Search

Malihe Sadat Moayed,1 Abbas Ebadi,2 Masoud Khodaveisi,3 Mohssen Nassiri Toosi,4 Ali Reza Soltanian,5 Mahnaz Khatiban6 1Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran; 2Nursing Education, Behavioral Sciences Research Center, Life Style Institute, Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, Iran; 3Chronic Diseases (Home Care) Research Center, Community Health Nursing Department, Hamadan University of Medical Sciences, Hamadan, Iran; 4Internal Medicine, Hepatologist, Liver Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; 5Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran; 6Mother and Child Care Research Center, Medical-Surgical Nursing Department, School of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran Introduction: Liver transplantation is the global treatment of end-stage liver diseases. Since the patients’ survival rate has been improved, the patient may experience reductions in physical, cognitive, and psychosocial functions after liver transplantation influencing their adherence to care and treatment. The transplant survival is complex and patients’ adherence to care and treatment should be considered when health care providers make decisions regarding treatment. This qualitative study aimed to explore factors influencing health self-management in adherence to care and treatment among the recipients of care and treatment.Methods: In this study, 23 interview sessions were carried out with a total 18 patients, 2 family members and 3 transplantation team members from May to November 2017. The patients were selected using the purposive method from both genders, with a various age range and initial diseases leading to liver transplantation, and time passed from liver transplantation. A semi-structured interview guide was developed based on literature review and pilot interviews. The participants were asked to describe their experiences of self-management behaviors in adherence to treatment and care. The data were analyzed using a conventional content analysis method and managing via the MAXQDA-10 software.Results: Two themes were developed during data analysis as “self-regulation” and “self-care”. “Self-regulation” consisted of “intentionally changing”, “positively thinking”, “information seeking”, “problem-solving”, “past knowledge transferring”, and “self-controlling”. “Self-care” had three sub-themes “shift to independence”, “vigilance”, and “self-care support”.Conclusion: The participants perceived the health self-management in adherence to care as a set of factors related to “self-regulation” and “self-care” behaviors. “Self-regulation” is required to create a balance in life. Also, “self-care” efforts can help with maintaining and improving patients’ health. Keywords: liver transplantation, qualitative research, self-management, self-care, self-regulation, adherence, recipient, compliance, treatment

Background: Non-adherence to medical care programs in transplant recipients is considered one of the life-threatening factors in transplant recipients, which can prevent achieving the desired levels of health care. Objective: To determine perceptions of liver transplant recipients about the barriers to their adherence to medical care programs. Methods: This study was conducted based on a qualitative content analysis method using semi-structured interviews with 23 liver transplant recipients, their families, and the transplant teams. A purposive sampling method was used in liver transplant clinics affiliated to Tehran University of Medical Sciences, Tehran, Iran, from May to November 2017. Results: Three main categories including factors related to therapeutic problems (educational problems and medication challenges), personal factors (self-management disability), as well as social problems (cultural conditions and passive family) were identified as the barriers to adherence to medical care programs. Conclusion: Paying attention to barriers to adherence to medical care and planning for moderating them in a collaborative effort between transplant recipients and health care providers could increase the likelihood of survival and quality of life in these patients. [ABSTRACT FROM AUTHOR]

Background: The present study investigates the effect of resilience training in improving the ability to cope with stress and hope of mothers with cancer children., Methods: In this interventional study, 70 mothers parenting children with cancer were selected as available and randomly classified into the control and experimental groups. The mothers of the two groups completed the parenting stress and hope questionnaire. In the test group, nine sessions of resilience training were held by the researcher for 60 min. One month after the intervention, they were again asked to complete the parenting stress and hope questionnaires. Moreover, in the control group, the mothers completed the parenting stress and hope questionnaires again 2 months later without any intervention., Result: The difference between the average scores of hope and parental stress showed that the mean score of hope in the intervention and control groups increased by about 5.45 and 2.74 units, and the hope variable was improved in both groups. The mean score of parental stress in the intervention group decreased by 39.62 units. However, in the control group, it increased by 2.45 units, and parental stress in this group declined., Conclusion: Resilience training significantly reduced the level of parental stress and increased the level of hope in the mothers of the test group. Therefore, it is recommended to use resilience in reducing the level of parental stress and increasing the hope level of mothers with children with cancer., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: Emergency medical services (EMS) providers encounter a variety of challenges due to the unpredictable, uncontrollable, and dynamic conditions in the pre-hospital field. This study explored the perceived professional challenges among EMS providers., Materials and Methods: This study was conducted using a qualitative research approach and the method of content analysis. Eighteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. The collected data were then analyzed based on the Granheim and Lundman's method., Results: Based on data analysis, five categories and one theme were identified. The extracted theme was professional challenges. The five categories were as follows: Ineffective policies; multicultural and multidisciplinary factors; ambulance dispatch route problems; legal issues; and abuse against the emergency medical services CONCLUSION: In general, it has been found that EMS providers encounter numerous and complex professional challenges during their work. EMS managers can utilize the findings of the present study to develop strategies for reducing the professional challenges faced by EMS providers. By doing so, they can improve the quality of care in the prehospital field., (© 2024. The Author(s).)

Background: Nausea and vomiting are two common symptoms in myocardial infarction patients. This study aims to determine the impact of p6 acupressure on nausea, vomiting, comfort, and the need for anti-vomiting drugs in myocardial infarction (MI) patients., Methods: This research involved 90 patients with acute heart attacks experiencing persistent nausea despite taking anti-vomiting drugs. They were divided into three groups: acupressure, placebo, and control. The acupressure group wore a wristband with a button, the placebo group had a similar wristband without a button, and the control group received no wristband. Data on nausea severity, comfort, frequency of nausea, vomiting, and retching was collected before and after the intervention at different time points. The study also assessed the use of anti-vomiting drugs within 24 h of the intervention., Results: The patients in the acupressure group, compared to those in the placebo and control groups, experienced significantly lower severity of nausea, frequency of vomiting, nausea, and retching and a substantially higher level of comfort level during the two, four, and 6 h after the start of the intervention (P < 0.05). However, no significant difference between the placebo and control groups was observed (P > 0.05). During the 24 h after the start of the intervention, administration of anti-vomiting drugs to the acupressure group was significantly less than that done in the placebo and control groups (P < 0.05)., Conclusions: The results illustrated that p6 acupressure reduces nausea, vomiting, and retching and increases the comfort level in myocardial infarction patients., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors. Published by Elsevier Inc.)

Aim: To investigate the efficacy of a new low-profile catheter on incidence of the catheter-associated urinary tract infections (CAUTI) in comatose patients admitted to the intensive care unit., Background: Catheter-induced urothelial injury is a key component in the development of urinary tract infections in catheterized patients., Methods: In this prospective randomized blinded clinical trial, 80 patients requiring indwelling urinary catheterization were equally randomized to either the standard Foley catheter (control) or the low-profile catheter (experimental) group. The signs of urinary tract infection for comatose patients were considered (ie, ≥10 5 of colony-forming unit/milliliter of urine, hematuria, serum leukocytes, and body temperature) and recorded at baseline and on days 3 and 5 after catheterization. The analysis of covariance was applied by the SPSS-20 software at a 95% confidence level., Results: An increasing proportion of patients with elevated urinary colony counts were seen in the Foley catheter group compared with the low-profile catheter group (12.5% vs 5%). However, there were no between-group differences in the urinary colony counts and body temperature after controlling for antibiotic doses and fluid intake. Patients in the low-profile catheter group had significantly lower rates of hematuria and serum leukocytes than those in the Foley catheter group., Conclusion: A newly designed low-profile urinary catheter has demonstrated a trend toward reducing the incidence of CAUTI in patients with indwelling urinary catheters. Further studies with larger sample sizes and follow-up are needed to confirm the benefits., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: After coronary artery bypass graft surgery patients are susceptible to mental disorders such as stress, anxiety, and depression following discharge from the hospital and often require post-discharge support and follow-up. Telenursing is an accessible method that may reduce stress, anxiety, and depression experienced by patients. This study aimed to investigate the impact of telenursing on depression, stress, and anxiety in discharged patients after CABG surgery., Materials and Methods: A randomized clinical trial was carried out. Eligible patients were divided randomly into intervention (n=40) and control (n=40) groups. Depression Anxiety Stress Scale-21 (DASS21) questionnaire was filled out by both groups one day before discharge from the hospital. The intervention group received SMS reminders of their treatment plan, referrals to the cardiac rehabilitation clinic, and routine care three times a week for six weeks, while the control group received routine care provided by the hospital only. In the week following the completion of the intervention period, both groups returned to fill out the questionnaire, and the data were analyzed using SPSS version 16.0, descriptive and inferential statistics, and independent and paired T-tests., Result: The mean scores of depression, stress, and anxiety before intervention in the intervention group were 11.95, 18.75, and 18.17, and in the control group were 11.55, 18.37, and 17.4 respectively. The mean scores of depression, stress, and anxiety after intervention in the intervention group were 7.85, 10.5, and 10.45, and in the control group were 10.56, 17.9, and 16.5 respectively. No significant differences were seen between the two groups before the intervention (P>0.05), but the results showed significant differences between the two groups' mean scores of depression, stress, and anxiety after intervention (P<0.001)., Conclusion: Telenursing can reduce stress, anxiety, and depression in discharged patients after coronary artery bypass graft surgery by providing proper and cost-effective follow-up., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Aim: This study aimed to explain the experiences of individuals with multiple sclerosis (MS) about the collaborative care programme., Design: This qualitative study was conducted from July 2021 to March 2022., Methods: We conducted this study with individuals with MS who participated in the collaborative care programme in Hamadan, Iran. A purposive sampling with maximum variety was applied to recruit patients until data saturation. Eventually, 18 patients consented and were interviewed using a semi-structured interview guide. The transcriptions of audio-checked interviews were analysed using a conventional content analysis approach of Graneheim and Lundman by MAXQDA 10, 2010 edition., Results: The study identified three main categories. that emerged from the participants' experiences of collaborative care: the 'Beginning of Communication', which included two subcategories, 'Introduction and Acquaintance with Each Other' and 'Formation of Trust'; 'Mutual Interaction', which included three subcategories, 'Dialogue', 'Mutual Goal Setting' and 'Mutual Agreement of Care Solutions'; and 'Exchange of Targeted Behaviors', which included six categories, Implementation of Strategies for 'Nutritional Behaviors', 'Sleep and Rest', 'Constipation Relief', 'Promotion of Physical Activity and Exercise', 'Fatigue Reduction' and 'Stress Management'., Conclusions: The findings highlight the statistically significant role of collaborative care in MS management. Utilizing these research findings can update the development of interventions based on collaborative care, which can provide appropriate support to individuals with MS., Patient or Public Contribution: Individuals with multiple sclerosis., (© 2023 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Background: The chronic nature of multiple sclerosis (MS) affects patient's activities of daily living (ADL) and quality of life (QOL). Nursing interventions based on patients' active participation in goal-setting can be beneficial in improving ADL and QOL., Aims: This study aimed to determine the effect of applying the nursing process based on King's Theory of Goal Attainment (TGA) on ADL and QOL of persons with multiple sclerosis (PwMS) during the COVID-19 pandemic., Methods: In this clinical trial, 70 patients referred to the MS Society of Hamadan, Iran, were recruited using the convenience sampling method and randomly assigned into 2 groups. A 4-stage TGA was developed and implemented for the intervention group for a month. Data were gathered by ADL, instrumental ADL (IADL), and QOL questionnaires, and Goal of Attainment Scale (GAS) before and 2 months after the intervention., Results: Intervention group achieved a higher number of prioritized goals (p < 0.001) and reported higher QOL (P < 0.001) and instrumental ADL (IADL; P = 0.002) than the control group., Conclusions: Given the results, TGA could effectively promote mutual goal attainment, QOL, and IADL for PwMS during the COVID-19 pandemic., Trial Registration: ClinicalTriasl.gov Identifier: IRCT20201210049668N1., (© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background: Appropriate self-management (SM) is crucial in controlling epilepsy and improving self-efficacy, medication adherence and avoidance of seizure triggers in patients with epilepsy (PWE. The aim of this study was to evaluate SM and its predictors among adult PWE in Iran., Methods: This cross-sectional study was conducted in 2021. The participants were 335 adult PWEs that were selected from healthcare settings in Hamadan, Iran. Epilepsy Self-Management Scale (ESMS) was used to measure patients' self-management behaviors. Data were analyzed using the independent samples t-test, Pearson's and Spearman's correlation analyses and multiple linear regression analysis., Results: The mean score of SM was 114.37±11, indicating moderate level of SM, and the mean scores of SM in the medication management, seizure management, and safety management subscales were significantly more than the mean scores of the other subscales (P < 0.05). Age, place of residence, marital status, seizure type, seizure frequency, and epilepsy duration significantly predicted 53% of the variance of SM (adjusted R square = 0.532)., Conclusion: PWEs have moderate SM and need SM-related education, particularly about lifestyle management and information management. Predictors of SM should be considered to boost SM practice., (© 2023 Babaei K., et al.)

Purpose: This study aimed to determine the effect of cardamom inhalation on intra and postoperative nausea and vomiting (IONV/PONV) of mothers undergoing spinal anesthesia for elective cesarean section., Design: A single-blind, randomized, placebo-controlled clinical trial study., Methods: Seventy eligible participates were equally randomized to the intervention or placebo group. The demographic and clinical characteristics questionnaire, a 100 mm Visual Analogue Scale (VAS) to measure the severity of nausea; and the mothers' emetic episodes checklist were used. Upon the first episode of nausea, participants inhaled through a plastic bag containing distilled gauze pads in normal saline with or without Cardamom essential oil., Findings: Following the intervention, nausea severity in placebo (25.28 ± 32.38) and cardamom (13.14 ± 19.96) groups declined (P < .001), however after controlling the initial severity of nausea, the declining extent was more noticeable in the intervention group than in the placebo group. The episodes of nausea (37.1% vs 65.7%, P = .006), and retching (20% vs 45.7%, P = .028) were significantly lower in the intervention group than in the placebo group. Administration of antiemetic medications was lower in the intervention than the placebo group (37.1% vs 65.7%, P = .009)., Conclusions: Cardamom aromatherapy was effective in alleviating mothers' experience of nausea and retching across the cesarean surgical continuum. As such, it can be considered as a palliative treatment for IONV/PONV in Cesarean section surgeries., (Copyright © 2021 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Introduction: An implantable cardioverter-defibrillator (ICD) is the only approach to treat patients with life-threatening ventricular arrhythmias. Adaptation and acceptance of ICD play an important role in the optimal treatment of the patients. The aim of this study was to determine adaptation status and related factors in patients living with ICDs., Methods and Materials: In this descriptive-analytical study, 148 patients referred to Kowsar Hospital in Shiraz and Farshchian Hospital in Hamedan city between July 2020 and September 2021 were included in the study. Patients' adjustment status was measured based on the mode of the Roy nursing model and using the Baecke physical activity questionnaire, Pittsburgh sleep quality, mini nutritional assessment (MNA) nutrition questionnaire, constipation scoring questionnaire, self-concept scale, and multidimensional scale of perceived social support (MSPSS)., Results: Patients had low physical activity and poor sleep quality. Negative self-concept in relation to the disease and adherence to physicians' recommendations was observed among patients. In addition, patients did not have optimal interpersonal communication. Multivariate regression findings showed that the number of years of device implantation and the number of shock discharges are effective factors in the incidence of insomnia and the negative self-concept of patients., Conclusion: Patients living with ICD did not adjust to the new conditions after placement of the device. Low level of physical activity and sleep disturbance and also negative self-concept about the disease and adherence to treatment was observed among the patients. Shock discharges and duration of the device implantation were associated with impaired self-concept and insomnia in the patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Healthcare providers agree that promoting spirituality among older adults while caring for them increases their quality of life. However, there is little knowledge about the spiritual needs of the elderly, especially in the Muslim community. This qualitative study attempted to explore the spiritual needs of Muslim older adults. Fifteen non-hospitalized Muslim older adults from Hamadan City, Iran, were interviewed. The semi-structured interviews were analyzed using conventional content analysis. After identifying semantic units from the text, related codes were extracted and placed in subcategories and categories based on their similarities. Once the data were analyzed, one theme was formed. The study's findings showed that the spiritual needs of older adults fell into three main categories: religious needs, the need for transcendence, and the need for connection. Religious needs included subcategories of religious practices and beliefs, and the need for transcendence included the search for meaning and purpose in life, and the need for peace and stability and balance. Also, the need for connection included the need to connect with nature and connect with others. Healthcare professionals and family caregivers should be trained in the specific competence of recognizing older people's unmet spiritual needs and fulfilling them., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Hugo point is the most important pain control point in the body, so the study was performed to determine the effect of Hugo point massage on respiratory volume and the pain intensity after chest tube placement., Materials and Methods: The study was performed as a randomized crossover clinical trial on 61 patients with a chest tube. Patients were placed in every 2 h through the ternary permutation block once under a false point pressure, once under a Hugo point pressure, and once without intervention. Data were collected using a questionnaire of demographic, clinical information, the Numerical Pain Rating Scale, and spirometry. Analysis of variance with repeated measures was used to analyze the data., Findings: There was no significant difference in the pain intensity before and during the intervention between the three groups. However, after the intervention, the mean pain intensity in the control group was higher than the Hugo and placebo groups (P < 0.001), and the mean pain intensity in the placebo group was higher than in the Hugo group (P < 0.001). There was no significant difference between the three groups in terms of the rate of ascent and retention time of spirometry ball the three times before, during, and after the intervention., Conclusion: Hugo point massage reduces the pain intensity; however, has no significant effect on their respiratory volume. Hugo point massage is recommended to reduce the severity of pain in patients with chest tube., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier Inc.)

Objective: To investigate the relationship between outcomes and demographic-clinical variables in in-hospital cardiac arrest (IHCA)., Methods: The Medline database was searched along with Google Scholar, Scopus, Web of Science, and Persian language database without time limitation until January 6 th , 2020. The inclusion criteria included papers published in journals or presented in English and Persian congress that reported the IHCA outcomes based on the Utstein criterion. All the descriptive, cross-sectional, and cohort studies on CPR were covered based on inclusion and exclusion criteria. Primary checks covered titles and abstracts followed by a full-text check of the remaining papers from the first screening stage. Data analysis was done using comprehensive meta-analysis (CMA) software version 2.0. The finding's heterogeneity was checked using Q and Cochran tests with heterogeneity >50% and the random-effects model was used to estimate survival and favorable neurological outcome (FNO) in the analysis. To detect the publication bias of studies, the subgroup test, meta-regression test, sensitivity analysis test, funnel plot, and Eagger's regression test were used., Results: Survival to discharge was 19.1% (95% CI=16.8-21.7) and FNO in the survived to discharge cases was 68.1% (95% CI=55.8-78.3). Survival to discharge and FNO were notably higher in men, CPR duration <15min, and shockable dysrhythmias., Conclusion: IHCA outcomes are poor in developing countries. The outcomes of IHCA in terms of gender were inconsistent with the result reported by other meta-analyses., Competing Interests: The authors declare that they have no competing interests

Improving ethical practice needs recognizing the relationship between moral reasoning and moral courage among nurses. We examined factors (moral reasoning, practical consideration, moral dilemmas familiarity, and demographic and work characteristics) associated with moral courage among nurses. A cross-sectional design was run at all five hospitals affiliated to Hamadan University of Medical Sciences in west of Iran. A proportionate random sampling due to the total size of the nurse population in each hospital, 224 eligible nurses were completed the study questionnaires: demographic-work characteristics, Professional Moral Courage (PMC), and Nursing Dilemma Test. The relationships were examined by multiple regression analysis. Participants reported a more than moderate level of moral reasoning and PMC (43.21±5.98 and 56.16±10.18 respectively). The multivariate model showed the nurses' PMC is positively predisposed with moral reasoning (β=0.21, p<0.01), but negatively with practical consideration (β=-0.16, p<0.01). More moral courage was found in the nurses who were never married (p<0.001), graduated from a public university (p<0.01), working in the critical care and emergency environments, as well as night shifts (all p<0.001). Moral reasoning is a predictor of moral courage, and both should be considered in designing nursing education to improve ethical nursing practice., (Copyright © 2021 Tehran University of Medical Sciences.)

Background: Human resources are one of the most critical organizational resources, the reinforcement and maintenance of whom require much energy in health organizations, particularly in long-term crises. Many methods have been suggested in this regard; however, there is a need for their integration and clarification., Methods: We systematically searched the international databases, including PubMed, Scopus, and Web of Science, from 2003 to April 2021by using some relevant keywords. The quality of the included studies was assessed using the AMSTAR checklist., Results: The search resulted in 1613 papers, among which there were 16 systematic reviews. The studies addressed a wide range of problems and solutions. Twelve items and four items were classified with moderate quality (AMSTER score 5-8) and high quality (AMSTER score 9-11), respectively. Half of the studies ( n  = 8) dealt with mental and psychological problems resulting from crises as the most important factor in the decline of health system staff's durability in organizations. They also provided different solutions such as mental health counselling during and after the crisis, flexible work schedule, promoted trust in the organization, support of staff's family, and enhanced awareness to support employees. And the other articles addressed managerial problems as the most critical factor in the decline of health system staff's durability in organizations and proposed solutions such as suitable planning before, during, and after the crisis and the use of material and spiritual incentives to increase the employees' motivation and organizational resilience to maintain the staff., Conclusion: In the present review study, three dimensions (namely, resilience, motivation-hygiene measures, and development of manager's soft skills) are considered as the main factors reinforcing and maintaining human resources in the health systems in long-term crises and disasters., Competing Interests: No potential conflicts of interest were reported by the authors., (Copyright © 2021 Amir Mohammad Salehi et al.)

Background: Polyethylene covers are claimed to be useful in preventing ocular surface diseases (OSD); however, evidence of their clinical efficacy is limited. This clinical trial aimed to compare the use of polyethylene eye covers and artificial teardrops versus normal saline on the incidence and severity of OSD in comatose patients., Methods: Of 90 eligible patients randomly assigned to three treatment groups, 79 patients completed the study, In group A, patients (n = 25) received artificial teardrops for left and normal saline for right eyes, in group B (n = 29) polyethylene covers for left and normal saline for right eyes, and in group C (n = 25) polyethylene covers for left and artificial teardrops for right eyes. As the patients were comatose, their blinding did not applicable, and a blinded observer evaluated the patients' eyes based on the Corneal Fluorescein Staining Pattern. The blinded analyzer analyzed collected data by SPSS-16 software at a 95% confidential level., Results: The OSDs were observed in 65 (41.14%) out of 158 eyes examined. The artificial teardrop was more effective than the normal saline in group A, polyethylene eye cover was more useful than the normal saline in group B, and polyethylene eye cover was more effective than the artificial teardrop in group C in reducing the incidence of OSD (p< 0.01). Polyethylene eye covers had the most impact on reducing the severity of the OSD compared to the other interventions (p< .001)., Conclusions: Polyethylene eye covers significantly reduced the incidence and severity of OSD. Using polyethylene cover is suggested as a safe, effective, and accessible eye care intervention for preventing OSD in comatose patients., Trial Registration: (IRCT201609129014N115), Iranian Registry of Clinical Trials., Competing Interests: The authors have declared that no competing interests exist.

Introduction: In an emergency setting, the occurrence of disruptive behaviors hinders team participation and cooperation. Exploring nurses' perception of disruptive behaviors can lead to a better identification of these behaviors in emergency departments and the provision of better recommendations. This study aimed to explore nurses' perception of disruptive behaviors among emergency healthcare teams in hospitals affiliated to the Hamadan University of Medical Sciences, Hamadan, Iran., Method: The study was carried out using qualitative content analysis in 2018-2019. Twenty participants from emergency departments of five hospitals in Hamadan, Iran, were enrolled using purposive sampling. Data were collected using semi-structured interviews that continued until data saturation. Data analysis was performed using Erlingsson and Brysiewicz's qualitative content analysis approach., Results: Three main themes emerged including observable disruptive behaviors, hidden disruptive behaviors, and trigger factors. Observable disruptive behaviors consisted of two main categories: violence and incivility. Hidden disruptive behaviors included troubling behaviors, poor communication, and irresponsibility. Finally, the trigger factors of disruptive behaviors involved two categories: professional incompetency and workplace discrimination., Conclusion: Exploring nurses' perception showed that trigger factors such as professional incompetency and workplace discrimination could cause the occurrence of observable and hidden disruptive behaviors in emergency healthcare teams., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Depression is a common disorder in patients with implantable cardioverter defibrillator (ICD). There are a variety of studies estimated the prevalence of depression in these patients. The present study aimed to investigate the prevalence of depression in patients with ICD., Methods: In the present study, we conducted a systematic review of studies published in PubMed, Scopus, Web of Science (WoS), Medline, and EMBASE without any time filtration to obtain studies investigated the prevalence of depression in patients with ICD. Search terms consisted of "Implantable Cardioverter Defibrillator(s)" in combination with "depression," "depressive," "prevalence," "implanted cardioverter," "implantable," and "implantable defibrillator.", Results: We identified 15 relevant studies, comprising data from 10,182 patients with ICD from whom 2400 (23.58%) (95% CI, 15.36-31.79) had depression. The results of the subgroup analysis showed that the prevalence of depression among middle-aged patients (28.58% with confidence interval of 95%, 21.51-35.65) was higher than elderly patients (22.23% with confidence interval of 95%, 11.21-33.24) and it was not significantly correlated with the mean age of samples (P = 0.255), sample size (P = 0.686), and the publication date (P = 0.784), although there was a significant correlation between the prevalence of depression and the quality of articles so that the prevalence was decreasing with an increase in the quality (P = 0.046)., Conclusion: Around 1 in 4 patients with ICD (23.58%) experiences depression progression after an ICD placement. This prevalence is comparable to that in the general population, and close to that of the patients with common chronic diseases.

Background: Brain stroke causes physical and mental disabilities, as well as dependence on one's family. In such cases, the families suffer from severe crisis and anxiety due to the unexpected incidence of the disease and unawareness of the associated consequences., Objectives: The aim of the present study was to evaluate the effectiveness of informational support on the level of anxiety in family caregivers of hemiplegic stroke patients., Methods: This quasi-experimental study was performed on 78 family caregivers of hemiplegic stroke patients admitted to the Neurology Department of Farshchian Hospital in Hamadan, Iran, over 8 months. The subjects were selected through convenience sampling method and divided into two groups of intervention (n = 40) and control (n = 38). Intervention started from the third day of hospitalization and continued until the eleventh day. During this period, information about the ward, equipment, patient status, and care procedure at home, was provided for the intervention group individually and in groups. On the other hand, the control group only received the routine care. Anxiety level of caregivers was measured through the Spielberger scale both before and after the intervention. Data analysis was performed in SPSS software (version 16)., Results: Based on the results, both groups were similar in terms of demographic variables (P > 0.05). Moreover, there was no significant difference between the two groups regarding the mean level of state and trait anxiety before the intervention (P > 0.05). However, after intervention, the mean level of state and trait anxiety of the intervention group showed a significant reduction in comparison to that of the control group (P < 0.05)., Conclusions: According to the findings, it can be concluded that informational support is effective in reducing the state and trait anxiety in family caregivers of stroke patients. Therefore, it is suggested that nurses consider informational support as an important nursing intervention during hospitalization., Competing Interests: Declaration of Competing Interest No conflict of interest has been confirmed by the authors., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Training nursing students in older patient education may be facilitated by the student elderly simulated-patient strategy. The purpose of this study was to determine the effects of simulation-based learning on students' skills in providing education to older patients. A quasi-experimental design with repeated measures was used. Nursing students enrolled in clinical courses in their semesters 7 and 8 of the program were randomly assigned to simulation-based learning (SBL) group (n = 35) or lecture-based learning (LBL) group (n = 35). In SBL, the student simulated-elderly patients equipped with devices for the age-related hearing loss, vision impairment, and neck, finger, and arm joint stiffness was trained to present the educational content to the students. Outcome (knowledge, attitudes, and skills) data were collected at pre-test, post-test, and one-month follow-up, using reliable measures. Data were analyzed with repeated measures analysis of variance. Students in the SBL and LBL groups were comparable at pre-test. All students demonstrated improvement in knowledge and skills in older patient education over time; however, students in the SBL group had larger and more durable improvements in these outcomes than those in the LBL group (all p's < .001). SBL is a promising instructional method, with long term benefits in improving students' skills., Competing Interests: Declaration of competing interest None., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Moral reasoning is a vital skill in the nursing profession. Teaching moral reasoning to students is necessary toward promoting nursing ethics., Objectives: The aim of this study was to compare the effectiveness of problem-based learning and lecture-based methods in ethics education in improving (1) moral decision-making, (2) moral reasoning, (3) moral development, and (4) practical reasoning among nursing students., Research Design: This is a repeated measurement quasi-experimental study., Participants and Research Context: The participants were nursing students in a University of Medical Sciences in west of Iran who were randomly assigned to the lecture-based (n = 33) or the problem-based learning (n = 33) groups. The subjects were provided nursing ethics education in four 2-h sessions. The educational content was similar, but the training methods were different. The subjects completed the Nursing Dilemma Test before, immediately after, and 1 month after the training. The data were analyzed and compared using the SPSS-16 software., Ethical Considerations: The program was explained to the students, all of whom signed an informed consent form at the baseline., Findings: The two groups were similar in personal characteristics (p > 0.05). A significant improvement was observed in the mean scores on moral development in the problem-based learning compared with the lecture-based group (p < 0.05). Although the mean scores on moral reasoning improved in both the problem-based learning and the lecture-based groups immediately after the training and 1 month later, the change was significant only in the problem-based learning group (p < 0.05). The mean scores on moral decision-making, practical considerations, and familiarity with dilemmas were relatively similar for the two groups., Conclusion: The use of the problem-based learning method in ethics education enhances moral development among nursing students. However, further studies are needed to determine whether such method improves moral decision-making, moral reasoning, practical considerations, and familiarity with the ethical issues among nursing students.

Objectives: Comprehensive nursing assessment, as the first step in the nursing process, involves the systematic and constant data gathering to facilitate the development of the patient-specific nursing process. The aim of this study is to determine the effects of applying an assessment form based on the health functional patterns on nursing student's attitude and skills in developing nursing process., Methods: A randomized controlling design was conducted. Of 84 undergraduate nursing students, 42 students were allocated to the intervention or control group. In clinical education, a patient assessment form based on Gordon's functional health patterns was applied to help students in the intervention group to develop nursing process, while the control group received traditional methods. The data were gathered using a demographic information questionnaire, skills in nursing process development checklist, and attitudes towards nursing process questionnaire., Results: The average scores for students' attitude and skills in developing nursing process in the intervention group were greater than those of the control group., Conclusion: Applying nursing assessment using the patient assessment form based on Gordon's functional health patterns can improve the students' learning in developing nursing process.

Background: The standard precautions (SPs) should be disseminated and implemented by healthcare providers. This study aimed to examine the effects of a multi-component educational intervention on nurses' knowledge and adherence to the SP guidelines in intensive care units (ICUs)., Methods: This small-scale study consisted of a cluster randomised trial. Two ICUs, located in different hospitals, participated in the study. Nurses (n = 15) in one ICU received the multi-component educational intervention. The intervention involved an educational (with multiple instructional media) and a behavioural (with hands-on practice) component. Nurses' knowledge and adherence were assessed at pre-test and two and six weeks after the intervention., Results: Results showed significant group by time interaction effects for both outcomes: a large improvement was found in the experimental group over time, but not in the control group. The experimental nurses' knowledge improved from 15 ± 2.47 at pre-test to 19 ± 2.65 and 19.53 ± 0.92 at follow-ups. Similarly, their adherence increased from 19.87 ± 4.44 at pre-test to 29.20 ± 5.00 and 28.40 ± 4.37 at two and six weeks post-test, respectively., Conclusions: The multi-component educational interventions had demonstrated initial effectiveness in enhancing ICU nurses' knowledge and adherence to the SPs guidelines. The intervention is a promising approach for designing effective continuing education initiatives aimed to improve nurses' practice., Competing Interests: 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.

Background: Bladder irrigation can be performed to prevent catheter-associated urinary tract infections (CAUTI), but its efficacy has been not reported in short-term indwelling urinary catheterization. This clinical trial aimed to examine the efficacy of bladder irrigation with normal saline solution in preventing CAUTI in comatose patients admitted to intensive care units., Materials and Methods: Eligible patients were randomized to the experimental group or control group. The experimental group received daily bladder irrigation with 450 cc sterile normal saline, in 3 150-mL doses, for 3 consecutive days. Data on signs of CAUTI, including urine culture, axillary body temperature (primary outcomes), and other urine and blood parameters (secondary outcomes) were obtained at baseline and 5 days later., Results: Results of group comparisons and logistic regression analysis that controlled for fluid intake showed that the risk of CAUTI decreased by 99% in the experimental group compared with the control group (odds ratio, 0.01; P < .001). Additional findings indicated a decrease in axillary body temperature and improvements in urine appearance, urinary red cells and white cells, and erythrocyte sedimentation rates and white-cell counts in the blood following bladder irrigation., Conclusion: Daily bladder irrigation with normal saline during 3 days demonstrated efficacy in preventing CAUTI in comatose patients., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

To examine if the application of Orem's self-care model could improve self-care knowledge, attitudes, practices, and respiratory conditions of trauma patients with chest tubes, a quasi-experimental study was conducted. The participants were assigned to two groups-namely, Orem's model and routine care. Although the patients' self-care knowledge, attitudes, and practices were improved in both groups over the course of 3 days since the initial assessments, there was a greater degree of improvement in the experimental group than that in the control group. However, there were no differences in the improvement of the chest parameters between the two groups. Orem's model was effective in improving self-care in patients with chest tube.

Objectives: This study aimed to investigate the effect of Educational program on quality of life (QOL) in menopausal women in 2016 in Hamadan, Iran., Methods: In this clinical trial study, 100 postmenopausal women were randomly selected and allocated to case and control group (50 per group). Data collection tool included questionnaires of demographic information and Menopause QOL, which were completed by the samples before the intervention. In the case group, education program was run during 5 sessions for 45 to 60 minutes. Immediately and Three months after intervention, information were collected using questionnaire in both groups and they were analyzed using SPSS 16 software., Results: The menopause women in both intervention and control groups had similar demographics. There was not a significant difference in the QOL mean scores in before of the intervention between the two groups of intervention and control in all dimension of QOL. There was a significantly difference in the mean of QOL scores between the two groups in immediately after the intervention and 3 months after the intervention in dimension of vasomotor, psychosocial, sexual and physical ( P < 0.001)., Conclusions: This study recommend that a unit in health and treatment centers be established for training menopausal women about health care by holding didactic classes., Competing Interests: Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Several observations have addressed high rates of occupational burnout among personnel of emergency medical services (EMSs) centers. Occupational burnout influences EMS personnel's well-being and quality of life. The main objective of this study was to assess burnout and its determinants among Iranian EMS personnel. This study was carried out at all EMS centers in two provinces of Kermanshah and Hamadan located at the west of Iran. The sample consists of 260 personnel (110 in Hamadan and 150 in Kermanshah) that were consecutively entered. The information was collected by researcher attendance at their workplaces using a self-administered questionnaire. Occupational-burnout was measured using the Maslach Burnout Inventory. An average of 46.54% of personnel displayed high frequency in the subscale emotional exhaustion, 38.85% displayed high frequency in the subscale depersonalization, and only 2.69% of them displayed high frequency in the subscale incompetence/lack of personal accomplishment. Regarding the severity of burnout, severe emotional exhaustion and depersonalization were detected in an average of 25.39% and 37.69 of the personnel, respectively; while, an average of 97.31% expressed a low level of the lack of personal accomplishment. Frequency and severity of burnout were adversely affected by younger age, single status, history of smoking, lower income, higher work experience, longer shifts, and even work status of the spouse. Iranian EMSs personnel considerably suffered from emotional exhaustion and depersonalization. This should be effectively managed and improved by organizational supports, psychological consultations, and effective management aimed to improve determinants of appearing occupation-related burnout.

There are some strategies including problem based learning (PBL) that could enhance the learning experience. This quasi-experimental design was conducted to compare the effects of PBL with traditional clinical education that is commonly used for nursing students. The effects were observed by monitoring differences in their special and general competencies, performance and attitudes towards learning experiences. In 2010, 70, undergraduate nursing students were assigned into two groups as either PBL (n = 34) or Control group (n = 36) at Hamadan University of Medical Sciences in Iran. The research tools used in this study were: the "students' competency self-evaluation" and the "students' attitudes toward their learning experiences" questionnaires, and also a "Coding system of performance" checklist. The groups were similar in most demographic characteristics. The PBL students' general and special competencies improved in the post-test significantly more than those of the control students (P < .001). The PBL students' attitude was significantly better than the control group (P < .01) as well. There was also an incredible enhancement only in the PBL students' performance (P < .01). Therefore the Problem-based learning fostered nursing students' competency, attitude, and performance., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background: Lecturing is the most common teaching method in the medical education. Problem-based learning (PBL) is one of the active and student-oriented learning strategies which have gained attention in the recent decades., Objective: To compare the effect of PBL and lecture-based learning (LBL) on the satisfaction and learning progress of undergraduate midwifery students., Design: Quasi-experimental study., Settings: Hamadan University of Medical Sciences, Hamedan, Iran., Participants: Fifty-six undergraduate midwifery students in two different classes participated in the study., Methods: Randomly, one class (experimental group) received PBL in addition to LBL and the other one (control group) received traditional LBL. "Pregnancy and childbirth", a 2-credit course, was selected for this purpose. Scientific pre-test and post-tests were performed and satisfaction questionnaire was filled in for both groups. A questionnaire to compare PBL and LBL was filled in only for the experimental group. The instruments used in the study were "Demographic data form", "Students' learning progress test", "Student's satisfaction of teaching method", and the "Teaching method evaluation"., Results: Learning progress in PBL group was significantly more than control group. PBL improved application of theory lesson in clinical practice, increased learning motivation and enhanced educational activity in class. There was more satisfaction with PBL method. There was no relationship between the students' satisfaction and learning progress. 81.8% of students considered PBL the more suitable and better method., Conclusion: PBL should be applied more in undergraduate midwifery courses. According to these advantages, the quality of midwifery education can be improved via this method., (Copyright © 2012 Elsevier Ltd. All rights reserved.)