-Najah National University Hospital (NNUH). Methods: A cross-sectional study was selected for 271 cancer patients by using a convenience sampling method at NNUH. Demographic, clinical, and lifestyle characteristics are described. The results of the moderate to severe symptoms (score >4) reported by the patients were obtained using the ESAS. The BDI II scale was used to detect the level of depression. Results: The survey consisted of 271 patients, with a response rate of 95%. The average age of the patients was 47±17.7 years, with a range of 18 to 84 years. The male to female ratio was around 1:1 and 59.4 % of the patients were outpatients, and 153 (56.5 %) had hematologic malignancies. Fatigue (62.7 %) and drowsiness (61.6 %) were the most common moderate to severe symptoms in ESAS, also Pain (54.6 %), nausea (40.2 %), , lack of appetite (55.0 %), Sortness Of Breath (SOB) (28.5%), depression (40.6 %), anxiety (47.2 %), and poor well-being (56.5 %) were reported. In terms of BDI II depression scores, the majority of cancer patients (n=104, 38.4%) had minimal depression, while 22.5 %, 22.1 %, and 17.0 % had mild, moderate, and severe depression, respectively, with statistically significant associations between all symptoms of ESAS symptoms and BDI II scores. Conclusions: Fatigue and drowsiness were the most reported symptoms according to the ESAS scale among cancer patients, while depression ranged from minimal to severe according to BDI II mostly minimal depression, whereas moderate to severe depression symptom was reported on cancer patients using ESAS. ESAS and BDI II were functional tools for depression symptoms among cancer patients to establish palliative care services. Implications: ESAS is an applicable tool for assessing palliative care symptoms among cancer patients at NNUH to improve their quality of life.
Association between Autism and Iron Deficiency in Autistic Children in the Northern West Bank
(2013) Sajed Faisal Al Ali; Dr. Aidah Abu Elsoud Alkaissi; Dr. Sabrina Russo
Background: Iron has an important role in cognitive, behavioral, and motor development. A high prevalence of iron deficiency (ID) has been reported in people with autism. Children with autism are at risk for ID and this condition may increase the severity of psychomotor and behavioral problems, some of which already inherently exist in these children. Aim: The aim of this study is to investigate the association between autism and iron deficiency in autistic children in the northern West Bank and to identify food selectivity and compare indices of food selectivity among children with autism, children with mental disorders and typically developing children (normal children). Participant and Methods: 90 children with an age range of 3 to 13 years participated in a case control study distributed into study group and two control groups. Thirty children diagnosed with autism according to DSM-IV and ICD-10criteria served as a study group, 30 children with mental disorders other than autism served as a control group, and 30 typically developing children taken from the public functioned as a second control group. The three groups were matched for age, gender and geographical area. Serum ferritin, hemoglobin, hematocrit, mean corpuscular volume, and red cell distribution width values were measured and analyzed with food habit survey and demographic data. Results: ID was detected in 20% (N = 6/30) of autistic children based on Serum ferritin level (SF< 10µ/l), compared with 0% for the two control groups (p= 0.0001). Anemia was defined as hemoglobin <110g/l for children under the age of 6 years and hemoglobin <120g/l for children between 6 and 13 years of age .When analysis done for HGB to these six children (children who have low serum ferritin); it was found that 66.6% (4/6) of the children two were pre-school male children (HGB is less than 110g/1), and the other two were one male and one female of school children (HGB is less than 120g/l) have iron deficiency anemia, and the iron deficiency anemia was 13.3% (4\30) for all autistic group. The results indicated that these differences were for males. It was found also that the frequency of low iron intake in these children was associated with feeding difficulties and food selectivity; there was a significant difference between children in the autistic group who chose foods with a red color as a favorite 23% (7/30) compared to the other two control groups: 0%, respectively (p= 0.0001). The results demonstrated also a significant difference in the frequency of snacks per day (≥ 4) in autistic children 40% (12/30) compared to both mental disorder 16.7 % (n = 5/30) (p = 0.006) and typically developing children 6.7% (n = 2/30) groups (p = 0.001). Conclusion: Results of this study indicated that there is an association between autism, iron deficiency and anemia. Low levels of serum ferritin in autistic children might be a sign of iron deficiency and an early precursor of iron deficiency anemia. These findings suggest that food selectivity is more common in children with autism than in typically developing children. These findings suggest that ferritin levels should be measured in children with autism as a part of routine investigation. Keywords: Child, Autism, Mental disorder, typically developing children, Iron deficiency, Iron deficiency anemia, Ferritin.
Blood Profile of Schizophrenic Clients in Northern Palestine
(2013) Hisham zaher zhran; Dr. Iyad Ali; Dr. Adham Abu Taha
Background: People with schizophrenia die prematurely because antipsychotic medications and patients’ lifestyle, contribute to excess morbidity and mortality in these patients. Hematological side effects of antipsychotic drugs such as leucopenia, neutropenia, agarnulocytosis, leukocytosis, thrombocytopenia, thrombocythaemia and anemia occur infrequently but remain a potential cause of serious toxicity and people with schizophrenia make poor dietary choices. Complete blood count is one of the measures to investigate these morbidities and mortalities. Objectives: The objective of this study was to investigate the blood profile and general characteristics in a group of schizophrenic patients in Northern West-Bank, Palestine. Methods: A cross sectional study was conducted between August 2011 and February 2012 at the governmental primary psychiatric health care centers in Northern West-Bank, Palestine. Two hundred and fifty patients were selected by convenience sampling method. A complete blood count (CBC) was performed on blood samples collected from the selected patients to investigate the white and red blood cells, as well as platelet count. Results: The number of schizophrenic patients having anemia in our study was 63 (25.2%). Regression analysis showed that gender was significant factor associated with the prevalence of anemia in schizophrenic patients, the prevalence of female patients they have anemia more than male patients. The majority of patients had normal white blood cells and platelets counts. Conclusion and recommendation: Anemia was found among 25.2% of study population in schizophrenic patients as result of poor nutritional status, unhealthy life style of these patients, and antipsychotic drugs. It is recommended that mental health providers deliver patients with an appropriate community-based intervention strategy for prevention, detection and treatment of anemia. Furthermore, the low educational achievement among participants makes education a potentially important area for interventions targeted at this group. Lastly, the job skills of patients should be improved.
Burnout and Psychological Distress Among Primary Health Care Nurses and Midwives in North West Bank
(An-Najah National University, 2018-01-22) نعيرات, إيهاب; الشاويش, إيمان
Background: Nurses and midwives in the health care system play an important role that cannot be overemphasized. Nurses work at varying levels of the healthcare system and the nursing profession demands a substantial amount of energy, time and dedication spent in both performing nursing medical tasks, as well as managing patients. This dedication and investment of time can lead to psychological distress and burnout among those who practice the nursing profession. Purpose: This study assesses the prevalence of burnout and psychological distress among primary health care nurses and midwives working in the Northern West Bank (WB). Methods: The method for data collection was a quantitative survey through a self-administered questionnaire. The Maslach Burnout Inventory (MBI) and the General Health Questionnaire (GHQ-28) were used to assess burnout and psychological distress among 295 nurses and midwives working in the Palestinian governmental primary health care centers in the Northern West Bank. Data analysis was conducted using a variety of inferential and descriptive using the SPSS system version 20. Results: The prevalence of burnout was 10.6% among 207 nurses and midwives who participated in this study. High levels of burnout were identified in 36.7% of the respondents in the area of emotional exhaustion, 14% in the area of depersonalization and 17.9% in the area of reduced personal accomplishment. Meanwhile, 22.6% scored positive in the GHQ-28 indicating presence of psychological distress. Conclusion: Findings from this study contribute to the understanding of the relationship between nurses' burnout syndrome and the level of psychological distress. Results also point out that burnout and psychological distress is not uncommon among nurses and midwives working in primary health care in the Northern West Bank. Nurses' burnout and psychological distress levels seem to have special characteristics relating to the unique composition of health care in the Palestine. Recommendation: Encourage the Palestinian Ministry of Health to communicate with the relevant health professionals to establish regular stress management programs for nurses and other health personnel in the West Bank.
Depressive Symptoms Among Palestinian Deaf Adults
(2014) Ibrahim Fakhri Ibrahim Aqtam; Dr. Adnan Sarhan
The aim of the Study: The study aims to assess the prevalence of depressive symptoms among Palestinian deaf adults. Method: A quantitative cross-sectional design was adopted to answer the research question for the study. The framework is based on factors derived from previous studies on the Patient Health Questionnaire PHQ-9 (Robert & Spitzer et al, 2001). The subject population was composed of 217 adults from three representative West Bank Palestinian cities. Participants ranged in age from 15 to 65 years divided as males (n=136) and females (n=81). All participants attend special deaf centers and use the Palestinian Sign Language (PSL). Results and Data Analysis: The data analyzed using Statistical Package for Social Sciences (SPSS). We used mean, standard deviation, and multivariate logistic regression. According to the multivariate analysis results of the study showed, (OR=2. 0) (95% CI, 1.2-3.4) minimal depression, (OR= 1.7) (95% CI, 1.2-2.3) mild depression, (OR=1. 4) (95% CI, 1.1-1.9) moderate depression, and (OR=0. 9) (95% CI, 0.7-1.2) severe depression. Conclusion: The concluded result of our study is that more than half of the respondents suffer from depression at varying levels, which is considered significant conclusion. Tendency for depression might be a common health problem among deaf adults attending primary health maintenance installations. Further research on socio-demographic characteristics and the force of depression on their health status is required. Keywords: Depression, Prevalence, Cross sectional, Deaf, Palestinian.
Estimation Ten-Year Risk of Coronary Heart Disease in Patients with Schizophrenia
(2013) Saqer M. Al-qoroum; Prof. Waleed Sweileh Supervisor; Dr. Samah Al- Jabi
Background: Studies indicated that patients with schizophrenia have shorter life span than that of general population. Objective: To estimate ten-year risk of coronary heart disease (CHD) in patients with schizophrenia. Methods: A cross-sectional study was carried out in four governmental primary psychiatric health care centers in northern West-Bank (Nablus, Jenin, Qalqilia, and Tulkarem). 112 patients diagnosed with schizophrenia were recruited for the study. A convenience, non-probability sampling method was used. Ten-year risk of CHD was calculated using Framingham risk scoring formula which includes the following variables: age, gender, smoking status, high-density lipoprotein- cholesterol, systolic blood pressure and history of anti-hypertensive drugs hypertension. Risk of CHD was categorized based on total scores into the followings: Ideal (<5%), low (5-9%), intermediate (10-20%) and high (>20%). Descriptive and analytical statistics was conducted using Statistical Package for Social Sciences (SPSS) version 20. Results: The mean age of the participants was 43 ± 10.85 years. The majority were males (76; 67%). There was no significant difference between males and females in age (P=0.72), duration of psychiatric illness (P=0.085), systolic blood pressure (P=0.75), diastolic blood pressure (P=0.7) and total cholesterol level (P=0.17). The mean ± standard deviation (SD) ten-year CHD risk score was 5.6 ± 5.8 (median (inter quartile range (Q1 – Q3)): 3 (1 – 9)). The mean ± SD ten-year CHD risk score for females was 1.5 ± 1.58 (median (Q1 – Q3): 0.75 (0.5 – 2)) while that for males was 7.5 ± 6 (median (Q1-Q3): 6 (2–13)). Based on Framingham risk scores, there were 87 (77.7%) patients in low risk, 22 (19.6%) patients in intermediate risk and 3 (2.7%) patients in high risk. Univariate analysis showed that there were significant differences between low <10% risk score and intermediate/high risk ≥ 10% risk score categories with respect to age distribution (P<0.05), gender (P<0.05), smoking (P<0.05), total cholesterol (P<0.05), diastolic blood pressure (P<0.05) and duration of psychiatric illness (P=0.03). However, there was no significant difference between the low <10% and intermediate/high ≥10% categories in terms of systolic blood pressure, waist circumference and HDL-C levels. Multivariate analysis on male patients showed that age [O.R=1.524, 95% CI (1.213-1.914)] and diastolic BP [O.R=1.207, 95% CI (1.045-1.393)] were significant factors associated with intermediate/high ≥ 10% CHD risk. Conclusions: One fifth of schizophrenia patients had a CHD risk ≥ 10%. Efforts to decrease CHD risks among patients with schizophrenia should be directed mainly toward diastolic BP as modifiable risk factor. Key words: Schizophrenia, Framingham Risk Score, CHD, Palestine
The Experience of Mothers and Teachers of Attention Deficit / Hyperactivity Disorder Children, and Their Management Practices for the Behaviors of the Child A Descriptive Phenomenological Study
(2012) Lubna Harazni; Dr. AidahAbu Elsoud Alkaissi
Abstract Introduction: ADHD (attention deficit hyperactivity disorder)is a childhood disorder affecting children worldwide and has a major burden on the child, family and other caregivers. Aim: The aim of this study is to investigate and describe the experience of the adults that interact on a daily basis with school-aged children with Attention Deficit Hyperactivity Disorder, which are mothers and teachers. This study aims also to understand management practices that are used by mothers and teachers to deal with the most prominent signs of ADHD, which are hyperactivity, impulsivity, and inattention in order to formulate a care plan. Design :The study used a qualitative descriptive phenomenological method to explore the experiences of primary caregivers of ADHD children to capture as much as possible the way in which the phenomenon is experienced. Data collection: Face to face, in-depth, semi-structured interviews were conducted with participants – the mothers and teachers of ADHD children. The interview guide allowed mothers and teachers to express their experiences with the ADHD child. Sample:Purposive sampling was used; four children diagnosed with ADHD were chosen. The sample was 4 mothers and 12 teachers (3 teachers for each child). Setting: Interviews were conducted in schools and homes of children with ADHD. Data Analysis: The data was analyzed by using Giorgi’s phenomenological psychology method (1985). Results: Three major themes emerged from the mothers’ interviews and ten sub-themes; (1) the burden of caring (academic track burden, activities of daily living burden, psychological and emotional burden);(2)inadequate support(lack of support from spouses and relatives, lack of support from schools, lack of support from community);(3)disturbances of the child's behavior (hyper activity, inattention, impulsivity, hostility). Five major themes also emerged from the teachers interviews and thirteen sub-themes; (1) lack of information (about the nature of the disease,about student health and follow-up, about the ideal method for dealing with child); (2)child´s behaviors disruptive (inability to follow class rules, inattention and impulsivity, using verbal and physical abuse);(3) the lack of resources (lack of time, lack of materials and experts); (4) lack of support (lack of Ministry of Education support and school team, lack of parental support); (5) the burden of having the child in the class (burden of managing the safety of the child, burden to calm the child and the other students, emotional burden). Conclusion : The findings of the study demonstrate the importance of understanding the experience of the mothers and teachers of ADHD children. It reflected the difficulties and issues of dealing and caring with ADHD children. There were clear defects in the knowledge, understanding, services provided for the children, and available support for the care givers. Improving services in terms of family and school care should be a major concern. The recommendations made on the basis of the results of this study can be used as a guide to improve the delivery of care services for people who have children with ADHD. Key words: ADHD, experience, descriptive phenomenology Definition of Concepts: - ADHD (attention deficit hyperactivity disorder):is a chronic behavioral disorder with three major symptoms including hyperactivity, impulsivity and inattention. It mostly starts in childhood, and is associated with impairment in the functioning of the child in school and at home, in social settings and at work.
The Experience of Palestinian Children Facing Traumatic Events The Case of a Village under Military Occupation: A Descriptive Phenomenological Study
(2016) Farid Abu Liel; Dr. Sabrina Russo
Introduction: The objective of this research is to provide an overview of the effects of war and living in a conflict zone on children; to capture their lived experience facing traumatic events and to explore the phenomenological experience of those children who live in a village nearby an Israeli settlement and separation wall, under a daily struggle against the Israeli occupation. The research seeks to understand the effect of trauma on children who live in a violent environment in order to understand the impact of such traumatic events on them, and to explore their feelings and thoughts. Aim: The aim of this study is to investigate and describe the experience of Palestinian children facing daily traumatic events. It is also our concern to understand how these children are psychologically affected by their experience. Military occupation poses a challenge for the mental health of children in Palestine, and it is influenced by a set of complex and interactive individual, social, cultural, and economic factors. Lack of studies in such issues makes it difficult to understand the phenomena in relation to the special cultural and social aspects in Palestine. Understanding these factors is critical in provision of effective and culturally appropriate care. We will employ a qualitative approach in order to create a rich and deep understanding of this important issue. Design: The design used is a qualitative phenomenological descriptive design. This design is used to study and to explore the lived experience of the Palestinian children who face traumatic events by describing the aspect of this experience and by focusing on what exists. Sample: Purposive sampling was used; 15 children who lived in a Palestinian village under military occupation and experiencing settler attacks. Setting: Interviews were conducted in a private room in the respondent’s house. Data Analysis: The data was analyzed by using Giorgi’s phenomenological psychology method (1985). Results: Three major themes emerged from the children’s interviews and ten sub-themes; (1) Exposure to Traumatic Events (Life threatening, witnessing violence, direct violence, deprivation of freedom, lack of safety and fear); (2) Normalization (1Role playing the traumatic events, Underestimation of danger); (3) Resilience (self-efficacy, 2Awareness and belonging, and trust in adults). Conclusion: The findings of the study demonstrate the importance of understanding the experience of the Palestinian children facing traumatic events. It reflects how these children face the traumatic events regarding the military and settler actions in their village, how they react to these events, and the degree to which they are affected. The children normalized the events through role playing the trauma and acting out violence and underestimation of danger, but then demonstrated resiliency that allowed them to increase their courage to continue. Key words: Phenomenology, trauma, children, war
The experiences of Mothers caring for adults affected by schizophrenia in Hebron district – Palestine: A descriptive phenomenological study
(An-Najah National University, 2017-09-18) دعيس, مالك ربحي حسين; الطل, مريم
Introduction: Schizophrenia is a mental illness which cause severe disability and considered as major cause of suffering for clients affected with it. Diagnosis with Schizophrenia affects functioning within the family and caregivers, this manly resulted because the caregivers have to take their role in caring. Aim: This study aimed at understanding the experience and management’s practices that used by mothers of client affected by schizophrenia include difficulties and barrier that mother of face, and investigate both the positive and negative experiences of care giving, mother coping strategies, supportive factors, attitudes and perceptions Design :The study used a qualitative descriptive phenomenological method. Data collection: Face to face, in-depth, semi-structured interviews were conducted with participants – 11 mothers of client affected with schizophrenia included. The interview guide allowed mothers to express their experiences with caregiving of client affected with schizophrenia. Sample: Purposive sampling was used The setting of data collection was Hebron Community Mental Health Center. In Hebron district – West Bank- Palestine. Data Analysis: The data was analyzed by using Giorgi’s phenomenological psychology method (1985). The result: From the experiences narrated by the mothers, 4 main themes and 18 sub themes emerged from the analysis of the data. The data obtained from mothers were transcribed verbatim. Which include Coping with new situation, Knowledge deficit, Emotional and social experience and Ongoing Struggle Conclusion: Each mother had unique experiences of their journey of caring and living, most of mothers experienced varies of difficulties and burden while caring for their client affected with schizophrenia include, psychological, Emotional, social and economic factors. Most of mothers experienced lack of knowledge and information regarding schizophrenia and how to manage or deal with symptoms. Also early experiences with the illness include feeling of loss, sadness, crying. Mothers experienced many lifestyle change include being socially isolated due to they had to be always with their client who become dependent. Mothers reported many needs to help them handle new situation, which included enough information and education, and counseling center, also they needed center for rehabilitation and entertainments activity for their clients supported with mental health professional’s. In this study coping mechanisms of mothers explored, which they used to overcome challenges introduced by their client affected with schizophrenia. Mothers developed themselves with coping strategies to handle with challenges and new situation that they obligate to be with, lastly, some mothers also reported positive, character building experiences arising from their caring for their relative with schizophrenia, that they feeled satisfied when their client become better, and some mother’s become closer and give more love to their client.
Family Burden among Caregivers of Mentally Ill Patients in Nablus District
(2013) Haneen To’meh; Dr. Mariam Al-Tell
Aim: The aim of this study was to assess family burden of caregivers of mentally ill patients and find out whether there is any relation between the perceived burden of caregivers of patients with mental illness and independent variables such as age, sex, education, economic status, and type of mental illness in Nablus District. Methodology: Descriptive, cross sectional design was used to achieve the aim of the study. Convenient sampling method was used to select the subject during the period from November 2012 – January 2013; it was distributed using quota method; 50 patients for each one of the following diagnosis: schizophrenia, mood disorder, and mental retardation, who were attending psychiatric outpatient clinics in Nablus district. The Zarit burden interview and the objective burden section from the Montgomery Borgatta caregiver burden scale were used to assess the burden. Result: The mean of subjective burden was mild to moderate (28.84), while objective was low (17.93). Also, the mean of psychological, social, and economic burden was low, and physical burden was low to moderate. The results showed that burden scores were significantly correlated with gender, educational level, and economic status. No significant differences were found between participants according to their age and type of mental illness. Conclusion: Higher subjective burden scores were correlated to being female, low educational level, and low economic status. While higher objective burden scores were correlated to being male, high educational level, and high economic status. Taking care of mentally ill patients affects the family negatively, so psychiatric nursing intervention should be focused on the need of the caregivers and an emphasis placed on community care for mentally ill patients as well as family intervention.
The Impact of Preoperative Education on the Psychological and Physiological Aspects of Patients Undergoing Abdominal Surgery
(An-Najah National University, 2017-09-18) طاهر, صلاح فتحي الحج; قدومي, جمال
Anxiety can be defined as an emotion distinguished by an unpleasant state of inner disorders and can be accompanied by subjective feelings of worry, nervousness, tension, and activation of the nervous system. Psychological and physical stress can be a result of pain. Anxiety can elevate the heart rate, blood pressure and cardiac outputbecause of the activation of the sympathetic, nervous, hypothalamic, and pituitary systems as well as the adrenal axis. Aim of the study: This study aims to assess the impact of preoperative education on the anxiety level of patients undergoing abdominal surgery and their postoperative pain. Methods The study was prospective, randomized, and controlled. Adult patients were randomly allocated to receive preoperative education. The patients were assessed for preoperative anxiety level and postoperative pain. The study population consisted of adult men and women over 18 years old undergoing any type of elective abdominal surgery in governmental hospitals in the Nablus district. One hundred patients scheduled for elective abdominal surgery were included in the study. Result At baseline, patients’ demographics and clinical characteristics were similar in both the experiment and control care groups, there were significant relationships between receiving an educational program and patient level of anxiety; this was evident due to the fact that moderate, severe, and extreme anxiety levels were higher in the control group than the treatment group. There was not a statistical significant relationship between the patient level of pain and participation in the educational program, this was evident in the pain scores being lower in the experimental group than control group in at each testing time. There was a significant relationship between the preoperative level of anxiety and the postoperative level of pain (at 6 hours postoperative, at significant level 0.05, with P-value 0.001.) Also, it was evident that pain level decreased when anxiety level was lower. There was a statistically significant relationship between pain and gender; as well as between anxiety and education level. But there was not a statistical significant relationship between anxiety level and other demographic variables. There was a significant reduction in the preoperative level of anxiety and postoperative level of pain among the patients who received the structured eduation program. There was a significant association between the preoperative level of anxiety and the postoperative level of pain. Conclusion In this study, preoperative education was effective in reducing preoperative anxiety among patients undergoing abdominal surgery, reducing postoperative pain, and improving vital signs. This study recommends that preoperative health education is included in routine care in preoperative preparations for surgical patients.
Incredible Years Program Efficacy for Parents of Children Affected by Autism Spectrum Disorder in West Bank
(An-Najah National University, 2018-01-11) وهدان, محمد محمود; رسو, سابرينا
13. Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. ASD is defined by deficiencies in communication and socialization, and the presence of restricted interests and stereotypic repetitive behaviors (Haisley, 2014). Parents with children who have ASD experience consistently high levels of stress, which are related, to some degree, with managing challenging child behaviors related to ASD (Estes et al., 2013). This stress can be decreased by the use of Early Intervention Programs for children with ASD. This will also improve parent’s behavioral management skills. Autism Spectrum and Language Delays Program for Parents with Preschool Children (IY-ASD) is an internationally standardized and validated program for teaching valuable parenting and behavioral management techniques to parents of children with severe disabilities including ASD (Webster-Stratton, 2015). 14. Aim: The goal of this study is to test the efficacy of the IY-ASD in reducing familial stress, increasing parenting skills of communication, socialization, problem solving, and reducing parental negative behaviors toward their children with ASD, in the Palestinian context. 15. Participant and Methods: An interventional study design was applied using a pre-post test approach. The research was conducted at An-Najah Child Institute (ACI) in Nablus. Thirty-one parents met the eligibility criteria and participated in the program groups for mothers (61.3%; n=19), and fathers (38.7%; n=12). Twenty one parents (68%) completed the program; ten parents withdrew from intervention prior to the completion of the study. 16. Results: Parental Stress Index (PSI) decreased after treatment with a mean difference of 11.1, which was found to be significant (95% CI 4.3, 17.9) (p = .002). Similarly, the mean related to total Parental Domain subscales decreased significantly (95% CI 1, 17; p=.030), while the mean score related to total stress decreased from 310 at baseline to 288 post-intervention with a mean difference of 22.1 (95% CI 9, 35.3) (p = .002). Fathers demonstrated lower negative behavior than mothers. The mothers discipline scores pre to post intervention was higher by 0.9 (95% CI; 0.2, 1.5) (p= 0.017) as compared to the fathers of children with ASD. 17. Conclusion: 18. Generally, the positive findings provided initial support to the hypothesis that the Incredible Years Program can reduce the stress of parents of children affected by ASD in Palestine, as well as improve behavioral management skills for participating parents. In general, mothers reported higher scores in aggression and physical discipline toward their children than fathers. Families with lower economic resources reported decreased levels of aggression compared with families of a higher salary.
Marriage Experience among Schizophrenic Clients: Qualitative Narrative Study
(2013) Wissam Obaied; Dr. Adnan Sarhan
Introduction Marriage is considered a normal developing relation between humans. This study examined the effects of marriage among schizophrenic clients, and if we must need to encourage their marriage or not . Aim : The aim of this study is to explore the effectsof marriage on single and married schizophrenic clients. Every relationship has its ups and downs, but what does "in sickness and in health" mean if one partner has schizophrenia? While severity of the illness is a factor, relationships can survive if each partner gets the right support (Connie, 2000). Design : This study is a qualitative narrative study .We tried to answer questions related to the marital status of schizophrenic clients. Data collection . Sample : About 80 schizophrenic clients . half of them are married for at least since three years and suffering from schizophrenia for a period which is not less than six months or more . The other half included single clients suffering from schizophrenia for at least six months or more. Setting : Interviews were conducted in three mental health centers in ( Nablus –Jenin and Tul-Karem ) were included in the current study . Data Analysis : The respondents were interviewed in the mental health centers after consenting to share in this study. The interviews were started with 12 close ended questions; about their demographic data such as; age, sex, occupation and other questions. The second part of the interview was composed of 12 direct face to face narrative questions with the married respondents, and 5 questions with the single ones. Narrative interviews were conducted (Narrative interview is a form of qualitative research that takes story as either its raw data or its product). The note was written during the interviews, after taking permission from the participants, and then deep analyses of the clients’ interviews were done. Results Seven main themes were emerged from the study: 1- The effect of marriage on the Recovery Process of Schizophrenic Clients .Most of the clients encourage marriage , both married and single clients ,they believe that marriage has appositive effects on their lives ,the need of admission and the number of suicide attempt was decreased , and single clients believe the same, but due to economic factors they cannot marry . 2- The effect of gender of the client on the recovery process of him / her and on his marriage .We can say that the male have more chance to marry , and the male client have more responsibility and more stress related to these responsibility . 3 - The effect of age of the client on the recovery process of him and on his marriage .We can say that the old client less stress and more adjustment with the disease . 4-The Effect of Stigma on Marriage and Recovery Process of Schizophrenic Clients .The stigma prevent the client from having many of their rights unfortunately , such as marriage and work . 5 - The effect of having children on the recovery process of schizophrenic clients. They said that their lives became better after marriage, and they said that , their children consider as the most reason of their happiness . 6 - The big effect of the schizophrenic client's family on planning his life, and the client also said that they are at control of their family members , and they are dependent a lot on them , and they cannot marry without their help and their agreement . 7 -The big effect of the schizophrenic client's community on planning his life and marriage .the stigma against the clients in the community have negative effect in the subject of clients marriage unfortunately .The psychiatrist some time did not encourage their marriage . Conclusion The client has the right like other persons to marry and have children, but before marriage, he must have a work or a job, and the partner must know about his / her condition from the beginning. In general, marriage has positive effect on the client’s recovery process, but the other partner faces many problems related to the disease, and must be very patient and has good understanding of his partner. Key words : Schizophrenia – Marriage – Single –Recovery process – Divorce .
Nurses’ Attitudes and Practices towards Inpatient Aggression in Dr. Kamal Mental Health Hospital
(2014) Hussein Al- Awawdeh; Dr. AidahAlkaissi; Dr. Sabrina Russo
Background: Inpatient aggression can occur for many reasons and there are many factors that contribute to this occurrence such as patient factors, staff factors and environmental factors. There are strategies to prevent and manage aggression. Aims: The aims of this study are to explore nurse's practices and attitudes of inpatient psychiatric aggression to identify the way the nurses handle aggression by patients and exploring the effects of patients, staff and environmental factors on the occurrence of aggression. Participants and methods: The study was conducted at Dr. Kamal Adwan Psychiatric Hospital in Bethlehem. All nursing staff in the mental health hospital who had worked for at least one year at the time of the study were recruited (67 nurses). The participants ranged in age from 20-50 years with a mean age of (35.1) (±SD = ±7.8) and included 30 females and 37 males. A questionnaire was used which has three scales: Attitude Toward Aggression Scale (ATAS), Management Of Aggression and Violence Scale (MAVAS) and Demographic Scale. Results: Nurses were inclined to perceive patient aggression as destructive, violent, intrusive and functional reactions. They were less inclined to view aggression as protective, communicative or acceptable normal reactions. Female nurses in this study were more likely to view aggression as having an intrusive role whereas, on the contrary, male nurses were more likely to view aggression as having a communicative role and they believed that the aggression could be managed in general. Longer professional experience was significantly associated with a higher frequency of the management of aggression in general. Nurses from the admission ward (male and female) were in less agreement with the Protective and Communicative Attitudes scales than the nurses from the other inpatient wards. On the other hand, nurses from admission ward (particularly female) and recovery ward (male and female) had a higher rate of violent and offensive reaction to aggression than nurses from the other wards. The nurses from the chronic female ward had a higher intrusive scale than nurses from the other wards. The highest level of the scientific grade group is a Master of Mental Health with a high level mean regarding the attitudes to the acceptable normal reaction scale, violent reaction scale, functional reaction scale, offensive scale, communicative scale, destructive scale, external causative factors scale, situational/interactional causative factors scale, Management: general, and Management: use of medication. The nurses agree that there are internal, external and interactional factors to inpatient aggression. Nurses believe that patients may be aggressive because of the environment of the psychiatric hospital. Nurses believe that aggression develops because staff do not listen to the patients, there is poor interaction between staff and patients and other people make patients aggressive. Nurses believe in the use of medications, restraint and seclusion widely , on the contrary, they believe in the use of non-physical methods like negotiation and expression of anger. Conclusion: This study demonstrate that there are different attitudes of nurses toward patient aggression in psychiatric inpatient settings. This study found that aggression is negatively viewed by Palestinian psychiatric nurses. These attitudes are reflective of the opinions of lay persons in our society. There is a need for training programs to reorient the opinions of nurses in relation to inpatient aggression. These programs should contribute to improved patient care and reduction in the frequency of aggressive acts within inpatient units. Key words: Aggression; mental health nurses; ATAS; MAVAS
Palestinian Women Attempted Suicide, Risks beyond the Experience A Descriptive Phenomenological Study
(2014) Einas Abu Safa; Dr. Aidah Alkaissi; Dr. Sabrina Russo
Introduction: suicide is a major public health problem all over the world. It described as “intentional, self-destructive, and self-inflicted acts. Aim: The aim of this study is to explore the risks beyond the experience of attempting suicide among a group of Palestinian women. Design: The study used a qualitative descriptive phenomenological method to explore the experiences of Palestinian women attempted suicide, to capture as much as possible the way in which the phenomenon is experienced, and the risks lays beyond the experience. Data collection: Face to face, in-depth, semi-structured interviews were conducted with participants – the women who previously attempted suicide. Sample: Purposive sampling was used; 20 women attempted suicide at least once. Setting: Interviews were conducted in a private place agreed for with the women. Data Analysis: The data was analyzed by using Giorgi’s phenomenological psychology method (1985). Results: From the interviews, Five themes and eighteen sub-themes emerged: violence (Sexual violence, domestic violence, collective violence, witnessing abuse, and child maltreatment); Losses (loss of parents, loss of cultural identity, loss of relation, and loss of security) ; psychological risk factors (Low self efficacy, Low Self esteem, Negative Self image, and Maladaptive coping mechanism); and Socio cultural factors (poverty, stigma, and dysfunctional family); Lack of support system (Non professional, and professional). Conclusion and Recommendation: The findings of the study demonstrate the importance of understanding the experience of the women attempted suicide, the risk beyond their experience, and the phenomena of suicide within the Palestinian community. It reflect the need for national prevention programs which include the implementation of national programs for mental health, recognizing the rights of females, tackling illiteracy among both males and females, prohibiting forced child marriage, providing economic and social support especially for young females, and promoting Islamic values rather than traditional customs. Key words: Attempted suicide, experience, risk, descriptive phenomenology. Definitions of Concepts: - Violence: is the intentional use of physical force or power, threatened or actual, against a person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation. This definition associate intentionality with the committing of the act itself, irrespective of the outcome it produces (WHO, 2005). - Sexual violence: any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, or otherwise directed, against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work(WHO, 2005). - Rape: Physically forced or otherwise coerced penetration even if slight – of the vulva or anus, using a penis, other body parts or an object(WHO, 2005). - Domestic violence: refers to a behavior by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, and psychological abuse and controlling behaviors (WHO, 2005). - Physical abuse: is an act of another party involving contact intended to cause feelings of physical pain, injury, or other physical suffering or bodily harm (WHO, 2005).
POSTPARTUM DEPRESSIONAND ANXIETY AMONG WOMEN UNDERGO CESAREAN SECTION COMPARED WITH VAGINAL DELIVERY IN NABLUS
(2023-05-31) Sojoud Abu-Baker
Background: Depression and anxiety are considered to be significant mood changes among pregnant women. Numerous studies have reported fluctuations in levels of depression and anxiety over time among women who planned for caesarean section (CS) more than a normal vaginal delivery. Based on data from the World Health Organization, around ten percent of pregnant women around the world and 13 percent of the women who have given birth experience a mental disorder, and primarily depression. Aim: The study aims to investigate the prevalence of depression and anxiety among women who have undergone a caesarean section versus woman who delivered normal, and to identify the related predictors of depression and anxiety. Methodology: A quantitative prospective cross-sectional approach was used in this study. The researcher used the Edinburgh Postnatal Depression Scale (EPDS). The Postpartum Specific Anxiety Scale (PSAS) for anxiety was used after two weeks and six weeks of postpartum and applied on 361women who underwent caesarean section and normal delivery at large hospitals in Palestine. Results: The study showed that the majority of the participants were aged 28-37 (38.8%) and 47.1% holding a bachelor's degree. About 30.5% of women experienced psychological stress after childbirth. Family support was available to 73.1% of participants. The study revealed significant differences in anxiety and depression scores after 2 weeks post-delivery, associated with various obstetric factors such as allergies, surgical procedures, medical diseases, and family psychological history (p < 0.05). Additionally, factors like gravity, parity, abortion, gestational age, number of foetuses, number of male and female babies, type of delivery, planned caesarean delivery, type of anaesthesia during delivery, health problems after delivery, and type of feeding also showed similar associations (p < 0.05). These findings underscore the importance of considering these obstetric factors as potential risk factors impacting maternal mental health during the postpartum period. Conclusions: The researcher found the total percentage of post-partum women who suffer from severe PPD and anxiety were high especially for CS group, according to the findings of the study, midwives should focus on providing healthcare for woman after six weeks of childbirth especial CS group, because through our study, the incidence of PPD and anxiety increase with time, especially in this period and focus on decreased factors that increased occurrence of PPD and anxiety. Keywords: Cesarean section, Postpartum depression, Anxiety, Risk factor, Women, Normal Delivery.
Prescription Pattern of Antipsychotics in Patients with Schizophrenia in North West-Bank
(2012) Jehad M. Bani Odeh; Prof. Waleed Sweileh; Dr. Ansam Sawalha
Background: Antipsychotic prescription patterns are fundamentally different across countries and even regions due to variations in factors including health care policies, availability and cost of drugs, psychiatric training, and preferred treatment modalities. Objectives: The objectives of this study were to evaluate the prescribing pattern of antipsychotic drugs and its conformance to international treatment guidelines among patients attending governmental primary healthcare clinics. Furthermore, predictors of antipsychotic prescribing pattern are investigated. Methods: A cross sectional study at 4 governmental primary psychiatric healthcare centers in northern West-Bank, Palestine was carried out. Patients' medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. Descriptive and statistics analysis was conducted using Statistical Package for Social Sciences SPSS 19. Results: A total of 250 patients were included in the analysis. Mean age of (mean ± SD) the patients was 41.5 ± 10.3 years. A total of 406 antipsychotic agents were used; 348 (85.7%) were form first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n = 126). There was no significant difference in positive (P=0.3), negative (P=0.06) and psychopathology (P=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Regression analysis showed that use of depot, use of anticholinergic agents and use high CPZeq doses were significantly associated with antipsychotic combination. Discussions and Conclusions: This study indicated that antipsychotic prescribing was not in conformance with international guidelines. Antipsychotic combination was common and has no clinical benefits or economic drawbacks.
PREVALENCE AND ASSOCIATED FACTORS OF POST-PARTUM ANXIETY SYMPTOMS AMONG PALESTINIAN WOMEN
(جامعة النجاح الوطنية, 2022-03-17) SaadAdeen, Sana
Background Over 20% of women are estimated to develop a mental disorder during pregnancy and/or for up to a year postpartum, with anxiety and depression being the most common co-morbidities. Postpartum anxiety is less well studied than postpartum depression in terms of prevalence and risk factors. Suffering from severe postpartum anxiety can put a strain on maternal neglect and disrupt the mother-infant relationship. Objective: The aim of the study is to determine the prevalence and associated factors of postpartum anxiety symptoms among Palestinian women. Setting: This study was conducted in Salfit and Nablus at governmental primary health care clinics affiliated with the Palestinian Ministry of Health. Methods A descriptive, cross-sectional design was utilized on a nonprobability convenience sample. A total of 510 mothers with one healthy baby (0 to 6 months) completed socio-demographic and obstetrics characteristic questionnaire along with Postpartum Specific Anxiety Scale (PSAS). Results: The majority of women reached postsecondary education (bachelor's degree 58%). The highest percentage of participants (42 %) were between the ages of 26 and 32 years. The majority of participants (81.4%) were unemployed. Although 63% of the participants planned their pregnancy, 36.9% did not. Despite 92% did not report any complications after childbirth and 60% had a normal delivery, but unfortunately, 36.3% of them did not follow up postpartum care at local clinic. Only (44.3%) of the participants reported that the feeding type was natural breastfeeding. Most of mothers (89.2%) had no feeding difficulties. The findings revealed that (91.6%) received support from their husbands. And, (85.7%) received support from other source. The total number of post-partum women who suffer from postpartum anxiety was 59 out of 510 (11.6%) according to the total score of PSAS. Conclusion: The results showed a slight variation in the proportions of anxiety according to the demographic variables and characteristics of the women in postpartum period, but these differences had no statistically significance. Only three factors were significant predictors of postpartum anxiety including feeding difficulties, presence of emotional support from husband and presence of emotional support from other source.

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