soi 1.18/jomenas.2016.7 issn 2412- 9763 (print) issn 2412
TRANSCRIPT
The Journal of MENA Sciences
ISSN 2412- 9763 (Print)
ISSN 2412-8937 (Online)
Vol. 2, No. 1
January, 2016
THE JOURNAL
OF MIDDLE
EAST AND
NORTH AFRICA
SCIENCES
© 2015-2016 Jomenas Press
SOI: 1.18/Jomenas.2016.7
© 2015-2016 Jomenas Press
Editorial Board
Ahmad Daraghmeh
Mechanical Engineering, Al-Balqa University,
Amman, Jordan
A. Heidari Faculty of Chemistry, California South University
(CSU), Irvine, California, USA
Elham Shayegh The American University of Iraq, Sulaimani, Iraq
Kwame Owusu The American University of Iraq, Sulaimani, Iraq
Mervat Abou Oaf The American University in Cairo, Egypt
Mohammed Abdulmumin University of Ghana, Ghana
Mohammad Mahmoud Al-Quds College, Jordan
Paul Boye The University of Mines & Technology, Ghana
Reza Hashemian
Northern Illinois University, United States
Tara Faidhalla The American University of Iraq, Sulaimani
Victor Temeng The University of Mines & Technology, Ghana
Zaidul Islam Sarker International Islamic University Malaysia, Malaysia
ii
© 2015-2016 Jomenas Press
Table of Contents
No' Articles
Page
1 A critique of Levine’s Conservation Model in the
Selected Article
Johan Al-Jabri
1
2 Consent Form Policy Analysis: Institution Hazem S. Akash
4
3 Developing Measure of Cancer Related Fatigue for
Adolescent Patients Ahmad A. Sawam
8
4 Clinical Research in Nursing: Design Analysis Salma A. Bashar
13
5 Spearman's Rank Correlation Coefficient Eugene Declercq
15
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
1
A critique of Levine’s Conservation Model in the Selected Article
Johan Al-Jabri
Clinical Nursing, Faculty of Nursing, Helwan University, Egypt
Abstract: This paper is a critique for Levine’s Conservation model regarding the article “Hanna, L.R., Avila, P.F.,
Meteer, J.D., Nicholas, D.R. & Kaminsky, L.A. (2008). The Effects of a comprehensive exercise program on
physical function, fatigue, and mood in patients with various types of cancer. Oncology Nursing Forum, 35 (3), 461-
469”, the critique is based on Chin and Krammer 2004.
[Al-Jabri, J. (2016). A critique of Levine’s Conservation Model in the Selected Article. J. Middle East North Afr.
sci, 2(1), 1-3]. (p-ISSN 2412- 9763) - (e-ISSN 2412-8937).http://www.jomenas.org. 1
Keywords: Nursing Theory Critique–Conservation Model- Levine’s Model.
1. Purpose
The purpose of this study was to evaluate the
effectiveness of a comprehensive exercise program
consisting of low-to-moderate intensity aerobic and
resistance exercise twice a week for 16 sessions with
patients in active treatment and cancer survivors
beyond treatment related to improvements in
physical function, fatigue, and mood.
2. Significance of the study.
Loss of physical function and weakness are
common issues among cancer population. Cancer-
related fatigue (CRF) also is an important topic when
discussing side effect of cancer and cancer treatment.
Exercise for patients with cancer is becoming widely
acceptable as therapy for alleviation of side effects
of cancer treatment and for enhancement quality of
life (QOL) of those patients. Benefits of exercise
illustrated in this population are almost universal.
Because of the variations in cancer type, stage, and
treatment regimen, researchers still work to develop
optimal and standardized exercise.
Quality of life is a commonly used term with
respect to the cancer population and has been
interpreted in many ways. In general, may be defined
as a composition of dimensions of wellbeing,
including physical, functional, cognitive, emotional,
social spiritual. Although many studies has
illustrated some aspects of alleviation symptoms of
cancer and cancer treatment, but none of the reported
studies involved comprehensive cancer exercise
program achieving a significant improvement in
physical function, fatigue, and mood in a mixed
group of cancer diagnoses, staging, and treatment
type.
3. Conceptual framework
Levine’s Conservation Model was chosen to
guide the present study. The model contains three
overarching concepts (wholeness, adaptation, and
conservation) and explains how the holistic human
being adapts to change through conservation.
Conservation is “the way in which complex systems
are able to continue to function, even when severely
challenged”. While balancing emerging supply and
demand.
In Levine’s Conservation Model,
conservation is a process and an outcome of
adaptation. And outcome of the model is to promote
the health of the patient, which simply is the
adaptation of patients to the demand of the
environment. Adaptation is reflected in patients’
integrity in the face of change.
Levine proposed that the whole person can be
understood by exploring the parts. This could be
achieved by four principles of conservation,
specifically conservation of energy, structural
integrity, personal integrity, and social integrity.
Levine’s Conservation Model has guided knowledge
development about fatigue. Levine stated that fatigue
is a manifestation of the body’s attempt to heal itself.
Fatigue is not a physical indicator, but has
psychological ramifications as well. Therefore, in the
present study, the physical and emotional health of
patients was evaluated. Fatigue was conceived as a
symptom of ongoing adaptation and measured as an
outcome through multiple instruments to
operationalize the four dimensions of conservation.
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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4. Sample
Patients received Cancer Exercise Program
(CEP) information from their oncologists, nurse,
other oncology staff, or the CEP specialist. Of the 63
patients who initially began the program, 39(62%)
completed the program. 24 patients discontinued the
program for different causes. Exclusion criteria was
those who are younger than age 18, cognitive
dysfunction, and inpatient status.
5. Measurement
Conservation of energy was evaluated
using the revised Piper Fatigue Scale (PFS) and
determining the patients’ activity level. Conservation
of structural integrity was evaluated by heart rate,
blood pressure, and six-minute walk (6MW) test.
Personal and social integrity were evaluated using
the subscales of the Profile of Mood States (POMS).
Health history, cancer diagnosis and staging, and
cancer treatment information was obtained from
patients and confirmed by medical records.
Fatigue was measured by revised (PFS), a
written questionnaire composed of 22 numerically
scaled items. Patients rated their fatigue in different
situations on scale from 0(none) to 10(great deal).
Scores are averaged to obtain a total fatigue score
(0=none, 1-3=mild, 4-6= moderate, and 7-
10=severe).
Mood was measured by the POMS. It is a 65-
item self-report, adjective checklist with subscale on
moods of tension, anger, fatigue, depression,
confusion, and vigor. Internal consistency
coefficients across the five moods ranged from 0.84-
0.95. Test- retest reliability coefficients ranged from
0.65-0.74for the five moods.
6. Interventions Patients received care in cancer center was
given information on the Cancer Exercise Programs
a complementary therapy. The Cancer Exercise
Program was based on three elements: exercise,
education, and support. Exercise included aerobic
exercise on a seated exercise machine or walking
(treadmill or hallway). Education included a wide
variety of topics focused on symptom management,
chemotherapy and radiation, nutrition, energy
conservation, relaxation and other beneficial issues.
Support came in form of peer support and specialists.
7. Data analysis Data was analyzed by SPSS version 11.5,
Cancer Exercise Program was tested by comparison
within the group from the preprogram measures
(baseline) to the post program measures using t test.
Significance was established at the p=0.05 level
using conservation two-tailed test.
8. Results Change of fatigue. Patients reported less
fatigue on Piper Fatigue Scale after the Cancer
Exercise Program compare to before Cancer
Exercise Program (CEP). 75% of sample improved;
25% reported no improvement.
Change in physical function. The distance
walked in feet on the 6MW test was significantly
increased following completion of the CEP
compared to before the CEP. 87% of the sample
improved. 13% reported no improvement.
Change in mood. Patients reported a
significant decrease in their Total Mood Disturbance
(TMD) after participation in the CEP as compared to
before the CEP. 80% of the sample improved; 20%
did not.
9. The Conservation Model Critique through
Study Application
9.1. Clarity In general study variables were clear all over
the study (title and body), variables were consistent
with Levine Conservation Model. The relationships
between variables were clear and fit the four
principles of energy mentioned by Levine. The
outcome which was according to Levine was
achieved by promoting the health of cancer patients.
The theoretical definitions were clearly stated
(fatigue and quality of life QOL) but some variables
were not (mood and physical function, social
functioning).
Mood can be defined as the healthy state of
mind, and physical function could be defined as
ability of a person to perform activities dependently,
and social functioning can be defined as the ability
of individual to interact in the normal in society
Operational definitions of the study variables
were stated and fit proposed theoretical definition of
these concepts in the theoretical framework.
Variables were measured by different tools which
were reliable for the purpose of the study.
9.2. Simplicity The study used Levine Model conservation
principles. Despite the only definition of
conservation of energy, different clear and simple
examples were identified for explanation of other
principles. The relationship between concepts were
successfully understood and directed toward the
outcome which is adaptation or health promotion of
cancer patients.
9.3. Generality
The study could be generalized to other
patients rather than cancer. The study results aligned
with Levine’s theory, validating favorable patient
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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response when incorporating exercise to treat fatigue
and mood disturbances in patients of cancer.
9.4. Empirical precision The study can be applied in different settings,
at different population and throughout several
nursing areas. The current study fits empirical
precision in its evidence of testability of
Conservation model.
9.5. Derivable consequences.
The results supported evidence that Levine’s
model in patient -centered model the patient could be
family, group, or a community. Moreover the person
could be a healthy one, this model fit all persons in
different ages and different health conditions
10. My Reflection on the theory Levine’s model can widely be used to guide
patients with different ages and health problems and
in several settings. The model could be a framework
for several researches. Moreover, could be used in
educational setting for the purpose of improving
nursing curricula in order to improve students
outcomes related to nursing profession.
Corresponding Author: Johan Al-Jabri
Clinical Nursing, Faculty of Nursing, Helwan
University, Egypt
E-mail: [email protected]
References 1. Cong, X. (2006). Kangaroo care for analgesia in
preterm infants undergoing heel Stick pain.
Dissertation thesis, Frances Payne Bolton
School of Nursing. Cleve -land. Ohio.
2. Fawcett, J. (2005). Contemporary Nursing
Knowledge. Analysis and Evaluation of Nursing
Models and Theories. (2nd Ed.). F.A Davis
Company.
3. Garton-Lutz, G. (2010). Evaluation of the impact
of sepsis bundles on severe sepsis mortality.
Master thesis, California State University.
Chico.
4. George, J. (2011). Nursing Theories, the base for
professional nursing practice. (5th Ed). Prentice
Hall.
5. Levine, M.E. (1991). The conservation principles:
A model for health. In Schaefer K. & Pond
(Eds), Levine’s conservation model: A
framework for nursing practice (1-11).
Philadelphia: F.A.Davis.
6. Mefford, L. & Alligood, M. (2011). Testing a
Theory of Health Promotion for Preterm Infants
Based on Levine’s Conservation Model of
Nursing. Journal of Theory Construction &
Testing. 15(2), 41-47.
7. Parker, M., E. (2001). Nursing Theories and
Nursing Practice. Philadelphia. F.A.
8. Peterson, S., & Bredow, T. (2004). Middle Range
Theories. Applications to Nursing Research.
(1sted). Philadelphia. Lippincott William &
Wilkins.
9. Schaefer, K. M. (2006). Myra Levine’s
Conservation Model and its applications.
10. Paker M.E. Nursing theories and nursing
practice. (94-112). Philadelphia: F A Davis.
11. Tomey, A. M. & Alligood, M.R. (2010) Nursing
theorists and their work. (6th Ed). St. Louis:
Mosby.
Received December 3, 2015; revised December 10, 2015; accepted December 15, 2015; published online January 2,
2016.
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
4
Consent Form Policy Analysis: Institution
Hazem S. Akash
Obstetrics and Gynecology Department, Women's Health Center, Assiut University
Akash [email protected]
Abstract: Policy analysis is very important to detect any gap in the policy implementation, here the author will
analyze the policy institutionally, to detect problems and make solution alternatives.
[Akash, H. S. (2016). Consent Form Policy Analysis: Institution. J. Middle East North Afr. sci, 2(1), 4-7]. (p-ISSN
2412- 9763) - (e-ISSN 2412-8937).http://www.jomenas.org. 2
Keywords: Consent form–Policy Analysis- Assiut University Hospital.
1. Introduction Consent to investigations and treatment is
considered a cornerstone in the doctor-patient
relationship (Habiba, 2000). The Oxford Dictionary
(2010) defines consent as “permission for something
to happen or agreement to do something”. This
definition does not entail understanding of the action
agreed to and for medical purposes the term
”informed consent” meaning “permission granted in
the knowledge of possible consequences” has been
developed. General Medical Council (GMC)
guidance requires the ability to comprehend and
weigh up information as well the ability to
communicate for informed consent (General Medical
Council, 2008).
Informed consent is a legal procedure to
ensure that a patient, client, and research participants
are aware of all the potential risks and costs involved
in a treatment or procedure. The elements of
informed consent include informing the client of the
nature of the treatment, possible alternative
treatments, and the potential risks and benefits of the
treatment. Informed consent is required for all
diagnostic, therapeutic and surgical procedures that
are complex, invasive and/or involve the risk of
serious injury.
Informed consent is the process by which a
fully informed patient can participate in choices
about his/ her health care. It originates from a legal
and ethical right to the patient to direct what happens
to his/her body and from the ethical duty of the
physician to involve the patient in his/her health
care. The patient has the right to make informed
decisions regarding care. The patient's rights include
being informed of his or her health status, being
involved in care planning and treatment, and being
able to request or refuse treatment.
2. Problem & Background Most authors describe consent as a principle
relatively new to medicine. This is however incorrect
as even Plato and Hippocrates used consent in their
medical practice. The Hippocratic physician
respected a principle of professional responsibility
which was more religious and of a moral type, but,
from a legal point of view, very weak in as much as
it depended upon regulations elaborated by human
beings (Nelson & Rich, 2000).
Most patients assisted and guided by their
physicians or other clinicians want the best
information available to make treatment decisions
(Washington, 2008). A 2003 survey found that 90
percent of California voters believe doctors should
inform patients about the scientific evidence
supporting different treatments. Patients and
physicians also believe patients should be aware of
major out-of-pocket costs before deciding on a
treatment approach (Alexander, 2003).
The basic difference between consent and
informed consent is the patients’ knowledge behind
the consent decision. Informed consent requires the
patient to understand the diagnosis and uncertainties
about it, as well as the different treatment options
(including doing nothing) and their advantages,
disadvantages and achievable outcomes (General
Medical Council, 2008). The amount of information
required to make informed consent may vary
depending on complexity and risks of treatment as
well as the patient’s wishes. Furthermore, individual
patients will have different intellectual capabilities
and understanding of their illness.
Informed consent is required for any
investigation or treatment proposed to a patient.
Understanding of the nature of procedure, benefits
and risks are the cornerstones of informed consent.
Doctors, as well as all health care professionals, are
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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required to obtain a patient's informed consent before
commencing any examination, diagnostic procedure
or treatment. The requirement of informed consent is
recognized in ethics and law. Informed consent is a
physician’s legal requirement to disclose information
to his/her patient and enables the patient to
understand, evaluate, and authorize a specific
surgical or medical intervention (Rao, 2008).
Informed consent is a process rather than a
one-off event. The essential elements of this process
are effective communication, full information, and
freely-given competent consent. (McManus et al,
2005).
The person must be able to understand the
information presented to them and be able to make a
decision. The person must be given enough
information and at a sufficiently understandable
level so that, based on it, they can make a decision.
The person must understand the consequences of
their decision. The person must be able to make their
decision without being coerced. Finally, the person
must give some indication of their consent, such as a
verbal agreement or by signing a consent form. One
way of thinking about the consent process may be
like this: C is competent to make decision, O is open
to making the decision, N is the necessary
background information to make the decision, S is
the steps to be followed if you agree or disagree, E is
the Explanation of the steps, N is notify someone
and T is tick the boxes and sign the form.
All these steps should be formally
documented. Obtaining a signature on a consent
form is normally the concluding part of the consent
process. It is important to realize that if the patient
has not been given appropriate information then
consent may not be valid despite the signature on the
form.
There are three key components of informed
consent: Competence: The individual must have the
capacity to either give or withhold their consent.
Sufficient information: That capacity must be
exercised on the basis of sufficient information.
Voluntary choice: The process must be conducted in
the absence of coercion so the individual can make a
voluntary choice. Voluntary choice means that the
patient’s consent to receive or decline a specified
health care service freely, without inducement or any
element of coercion, force, duress, bribe, fraud,
misrepresentation, deceit or any other form of
constraint (Dalla, et al 2001).
3. Statement of Policy All patients receiving treatment or therapy
shall be given sufficient information to enable them
to take a voluntary decision as to whether or not to
agree to that treatment or procedure.
3.1. Effectiveness Many studies showed evidence about the
effectiveness of the compliance of consent form;
Bottrell, et al (2000) explored reasons for the failure
of patients to recall major portions of the information
on consent forms and in oral explanations about
consent. Within one day of signing consent forms for
chemotherapy, radiation therapy, or surgery, two
hundred cancer patients completed a test of their
recall of the material in the consent explanation and
filled out a questionnaire regarding their opinions of
its purpose, content, and implications.
Only sixty percent understood the purpose and
nature of the procedure, and only fifty five percent
correctly listed even one major risk or complication.
They found that three factors were related to
inadequate recall: Education, medical status, and the
care with which patients thought they had read their
consent forms before signing. Only 40 percent of the
patients had read the form carefully. Most believed
that consent forms were meant to protect the
physician's rights. Although most thought that
consent forms were necessary and comprehensible
and that they contained worthwhile information, the
legalistic connotations of the forms appeared to lead
to cursory reading and inadequate.
3.2. Ethical Principles around Consent The four main principles of medical ethics are
justice, non-maleficence, autonomy and beneficence
(McManus et al, 2005). Autonomy is the main
ethical consideration underlying informed consent.
The patients’ right to determine what investigations
and treatment to undergo must be respected by all
doctors (General Medical Council, 2008). For
consent to be informed, patients rely on the
information provided by their doctor. Honesty and
truthfulness are required to make the process of
consent valid (General Medical Council, 1998). The
ethical principle of justice needs to be applied when
deciding what treatments are offered to or withheld
from patients. This touches the process of informed
consent and is further explored when the right to
demand certain treatments is discussed.
3.3. Legality Medical intervention without valid informed
consent is a criminal offence. Informed Consent
must be valid not to protect health care provider only
but to protect human rights and ensure the safety for
them.
3.4. Political acceptability No political barriers are known about
compliance of informed consent to insurer patient
right and protect health care providers.
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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4. Assiut University Hospital Consent form Policy
Description It made specific rules regarding which
procedures required written consent. It included
operation room procedures, transfusions of blood
products, invasive procedures and any procedure
which may have been considered to prove potentially
damaging to the health of the patient, or where there
was a risk of invasion of privacy or security.
Patients have the right to help decide what
medical care is best for them. The health care
providers must explain patient's health condition and
treatment choices.
The purpose of this policy is to empower
patients and family to make informed decisions
about the care which they are about to delivered at
hospital and to ensure that medical staff is protected
in case of legal complaints raised against them in
regards to care provided.
4.1. Proposed Solution
4.1.1 Alternative Number (1) Change the policy from consent form to
informed consent that support patient’s right to
participate in informed decision about the care which
delivered by Assiut University Hospital and protect
medical staff in case of legal complaints raised
against them in regards to care provided.
4.1.2. Stakeholders Patient, family, physicians, nurses and health
care provider.
4.1.3. Cost The informed consent is not expensive and
cost effectiveness rather than sued for not
accommodated procedure or patient claim that the
procedure was against his will.
4.1.4. Benefits The benefits of obtaining informed consent
extend beyond the simple transmission of
information from someone who has knowledge
(Health care provider) to someone who does not
(patient). The benefits of truly informed consent
include: Engaging the patient in his or her health
care, enhancing the physician-patient relationship,
encouraging physicians to thoroughly review the
patient’s therapeutic options, and reducing
discontent and litigation when there are
complications.
4.2. Alternative Number (2)
Change the policy from consent form to
shared decision to ensure patient involvement in
decisions and have been fully educated about
accessible treatment
4.2.1. Stakeholders Patient, family, physicians, nurses and health
care provider.
4.2.2Costs Cost effectiveness.
4.2.3. Benefits Shared decision making has potential benefits
for patients. To share their decision in their
treatment. And they will receive treatment in a
manner that they like it and recognize it.
The first alternative is better because the
informed-consent process often focuses on satisfying
legal requirements to protect physicians and other
providers from liability rather than true shared
decision making.
4.2.4. Policy Implementation
A journal club will be conducted to
encourage the health worker about the new solutions,
and to educate and train all health care provider how
to apply this policy in proper way, so certainly any
policy based on effective education program to be
ease to implement and applied.
4.2.5. Policy evaluation Evaluations are necessary to determine if
patients and family make informed decisions about
the care which they are about to receive at Assiut
University Hospital.
5. Conclusion In modern medical ethics, it is a person’s
implied right to autonomy, in which the policy and
concept of informed consent is based on.
It is taken that treating a competent patient is
morally acceptable only if patient has given his
informed consent to being treated, because failing to
secure the patients informed consent to his treatment
would violate the patient's autonomy.
Corresponding Author: Hazem S. Akash
Obstetrics and Gynecology Department, Women's
Health Center, Assiut University
E-mail: Akash [email protected]
References 1. Alexander, G. Caleb, P. Casalino, N. & David O.
(2003). “Patient-Physician Communication
about Out-of-Pocket Costs,” Journal of the
American Medical Association, Vol. 290, No. 7
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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2.Bottrell, M. M, Alpert H, Fischbach R. L, Emanuel
L. L. Hospital informed consent for procedure
forms: facilitating quality patient–physician
interaction. Arch Surg. 2000; 135: 26–33.
3. Dalla, P. et al. (2001). Is consent in medicine a
concept only of modern times? Journal of
Medical Ethics. 27:59-61.
4. GMC (2008) patients and doctors making
decisions together, General Medical Council,
London.
5. Habiba M. (2000) Examining consent within the
patient doctor relationship. Journal of Medical
Ethics. 26:183-87
6. McManus, J., J; S. G. Mehta, et al. (2005).
"Informed consent and ethical issues in military
medical research". Academic Emergency
Medicine. 12 (11): 1120–1126
7. Nelson, P. Rich, R. (2000). A historical
perspective of informed consent in clinical
practice and research. Oncology Nursing 15:81-
88
8. Oxford University Press. Print Publication Date:
2010. Print ISBN-13: 9780199571123.
Published online: 2010. Current Online Version:
2013
9. Rao, S. (2008) Informed Consent: An Ethical
Obligation or Legal Compulsion? J Cutan
Aesthet Surg. Jan 2008; 1(1): 33–35.
10. Washington, D. Moulton, B. Jaime S. & King,
M. (2008); “Aligning Ethics with Medical
Decision-Making: The Quest for Informed
Patient Choice,” Journal of Law, Medicine and
Ethics, 38:1
Received December 5, 2015; revised December 10, 2015; accepted December 12, 2015; published online January 2,
2016.
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
8
Developing Measure of Cancer Related Fatigue for Adolescent Patients
Ahmad A. Sawam
Clinical Oncology Departments, Faculty of Medicine, Minoufiya University, Egypt
Abstract: Fatigue is a common and frequently disabling symptom in cancer patients and cancer survivors. Fatigue
has been identified by adolescent patient as the most distressing of ten cancer-related effects at four sequential time
points during the first six months of cancer treatment as the most frequent of 29 acute cancer-related symptoms, and
as persisting symptom from months to years after successful completion of curative therapy. The aim of this paper is
to practice developing valid and reliable measure of cancer related fatigue for adolescent patients.
[Sawam, A. A. (2016). Developing Measure of Cancer Related Fatigue for Adolescent Patients J. Middle East North
Afr. sci, 2(1), 8-12]. (p-ISSN 2412- 9763) - (e-ISSN 2412-8937).http://www.jomenas.org. 3
Keywords: Tool development–Fatigue- Developing measure.
1. Cancer Related Fatigue in Adolescent Patients Various risk factors for fatigue have been
identified in the literature for cancer patients. Fatigue
may be caused by the disease itself, by treatment for
the disease, by physical symptoms or conditions
resulting from the disease or its treatment, and/or by
psychological responses to breast cancer (Bardwell,
Ancoli, 2008). Cancer-related fatigue (CRF) is a
complex multidimensional concept that includes
psychological, social, and physiological aspects. It is
defined as a "subjective feeling of tiredness that is
influenced by circadian rhythms and can vary in
unpleasantness, duration, and intensity" (Diane, Von,
& Duck-Hee, 2008). Cancer-related fatigue (CRF)
can affect patients on multiple levels of psychosocial
and physical functioning and usually causes a
noticeable decrease in patients’ quality of life. The
negative effects of this symptom are often
experienced even before a formal cancer diagnosis
and continue beyond the completion of treatment,
regardless of the type of cancer therapy received
(Diane, Von, & Duck-Hee, 2008).
2. Developing Measure of Cancer Related Fatigue
for Adolescent Patients Various methods for assessing CRF have been
used. In clinical trial settings, CRF has been assessed
by patients reporting its presence or absence and
intensity based on scores on either a single item or
aggregated items of specific measures. Variations in
how researchers and clinicians conceptualize this
debilitating symptom have resulted in the
development of different tools for assessing CRF
(Safaee, Moghimi-Dehkordi, Tabatabaee, &
Zeighami, 2009).
3. Purpose The developed measure of cancer related
fatigue for adolescent patients is a self-report
measure to assess the severity of fatigue and the
impact of fatigue on daily functioning and activity
level, of cancer adolescent patients.
4. Content The English version (Appendix 1) of the
instrument. The tool was designed to cover, three
domains: activity level, the intensity of fatigue, and
overall life quality of cancer adolescent patients. The
activity level scale consists of 12 items regarding
functional status (physical and mental). In some
patients, like the severely ill and not going to school,
the items: "go to school" may not be relevant. If so
this item may have to be omitted from the
questionnaire. The intensity of fatigue scale consists
of three items. The overall life quality is measured
by one single item included in the checklist. The
three domains and its items were derived from
research in cancer related fatigue in patients at
adolescent and school age.
5. Technical Quality
Psychometric properties of the tool were
examined. Internal consistency reliability was
examined by pilot study (includes 13 participants).
Internal consistency refers to the fact that different
items in a scale cover the same domain of content. It
implies that what is being measured is not a random
sample of items, but relates to one domain
consistently. Cronbach alpha reliability was
calculated by using Statistical Package for Social
Sciences (SPSS) program version 17. Cronbach
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
9
alpha reliability from the pilot study was 0.82, which
considered satisfactory according to Waltz,
Strickland, & Lenz (2005).
Content validity of the tool was established by
sending the tool items to two colleagues (PhD
nursing holders) in King Saud University in Saudi
Arabia. The items were rated on a four-point scale
(from one "not relevant" to four "very relevant").
The content validity index (CVI) for the total
instrument was calculated by taking the proportion
of items rated as either three or four. A CVI score
was .90 which indicates good content validity
according to Waltz, Strickland, & Lenz (2005).
6. Norms
To be able to compare new results of this
instrument with outcomes of previously published
research, the scores can be transformed into a 0 to
100 scale. All scales will transform in such way that
the lower score implies better functioning or well-
being, and higher score implies worst function or
well-being.
7. Administration The instrument was administered by using
self-reporting and interview. For all items responses
are given on five-point Likert scales. An example
can be given to instruct the respond. The time
needed for completion the instrument is 15 to 20
minutes, based on the pilot study.
8. Scoring and Interpretation The scoring of items is straight forward:
ranking from the left (first to the right) fifth column.
The activity level items are scored from one
(Unable), two (Only with help), three (Not assure),
four (Without help, with difficulty) and five
(Without help). In other words: the lower the score,
the higher is the level of burden or impairment. The
level of dysfunction in these items is, as a result,
negatively related to the score height: the higher the
score, the better the function. The same is true for
the quality of life item scores range from five
(excellent) at the top to one (very poor) at the
bottom. Fatigue intensity items are scored from one
(Very much), two (Quite a bit), three (Not assure),
four (A little) and five (No fatigue at all).
Scale scores are obtained by summating scores of
individual items. The highest total score is 80, and
the lowest score is 16. The total score can be
transformed into a 0 to 100 scale.
9. Cost The expected cost of administration this tool is
low, as it is includes only paper copy and
transportation. The estimated cost for ten participants
may be 50 to 100 Egyptian Pound.
Corresponding Author: Ahmad A. Sawam
Clinical Oncology Departments, Faculty of
Medicine, Minoufiya University, Egypt
E-mail: [email protected]
References 1. Lawrence, D., Kupelnick, B., & Miller, K. (2004).
Evidence report on the occurrence, assessment,
and treatment of fatigue in cancer patients.
Journal of National Cancer Institute, 3, 40-50.
2. Diane, M., Von, A., & Duck-Hee, K. (2008).
Predictors of Cancer- Related Fatigue in Women
with Breast Cancer Before, During, and After
Adjuvant Therapy. Cancer Nursing, 31(2), 134-
44.
3. Safaee, A., Moghimi-Dehkordi, B., Tabatabaee,
H., & Zeighami, B. (2009). Cancer Related
Fatigue: A Focus on Breast Cancer Patients
under Chemotherapy. The Open Breast Cancer
Journal, 1, 14-17.
4. Hinds, P., Hockenberry, M., & Tong, X. (2007).
Validity and Reliability of a New Instrument to
Measure Cancer- Related Fatigue in
Adolescents. Journal of Pain Symptom
Management, 34(6): 200-207.
5. Crom, D., Hinds, S., Gattuso, J., Tyc, V., &
Hudson, M. (2005). Creating the basis for a
breast health program for female survivors of
Hodgkin disease using a participatory research
approach. Oncology Nursing Forum, 32, 1131–
1141.
6. Bardwell, W., & Ancoli, S. (2008). Breast cancer
and fatigue. Sleep Medical Clinic 3(1), 61-71.
7. Waltz, C., Strickland, O., & Lenz E. (2005).
Measurement in Nursing and Health Research.
(3rd ED.). Springer; New York.
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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Appendix 1
The English version of the instrument.
CONSENT FORM
Dear participant,
This is a measure (under developing) of caner related fatigue for adolescent patients. The
purpose of this study is to develop a valid and reliable measure of cancer related fatigue for
adolescent patients, and this for improving the quality of care and to identify any factors that can
help in improving quality of life of cancer patients.
The participation in this study is voluntary, and you have the right to withdraw at any time they
want. All gathered information will be completely and strictly confidential, and will not be
accessed to another purpose except research.
If you have any comments, please contact me at any time.
If you accept to participate in this study, please sign hereunder:
Signature of the participant Signature of Data collector
ــــــــــــــــــــــــــــــــــــــــــــــــــــ ــــــــــــــــــــــــــــــــــــــــــــ
Date:
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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Measure of Cancer Related Fatigue for Adolescent Patients
1) A number of activities are listed below. We do not want to know whether you actually do
these, but only whether you are able to perform them presently.
Would you please mark the answer that applies most to your condition of the past week?
Unable only with
help
Not assure without help,
with difficulty
without
help
Care for myself (wash etc.)
Go to school
Doing light homework
Make clear thinking
Doing heavy homework
Doing my usual daily
activities
Enjoy my hobbies
Playing with my friends
Praying
Helping my family in house
Start an activity and finish it
Enjoy activities with my
family
2) Please mark the answer that applies most to your condition.
very
much
quite
a bit
Not
assure
a
little
No fatigue at
all
The best describe your fatigue right NOW
The best describe your Usual level of fatigue during
the past 24 hours
The best describe your WORST level of fatigue
during the past 24 hours
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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3) Please mark the answer that applies most to your condition.
extremely
poor
Poor neither
good nor
bad
good excellent
All things considered, how would you
describe your quality of life during the
past week?
Demographic Data
Instruction: Please complete the following demographic section by checking the appropriate
answer about yourself.
1. Gender: 1-Male 2-Female
2. Age:
3. Educational level:
4. Diagnosis:
5. Date of diagnosis:
6. Type of last treatment:
1. Surgical
2. Chemotherapy
3. Radiotherapy
4. Other, specify…….
7. Date of last treatment:
Thank you for your participation.
Received December 5, 2015; revised December 7, 2015; accepted December 9, 2015; published online January 2,
2016.
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
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Clinical Research in Nursing: Design Analysis
Salma A. Bashar
Clinical Department, Faculty of Science, Sohag University, Egypt
Abstract: Critique is very important in analyzing research constructs, to width the understanding of research
process, and to enhance knowledge among scholars.
[Bashar, S. A. (2016). Clinical Research in Nursing: Design Analysis. J. Middle East North Afr. sci, 2(1), 13-14].
(p-ISSN 2412- 9763) - (e-ISSN 2412-8937).http://www.jomenas.org. 4
Keywords: Clinical Research in Nursing–Design Critique- Nursing Critique.
1. Introduction This paper aims to analyze the design that is used in
a study of " Change in patient concerns following
total knee arthroplasty described with the
International Classification of Functioning,
Disability and Health: a repeated measures design"
2. Analysis of Design A repeated measures design and face to face
cross sectional interview were used in the study.
There is one group in the study that is used to
investigate how patient concerns change during the
first six weeks following total knee arthroplasty.
Neither blinding, masking nor placebo was used in
the study.
The purpose of the study was stated clearly
which was set to quantify the level of importance for
each of 32 previously identified concerns pre-
operatively, and across the first six weeks following
primary total knee arthroplasty and to convey this
change in importance post-operatively using the
components of the International Classification of
Functioning, Disability and Health.
In addition, the null hypothesis was stated
clearly that there would be no difference in the mean
rank of importance across time
Despite a repeated measures design was
appropriate to quantify how patient concerns change
during the first six weeks following total knee
arthroplasty, no information was given to use
alternative designs such as crossover and factorial
designs.
Convenience Sampling was used from the
waiting lists of orthopaedic surgeons working in a
large tertiary care hospital. 57 patients were enrolled
in the study, one person withdrew from the study
without any explanation and two people did not
return phone calls to set up an appointment to
become the study sample 54 participants.
Randomization was not applied.
The inclusion criteria were stated clearly
which were English-speaking ambulatory patients
with knee osteoporosis who were waiting for a
primary total knee arthroplasty.
Researchers described data collection where
evaluation conducted in four sessions: pre-
operatively and at two, four and six weeks after
surgery. Evaluation session was described
adequately.
The endpoint of the study was clearly stated.
This study showed that the importance of some
concerns change over time while others do not.
Ethical considerations included consent from
participant to take a part in the study. Approval from
the Institutional review board and the hospital was
not mentioned.
The study had limitations: All participants in
the study were recruited from a single tertiary care
hospital. This may be viewed as decreasing the
generalizability of this study to other settings and
may not be applicable to all total knee arthroplasty
populations. As there was no test-retest component
in this study, the reliability of the importance ratings
at each time point of data collection could not be
confirmed.
Another limitation of this study was the
inability to include non-English speaking
individuals. Therefore, the results are not applicable
to non-English speaking recipients of total knee
arthroplasty surgery.
Finally, sample size for this study was based
on sample size calculations of a concurrent
unpublished study of responsiveness of the
WOMAC. This seemed acceptable because there is
no previous importance ratings on which to base
sample size calculations. Where no significant
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
14
differences were found, it may be possible the study
was underpowered.
Corresponding Author: Salma A. Bashar
Clinical Department, Faculty of Science, Sohag
University, Egypt
E-mail: [email protected]
References 1. American Psychological Association. (2009).
Publication manual of the American
Psychological Association (6th Ed.).
Washington, DC: Author.
2. Polit, d. & beck, c. (2012). Nursing research:
generating and assessing evidence for nursing
practice, 9th edition. Lippincott Williams and
Wilkins. Philadelphia
3. Rastogi, R., Chesworth, B. M., & Davis, A. M.
(2008). Change in patient concerns following
total knee arthroplasty described with the
International Classification of Functioning,
Disability and Health: a repeated measures
design. Health Qual Life Outcomes, 6(1), 112.
Received December 10, 2015; revised December 15, 2015; accepted December 25, 2015; published online January
2, 2016.
The Journal of Middle East and North Africa Sciences 2016; 2(1) http://s-o-i.org/1.18/Jomenas.2016.7
15
Spearman's Rank Correlation Coefficient
Eugene Declercq
Public Health, Boston University School of Public Health, Massachusetts, United States
Abstract: This paper is for educational purposes for all students in all fields to get an understanding of how they
can do Spearman's rank correlation coefficient analysis using SPSS program.
[Declercq, E. (2016). Spearman's Rank Correlation Coefficient. J. Middle East North Afr. sci, 2(1), 15]. (p-ISSN
2412- 9763) - (e-ISSN 2412-8937).http://www.jomenas.org. 5
Keywords: SPSS Analysis– Correlation Coefficient - Spearman's Rank.
1. Spearman's rank correlation coefficient
A nonparametric measure between two
variables is appropriate for quantitative but only
ordinal or rank level of measurement.
The author will use a spearman correlation to
identify if there is a correlation between “levels of
education” variable and “how would you rate the
nursing care you received in this ward” variable.
Both variable are quantitative and measure in the
ordinal scale.
level of
education
how would you
rate the nursing
care you
received in this
ward
Correlation
Coefficient -.159
Spearman's rho Sig. (2-tailed) .010
N 263
The correlation between “levels of education”
variable and “how would you rate the nursing care
you received in this ward” variable was statistically
significant, = -.159, n = 263, p< .01. This means
that there is a weak negative relationship between
two variables
Corresponding Author:
Eugene Declercq
Public Health, Boston University School of Public
Health, Massachusetts, United States
E-mail: [email protected]
References
1. Munro, B. H. (2005). Statistical methods for
health care research (fifth Ed.). Philadelphia:
Lippincott Williams & Wilkins.
2. Pett, M. (1997) Non-parametric statistics for
health care research: Statistics for small samples
and unusual distribution. Thousand Oaks, CA:
Sage Publications.
3. Warner, R. (2008). Applied Statistics: From
Bivariate through Multivariate Techniques. Los
Angeles: Sage.
Received December 18, 2015; revised December 20, 2015; accepted December 23, 2015; published online January
3, 2015.
© 2015-2016 Jomenas Press
The Journal of Middle East and North Africa Sciences
Monthly Journal Online
Publisher: JOMENAS Press
Address: Anwar St. PO Box 11415, Amman, Jordan.
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