soi 1.18/jomenas.2016.7 issn 2412- 9763 (print) issn 2412

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

http://s-o-i.org/1.18/Jomenas.2016.7


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

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ii


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

[email protected]

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.


mailto:[email protected]

http://www.jomenas.org/


2

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



3

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.




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


mailto:Akash%[email protected]



5

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.



6

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


mailto:Akash%[email protected]


7

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


2016.



8

Developing Measure of Cancer Related Fatigue for Adolescent Patients

Ahmad A. Sawam

Clinical Oncology Departments, Faculty of Medicine, Minoufiya University, Egypt

[email protected]

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





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


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.




10

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:



11

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



12

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.


2016.



13

Clinical Research in Nursing: Design Analysis

Salma A. Bashar

Clinical Department, Faculty of Science, Sohag University, Egypt

[email protected]

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





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


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.




15

Spearman's Rank Correlation Coefficient

Eugene Declercq

Public Health, Boston University School of Public Health, Massachusetts, United States

[email protected]

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


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.






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Address: Anwar St. PO Box 11415, Amman, Jordan.

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