Abstract
The COVID-19 pandemic changed our lives and psychological health; thus, job stressors are escalating, and they warrant immediate interventions, especially providing social supportive behaviors. This study investigated predictors of job stressors and social supportive behaviors in various Jordanian hospitals during the COVID-19 era. Data were collected utilizing a descriptive cross-sectional study and a convenience snowball sample of 392 nurses from different hospitals in Jordan using an online survey in 2022. This study was consistent with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Nurses’ job stressors occur “occasionally,” and social support behaviors occur “once or twice a month.” The highest and lowest nurses’ job stressors and social support behaviors were ranked were reported. The GLM yielded that the predictors of nurses’ job stressors were social support behaviors and work area; these variables explained 19% of nurses’ job stressors variance. The GLM yielded that the predictors of social support behaviors were nurses’ job stressors, time commitment, nursing care delivery model, and marital status; these variables explained 20% of social support behaviors variance. There are many novel findings in the current study, as time commitment is a significant correlate of social support behaviors and marital status is a predictor of social support behaviors. Assessing and managing nurses’ job stressors, including controlling nurses’ workload, are urgently mandated. A staffing policy is needed to promote safe practices and positive patient, nurse, and organizational outcomes.
Plain language summary
Aim: This study investigated predictors of job stressors and social supportive behaviors in various Jordanian hospitals during the COVID-19 era. Methods: Data were collected utilizing a descriptive cross-sectional study and a convenience snowball sample of 392 nurses from two gvermental hospitals in Jordan using an online survey in 2022. This study was consistent with Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Nurses’ job stressors occur “occasionally,” and social support behaviors occur “once or twice a month.” The highest and lowest nurses’ job stressors and social support behaviors were ranked were reported. The GLM yielded that the predictors of nurses’ job stressors were social support behaviors and work area; these variables explained 19% of nurses’ job stressors variance. The GLM yielded that the predictors of social support behaviors were nurses’ job stressors, time commitment, nursing care delivery model, and marital status; these variables explained 20% of social support behaviors variance. Conclusions: There are many novel findings in the current study, as time commitment is a significant correlate of social support behaviors and marital status is a predictor of social support behaviors. Assessing and managing nurses’ job stressors, including controlling nurses’ workload, are urgently mandated. A staffing policy is needed to promote safe practices and positive patient, nurse, and organizational outcomes. The findings of this study have broad ramifications for policy, practice, and education. For policy, as all nurses in the current study reported significant levels of workload stress, there is a strong need for practice to assess and manage nurses’ job stressors, including controlling nurses’ workload. A policy for ample staffing can promote safe practices and high-quality care, reduce stress at work, and boost nurses’ and patients’ satisfaction. Appropriate staffing will solve issues related to non-nursing tasks, such as clerical work.
Background
The COVID-19 pandemic has significantly influenced our lives, including our mental and psychological health (Eibschutz et al., 2023; Fang et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022). Since the outbreak in China began in December 2019, many academics have pointed out the detrimental effects of quarantine on people’s mental and psychological health and well-being (Agbaria & Mokh, 2022; Brooks et al., 2020; Eibschutz et al., 2023; Fang et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022).
Individuals, particularly nurses, are highly susceptible to heightened stress, tension, and anxiety during a crisis (Agbaria & Mokh, 2022; Eibschutz et al., 2023; İzci & Çetinkaya, 2022; Li et al., 2022). To identify coping mechanisms for these stressors, several studies have identified the forms of personal (individual) and interpersonal (social) stressors that can be handled throughout this time (Agbaria & Mokh, 2022; Eibschutz et al., 2023). Personal (individual) stressors with particular relevance to COVID-19 include loss of structure and routine, confinement, uncertainty and fear of the unknown, confusion, fear of infection, decreased physical activity and exposure to sunlight, poor concentration, sleep disturbances, changes in eating patterns, excessive use of digital media before bed, and high consumption of news and media about COVID-19 (Agbaria & Mokh, 2022; Brooks et al., 2020; Buheji & Ahmed, 2020; Eibschutz et al., 2023; Fang et al., 2021; Hiremath et al., 2020; İzci & Çetinkaya, 2022; Li et al., 2022).
According to Amarneh (2017), Bry and Wigert (2022), Mrayyan et al. (2021), and Tabur et al. (2022), job stressors are harmful physical and emotional reactions that arise from interactions between nurses and their work environments. These reactions occur when the demands of the job exceed the capabilities of the nurses (Bry & Wigert, 2022; Bennadi et al., 2019; Eibschutz et al., 2023; Faremi et al., 2019; Qiao et al., 2018). Job stressors have been linked to job-related accidents, physical health issues, psychological breakdowns, job discontent, poor service quality, and lower work (Eibschutz et al., 2023; Mrayyan et al., 2021). Other investigations also observed these detrimental results (Alnazly et al., 2021; Bennadi et al., 2019; Bry & Wigert, 2022; Eibschutz et al., 2023; Faremi et al., 2019; Qiao et al., 2018; Tabur et al., 2022; Tu et al., 2021).
Social support offers people aid, resources, and care to help them cope with life stressors (Agbaria & Mokh, 2022; Alnazly et al., 2021; Tabur et al., 2022; Tu et al., 2021). Social support is crucial in reducing stress’s harmful consequences (Alnazly et al., 2021; Eibschutz et al., 2023; Tabur et al., 2022; Tu et al., 2021). Prior studies have demonstrated that social support behaviors can boost adaptation to chronic diseases, improve physiological, psychological, and mental health, and lower death rates (Agbaria & Mokh, 2022; Alnazly et al., 2021; Tabur et al., 2022; Tu et al., 2021). High social support behaviors also help people develop higher self-esteem, perceive themselves as better at handling stress, and have stronger perceptions of their abilities (Eibschutz et al., 2023; Li et al., 2022).
The literature demonstrated that social support behaviors are essential in managing nurses’ job stressors; however, a few recent studies tackled the topic during the COVID-19 era.
Purpose and Significance
Studies conducted previously on nurses, and other healthcare professionals demonstrate the value of social support behaviors in helping employees manage the demands of their jobs, including emotional distress (Agbaria & Mokh, 2022; Alnazly et al., 2021; Bry & Wigert, 2022; Fang et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022; Tabur et al., 2022; Tu et al., 2021). An essential first step in making targeted changes to nurses’ working environment is to understand the sources of stress they are exposed to and the benefits and drawbacks of the social support behaviors provided (Bry & Wigert, 2022; Eibschutz et al., 2023; Mrayyan et al., 2021). Yet, there are many studies on nurses’ stressors (Bry & Wigert, 2022; Mrayyan et al., 2021), but not job stressors (Eibschutz et al., 2023).
During the COVID-19 Era, several researchers, including Jordan, examined job stressors and social supportive behaviors in nursing (Alnazly et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022; Tabur et al., 2022; Tu et al., 2021) and healthcare (Eibschutz et al., 2023; Fang et al., 2021). A few recent research (Amarneh, 2017; Mrayyan et al., 2021) compared nurses’ job stressors and social supportive behaviors in different types of hospitals (teaching vs. non-teaching and public vs. teaching vs. private hospitals), but these were conducted before the COVID-19. This study is the first to investigate predictors of job stressors and social supportive behaviors in various Jordanian hospitals during COVID-19. This study answered the following research questions: (1) what are the variables of nurses’ job stressors? (2) what are the variables of social supportive behaviors? (3) what are the predictors of nurses’ job stressors?, and (4) what are the predictors of social supportive behaviors?
The current study’s findings will be used to build interventions that assist nurses in lowering job stressors and increasing social supportive behaviors.
Material and Methods
Design and Sample
An online quantitative cross-sectional design was used to explore the current concepts and evaluate the outcome variable of project success. The cross-sectional design help in establishing preliminary evidence in planning further studies. This design analyzes data from a population at a single point in time (Polit & Beck, 2019).
The study’s target population was Jordanian nurses in various hospitals. Data were gathered over 2 weeks, resulting in a non-random convenience snowball sample of Jordanian nurses. The inclusion criteria were set as nurses have to work in hospital settings, give their agreement to participate, and have online abilities to manage the online survey. The sample size was determined by the rule of sample size for the linear regression; 50+ 8
Ethical Considerations
Before gathering the data, the University’s Institutional Review Board (IRB) of the university where the first author works approved the study, the IRB No. 12/8/2021/2022, dated July 25th, 2022. The study procedures conform to the recognized standards of the Declaration of Helsinki. Nurses were told in the invitation letter that answering the online survey is their consent to participate. Participants had the option to forego completing the online survey. The researchers stored a password on participants’ coded responses on a personal computer; all participant data were anonymous and confidential; only the aggregate data were sent to the hospital’s administrators.
Data Collection
The EQUATOR (STROBE) checklist guided the reporting of this study (available at: www.strobe-statement.org) (Supplemental File). Data were collected by an online self-report survey administered in English using Google forms in 2022, preceded by a pilot study in which no changes were required. The researchers shared the survey link on her WhatsApp and Facebook groups. Nurses’ participation in the survey served as their consent form and encouraged them to invite their contacts. Data was gathered over 2 weeks, and after 1 week, participants received a reminder to complete the survey just once. Consequently, the online survey was created in that manner.
Instruments
Nursing Stress Scale
Nurses’ job stressors were assessed using the Nursing Stress Scale (NSS) (Gray-Toft & Anderson, 1981). This 34-item survey is graded on a 4-point Likert scale, where “one” represents “never” to “four” represents “very frequently.” A greater total score denotes a higher level of stressors. The original scale’s psychometric validity was proven (Gray-Toft & Anderson, 1981). In the current investigation, a Cronbach’s alpha of .90 was attained for the overall scale. The following subscales have reported Cronbach’s alphas in the current study: death and dying (.83), physician conflict (.82), inadequate preparation (.84), lack of support (.84), nurse conflict (.82), workload (.83), and uncertainty regarding treatments (.82). Any mean score greater than two was regarded as a nursing job stressor.
Social Support Behaviors
Social support behaviors were assessed using the Inventory of Social Supportive Behaviors (ISSB) (Barrera et al., 1981). This is a 40-item, 5-point Likert scale, where “one” represents the “least frequent” response and “five” represents the “most frequent” response. The scale had content and construct validities (Barrera et al., 1981). The initial scale has high reliability, ranging from 0.92 to 0.94, and the overall reliability was 0.93 (Barrera et al., 1981). These subscales’ reported Cronbach’s alphas in the current study are .74 for guidance, .80 for emotional support, and .90 for tangible assistance. A social support behavior was defined as any mean score greater than 3 (Barrera et al., 1981).
Data on the sample’s gender, marital status, time commitment, level of education, age, work shift, years of nursing experience and in current settings, average daily census at units/wards, work area (units vs. wards), wards/units’ organizational structure, and unit/ward’s nursing care delivery model were gathered using a demographic form created by the authors.
Data Analyses
Data were checked for assumptions and normality. According to the level of measurement, statistics were computed using the Statistical Package for the Social Sciences (SPSS) version 25 (IBM, 2017) at <0.05. Descriptive statistics were reported using frequencies and percentages or means and standard deviations. General Linear Model (GLM) was used to assess whether nurses’ job stressors and samples’ characteristics (independent variables) predict social support behaviors (the dependent variable) (Polit & Beck, 2019) and whether social support behaviors and samples’ characteristics (independent variables) predict nurses’ job stressors (the dependent variable) (Polit & Beck, 2019).
Results
Sample’s Characteristics
The majority of the sample were single males, working full-time in units with an average daily census of 16 to 20 or more, with a Baccalaureate degree, young as aged 24 to 34 years, working rotating shift or 12 hr day shift, with 1 to 4 years of experience in nursing or the current area of work. Nurses reported their area of work’s organizational structure as mostly vertical and that the nursing care delivery model was either primary or team. More details of the sample’s characteristics are listed in Table 1.
Sample’s Characteristics (
Some totals do not equal 392 because of missing data.
Ranked Subscales and Means of Nurses’ Job Stressors and Social Support Behaviors
The subscales of nurses’ job stressors and social support behaviors are listed in Table 2. The highest mean scores for nurses’ job stressors were for the “death and dying” and “workload” subscales, while the lowest was for the “lack of support” and “inadequate preparation' subscales. The highest mean score for social support behaviors was for "emotional support" subscale, while the lowest was for "tangible assistance” (Table 2).
Scores of the Subscales of Nurses’ Job Stressors and Social Support Behaviors (
Data presented as Mean (Standard Deviation).
On a 4-point Likert scale, the overall mean for each item of nurses’ job stressors was 2.31 (0.46), indicating that the nurses’ job stressors occur “occasionally.” The highest nurses’ job stressors did not have enough staff to cover the unit adequately (Mean = 2.65;
Individual Items of Nurses’ Job Stressors Scale (
Data presented as Mean (Standard Deviation).
On a 5-point Likert scale, the overall mean for each item of social support behaviors was 2.39(0.62), indicating that the social support behaviors occur “once or twice a month.” The highest social support behaviors were suggesting some action that the nurse should take (Mean = 2.77;
Individual Items of Social Support Behaviors (
Data presented as Mean (Standard Deviation).
Predictors of Nurses’ Job Stressors and Social Support Behaviors
The GLM yielded that the predictors of nurses’ job stressors were social support behaviors and work area; these variables explained 19% of nurses’ job stressors variance. The GLM yielded that the predictors of social support behaviors were nurses’ job stressors, time commitment, nursing care delivery model, and marital status; these variables explained 20% of the variance of social support behaviors (Table 5).
Significant Predictors of Nurses’ Job Stressors and Social Support Behaviors Using GLM (
Discussion
There were more male nurses in the current study, which could be related to the fact that full-time working mother nurses may be obliged to quit their jobs because they could not find child support services during the COVID-19 quarantine. Other variables are consistent with Jordan’s nursing task force, such as working in heavy workload units.
Nurses’ Job Stressors and Social Support Behaviors
The highest mean scores for nurses’ job stressors were for the “death and dying” and “workload” subscales, while the lowest was for the “lack of support” and “inadequate preparation' subscales. The highest mean score for social support behaviors was for “emotional support” subscale, while the lowest was for “tangible assistance.” This is the same trend as previous studies in Jordan (Amarneh, 2017; Mrayyan et al., 2021).
As before COVID-19, “death and dying” and “workload” are still the major job stressors post-COVID-19; these are universal stressors in nursing and other health-related professions. “Death and dying” and “workload” are regular stressors that exacerbate in the light of the COVID-19 pandemic (Fang et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022; Lorente et al., 2021) because of the unreadiness of the healthcare system and the chronicity of the disease.
Nurses’ job stressors occur “occasionally.” Additional work-related stressors escalate during respiratory illness epidemics such as COVID-19 (Eibschutz et al., 2023; Said & El-Shafei, 2021). However, the current data were collected after starting the COVID-19 pandemic. Nurses get used to COVID-19-related stressors; they return somehow to their work environment rhythm as before the pandemic. Thus, nurses’ job stressors occur “occasionally”; job stressors become the norm in the work environment.
The highest nurses’ job stressors did not having enough staff to cover the unit adequately; having too many non-nursing tasks, such as clerical work; and watching a patient suffer. In Jordan, before COVID-19, the highest nurses’ job stressors were floating to other units that were short-staffed and the difficult work with nurses outside the unit (Amarneh, 2017). In 2021, Mrayyan et al. reported that the highest nurses’ job stressors were a lack of opportunity to share their experiences with others in the unit and the death of a patient with whom a nurse developed a close relationship. Before COVID-19, the highest social supportive behavior was that nurses went to someone who could take action (Amarneh, 2017) and gave nurses some information to help them understand a situation nurses were in Mrayyan et al. (2021). As we can see, COVID-19 changed the work environment; short-staffing and non-nursing tasks are imposed on nurses, and the work environment becomes poisonous and draining (Eibschutz et al., 2023; Fang et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022). This is an alarming time to provide social supportive behaviors; however, such supportive behaviors at such a time could be insane.
Social support behaviors are typically observed “once or twice a month.” However, conditions that occur more frequently necessitate more regular social support interventions (Kupcewicz et al., 2018). This pattern may elucidate the present findings, as healthcare professionals, including nurses, have been overwhelmed by the abrupt onset of the COVID-19 pandemic (Fang et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022). They have had to prioritize critical resources and issues such as mortality and the significant workload exacerbated by staffing shortages, as a substantial number of staff contracted COVID-19. Consequently, social support behaviors are deprioritized and are fortunate to occur “once or twice a month,” if at all.
The highest social support behaviors were suggesting actions the nurse should take; assisting nurses in setting goals for themselves, and talking with nurses about their interests. These social support behaviors could be self-explanatory in that nurses are under huge COVID-19-related stressors, such as staffing shortages and rising tension between staff members (Eibschutz et al., 2023; Fang et al., 2021; İzci & Çetinkaya, 2022; Li et al., 2022); thus, they may need the help of peers, supervisors, and other healthcare professionals (Stevens, 2021). The lowest social support behaviors were giving nurses money over 25 JD, loaning nurses under 25 JD, and giving nurses money under 25 JD. These results are expected, as the COVID-19-related stressors will not be relieved by such a small amount of money; nurses are beyond these trivial financial matters; COVID-19-related stressors are not tiny job-related stressors.
Predictors of Nurses’ Job Stressors and Social Support Behaviors
The GLM yielded that the predictors of nurses’ job stressors were social support behaviors and work area; these variables explained 19% of nurses’ job stressors variance, which is more than what Mrayyan et al. (2021) reported using a similar sample’s characteristics using the standard multiple linear regressions, and more than what Amarneh (2017) reported using a similar sample’s characteristics using the stepwise multiple regressions. Because 201 (51.00%) of nurses in the current study were working in units where a turbulent work environment exists because of the nature of admitted cases and the high technology used, more job stressors are manifested in units; thus warrant providing more social supportive behaviors. Mrayyan (2009), who reported that job stressors in units were higher than those in wards supports this result. Units scored higher than wards in the “conflict with physicians” subscale of NSS. Units scored higher than wards in the “emotional support” and “tangible assistance” subscales of ISSB.
In the context of our study, wards refer to general patient care areas typically organized by medical specialty (e.g., surgical wards, medical wards). These areas often involve lower-intensity care and are characterized by a more predictable patient population with less frequent use of advanced technology. The work environment in wards is generally more stable, which can lead to different job stressors compared to units.
Units refer to specialized areas within the hospital that deal with high-acuity cases and require advanced technology and intensive monitoring. Examples include intensive care units (ICUs), emergency departments (EDs), and operating rooms (ORs). These settings are more dynamic and unpredictable due to the critical nature of the cases they handle, resulting in a turbulent work environment. Consequently, nurses working in units experience higher levels of job stressors due to the demanding nature of their work.
The distinction between wards and units is crucial as it highlights the varying levels of job stressors faced by nurses in different work environments. In our study, the predictors of nurses’ job stressors—social support behaviors and work area—explained 19% of the variance in job stressors. This is a notable increase compared to the findings of Mrayyan et al. (2021) and Amarneh (2017), who used similar samples but different regression methods.
The currents study’s results indicated that nurses working in units reported higher job stressors, particularly due to the turbulent work environment characterized by the nature of admitted cases and high technology use. This supports Mrayyan’s (2009) findings that job stressors are higher in units compared to wards. Specifically, units scored higher on the “conflict with physicians” subscale of the Nursing Stress Scale (NSS) and on the “emotional support” and “tangible assistance” subscales of the Interpersonal Support Evaluation List (ISSB).
We hope this additional context provides a clearer understanding of the study setting and the factors contributing to job stressors among nurses.
The GLM yielded that the predictors of social support behaviors were nurses’ job stressors, time commitment, and nursing care delivery model (consistent with Amarneh, 2017 in teaching and non-teaching hospitals; Mrayyan, 2009; Mrayyan et al., 2021 in the primary model), and marital status. These variables explained 20% of the variance of social support behaviors. This result is higher than what Mrayyan et al. (2021) reported using similar sample characteristics using the standard multiple linear regressions and more than what Amarneh (2017) reported using a similar sample’s characteristics using the stepwise multiple regressions. Nurses’ job stressors may predict social support behaviors, such support may decrease the detrimental impact of stressors on physical and psychological health, and social support behaviors help nurses cope with stressors (Eibschutz et al., 2023; Foy et al., 2019). Those who work full-time and have high patient-to-nurse ratios nursing care delivery model are more exposed to job stressors; in turn, they need more social supportive behaviors (consistent with Amarneh, 2017 in teaching and non-teaching hospitals; Mrayyan, 2009; Mrayyan et al., 2021 in the primary model). Concerning marital status and its prediction of social support behaviors, this is a unique finding of the current study that can be explained indirectly as female nurses have higher psychological distress than male nurses during the COVID-19 pandemic, supported by Yu et al. (2020) because of their different conflicting roles as nurses, mothers, and wives. Therefore, female nurses need more social support. A recent studies indicates that during the COVID-19 pandemic, female healthcare workers were more likely than their male counterparts to consider leaving or actually leave the profession (Algunmeeyn et al., 2020; Friedland et al., 2021).
Limitations
As there are some limitations in this study design and sample, further studies should be conducted using large, random samples from a wider geographic area. Future research should also look at the causes of stressors and strategies for coping with them. COVID-19-related turnover and intention to leave the nursing job should be further investigated.
Implications for Nursing Policy, Practice, and Education
The findings of this study have broad ramifications for policy, practice, and education. For policy, as all nurses in the current study reported significant levels of workload stress, there is a strong need for practice to assess and manage nurses’ job stressors, including controlling nurses’ workload. A policy for ample staffing can promote safe practices and high-quality care, reduce stress at work, and boost nurses’ and patients’ satisfaction (Toyama & Mauno, 2017). Appropriate staffing will solve issues related to non-nursing tasks, such as clerical work.
For practice, as all nurses in this study reported significant levels of “death and dying” stress and watching a patient suffer, psychological counseling should be initiated for nurses and other health care professionals. The lowest mean score for social support behaviors was “tangible assistance.” Instrumental support with concrete needs, such as helping with childcare and lending money, is simple to start with to enhance provided social support behaviors. When designing interventions, we must consider the variables this study revealed as predictors of nurses’ job stressors and social support behavior. For example, the work area predicted nurses’ job stressors, time commitment, and the nursing care delivery model and marital status predicted social support behaviors.
For education, nurses and nursing students should be introduced to various issues related to job stressors and social support behaviors, ways to prevent and relieve job-related stressors, and the available resources to help them manage their job stress in all educational settings, including work and in-service training and staff development programs.
Summary and Conclusion
Nurses’ job stressors occur “occasionally,” and social support behaviors are provided “once or twice a month.” The highest mean scores for nurses’ job stressors were for the “death and dying” and “workload” subscales, while the lowest was for the “lack of support” and “inadequate preparation” subscales. The highest mean score for social support behaviors was for “emotional support” subscale, while the lowest was for “tangible assistance.”
The highest nurses’ job stressors did not have enough staff to adequately cover the unit, while the lowest was the breakdown of the computer. The highest social support behaviors suggested some action the nurse should take, while the lowest social support behaviors were giving nurses money over 25 JD.
The nursing care delivery model was the only significant correlate of nurses’ job stressors. Time commitment, shift work, and the nursing care delivery model significantly correlate with social support behaviors. The GLM yielded that the predictors of nurses’ job stressors were social support behaviors and work area; these variables explained 19% of nurses’ job stressors variance. The GLM yielded that the predictors of social support behaviors were nurses’ job stressors, time commitment, nursing care delivery model, and marital status; these variables explained 20% of the variance of social support behaviors.
Regardless of the COVID-19 pandemic, “death and dying” and “workload” is universal job stressors, and “emotional support” is a universal social supportive behavior. Individual items of nurses’ job stressors and social supportive behaviors scale were reported during and after the COVID-19 pandemic compared to those pre-COVID-19. There are many novel findings in the current study, as time commitment is a significant correlate of social support behaviors, and marital status is a predictor of social support behaviors.
Supporting Information
Additional supporting information can be found online in the Supporting Information section at the end of this article.
Footnotes
Acknowledgements
The researchers would like to thank all participants for their input in the current study.
Authorship Statement
The authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors, and the authors agree with the manuscript. The authors have approved the content before submission or resubmission.
Authors’ Contributions
Study design: MTM. Data collection: MTM. Data analysis: MTM. Study supervision: MTM, AA, SA. Manuscript writing: MTM and AA. Critical revisions for important intellectual content: MTM, AA, SA.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval
The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of the Hashemite University- Jordan approved the study. IRB No. 12/8/2021/2022 dated July 25th, 2022.
Patient-Informed Consent Statement
Informed consent was obtained from all subjects involved in the study by stating on the front page of the survey, “answering this survey is your consent form to participate in the current study.”
Permission to Reproduce Material From Other Sources
No material was needed to be reproduced.
Transparency Statement
We report how we determined our sample size, all data exclusions, and all measures.
Data Availability Statement
Data are available for researchers upon request from the corresponding author.