Application of Orem's theory-based caring programs among chronically ill adults: A systematic review and dose-response meta-analysis

AIM

This study aimed to clarify the value of caring programs developed according to Orem's Self-Care Deficit Nursing Theory regarding quality of life and self-care as the primary outcomes and self-efficacy, anxiety, depression, and stress as the secondary outcomes among individuals aged 18-70 years with chronic diseases.

BACKGROUND

Chronically ill patients need to receive appropriate self-care training, counseling, and support. In this regard, the use of caring programs developed based on theories is highly suggested. Orem's Nursing Theory is the most well-known theory that provides a structure to involve patients in their self-care activities.

INTRODUCTION

Orem's Nursing Theory has been increasingly applied to guide practice for patients with chronic health conditions. However, recent trials have reported conflicting findings on the value of its application.

METHODS

Eight information sources (e.g., Web of Science Core Collection, PubMed, and Scopus) and the International Clinical Trials Registry Platform were searched up to 30 March 2022.

RESULTS

A total of 46 studies and 11 study register entries were eligible. Orem's theory-based interventions significantly improved the quality of life, self-care, and self-efficacy as well as significantly reduced anxiety and depression. However, the value of the interventions on stress was uncertain, as performing the meta-analysis was not possible.

DISCUSSION

Orem's Nursing Theory can help nurses in different fields to dynamically and carefully evaluate patients' self-care ability and implement appropriate nursing measures tailored to their needs, interests, and problems. Considering the inconsistent evidence to support the empirical adequacy of this theory, high-quality reviews are essential.

CONCLUSION

Orem's theory-based programs had a favorable effect on taking care of adults with chronic diseases.

IMPLICATIONS

This study augments the previous reviews related to the applicability of Orem's Nursing Theory. Considering the undesirable evidence quality and the high between-study heterogeneity, further well-designed trials are required to draw an evidence-based conclusion.

Comparison of the effects of virtual training by serious game and lecture on operating room novices' knowledge and performance about surgical instruments setup: a multi-center, two-arm study

BACKGROUND

Game-based training is increasingly implemented in different nursing fields, as it allows students to learn experientially, with the flexibility to regulate their training based on their personal progresses and abilities. This study aimed to compare the effects of virtual training by the "Playing with Surgical Instruments (PlaSurIn)" game and the lecture on the surgical instruments setup knowledge and performance of Operating Room (OR) novices.

METHODS

This study was conducted on 51 s-semester undergraduate OR technology students taking the course "An Introduction to Surgical Instruments and Equipment." An additional virtual training session was held via a learning management system using two different methods. The students of the Game Training Group (GTG, n = 27) played individually with the "PlaSurIn" game during a week, while the students of the Lecture Training Group (LTG, n = 24) received the lecture-based training during a week. To measure knowledge, all the students participated in a theoretical test with 10 multiple-choice questions before and immediately after the training. They also participated in an Objective Structured Clinical Examination (OSCE) after the training, and their performance was evaluated by the remained time for setup completion and the scores, errors, and bonuses.

RESULTS

The mean score of the theoretical test was significantly higher in the GTG than in the LTG after the training (p = 0.040). Additionally, the GTG participants had higher scores (p = 0.016), fewer errors (p = 0.001), and higher bonuses (p = 0.011) compared to the LTG ones. The remained time for setup completion was also significantly longer in the GTG than in the LTG (p < 0.001).

CONCLUSION

Virtual training by "PlaSurIn" was superior to the lecture-based method for the enhancement of surgical instruments setup knowledge and performance amongst OR novices.

"Playing with Surgical Instruments (PlaSurIn)" game to train operating room novices how to set up basic surgical instruments: A validation study

BACKGROUND

Game-based training has been considered as an alternative modality to traditional training in different perioperative nursing fields.

OBJECTIVES

To describe the adaptation and validation process of "Playing with Tweezers", a Portuguese game developed for novices to set up basic surgical instruments on the Mayo stand or a back table.

DESIGN

A validation study with three phases of translation, reconciliation, and evaluation (face, content, and construct validity).

SETTINGS

Several medical universities in Iran.

PARTICIPANTS

Twelve students in a pilot translation test, 18 experts in the reconciliation phase, 20 experts in the face and content validity stages, and 120 students (72 novices, 26 intermediates, and 22 experts) in the construct validity stage.

METHODS

Following "forward-backward" translation from Portuguese to English, the English version of the game was appraised in the reconciliation phase using a 57-item questionnaire. To test face and content validity of the final version of the game, a 30-item questionnaire addressing different aspects of the game was completed. The students' game performance (remained time for game completion, obtained score, and error) was compared to assess the construct validity.

RESULTS

Minor differences were detected and resolved during the translation process. The English version of the game was reconciled in two sequential steps, and the final game called "Playing with Surgical Instruments (PlaSurIn)" was developed. All the items regarding the face validity received 80-100% of positive responses. Moreover, regarding the content validity, all of the evaluated items obtained a content validity index of 0.90-1.0. Compared to the novices, the experts and intermediates received higher scores (p < 0.001 in two cases) and fewer errors (p < 0.001, p = 0.007). The remained time for game completion was significantly longer for experts than the novices (p = 0.011).

CONCLUSIONS

The "PlaSurIn", as a virtual training strategy, can prepare novices to set up basic surgical instruments.

Effects of Relaxation Techniques on Acute Postlaminectomy Pain: A Three-Arm Randomized Controlled Clinical Trial

PURPOSE

This study compared the effects of Benson relaxation with progressive muscle relaxation on pain severity after laminectomy.

DESIGN

Three-arm randomized, nonblinded, and parallel group trial.

METHODS

The study was conducted with 93 patients who underwent lumbar laminectomy. Patients were randomly assigned to three groups of Benson relaxation + routine care (n = 31), progressive muscle relaxation + routine care (n = 31), and routine care (n = 31). The two relaxation methods were performed at 2 (time 1), 12 (time 2), and 24 (time 3) hours after patients' regaining full consciousness in postoperative wards. Pain severity was assessed using the visual analog scale once before laminectomy, before and also 20 minutes after each relaxation session. In the control group, pain severity was measured at the same times as in the two relaxation groups.

FINDINGS

Both Benson relaxation and progressive muscle relaxation resulted in a significant reduction in pain severity in comparison with the control group at all three measurement times (except at time 1 in the progressive muscle relaxation group). However, no significant differences were found between Benson relaxation and progressive muscle relaxation in any of the three times.

CONCLUSIONS

The results suggest that both Benson and progressive muscle relaxation techniques can decrease acute postlaminectomy pain in the immediate postoperative period in adult patients.

Attitudes Study of Students and Staff of Nursing about Euthanasia in Behbahan City, 2018

Introduction: Nursing students are part of a clinical teaching team in the course of education. And it is important to examine their attitude toward euthanasia. Investigating the attitude of nursing students towards euthanasia has always been welcomed by researchers. These studies often indicate a lack of acceptance of euthanasia among nurses, but different percentages of opposition to euthanasia have been reported. This study aimed to determine the attitudes study of students and staff of nursing about euthanasia in Behbahan city in 2018. Materials and Methods: This descriptive-analytical study was conducted to investigate the euthanasia attitude among nursing staff and students in 2018. The study population is nurses and nursing students of Behbahan city. Population volume was 187 in Behbahan hospital staff and 117 students respectively, that with Cochran's formula with 95% confidence interval was 126 and 83 respectively (z: equal 1.96 p=q=0.5 d=0.5). Students were selected from semesters 4 to 8 in order to understand students correctly. Data were analyzed by SPSS software version 22 and statistical methods including: mean, frequency, T-test, Chi-Square, multiple regression test and significance level p <0.05 was used. Results: 107 nurses and 83 nursing students participated in this study. The mean age of participants was 27 years. Multiple regression was used to examine the relationship between the dimensions of euthanasia and demographic variables. Multiple regression results showed that naturalistic beliefs were significantly different between the two groups of nurses and students (p-value = 0.021). There was no significant difference between other aspects of euthanasia attitude in nurses and students. There were also significant differences between the two groups of men in terms of practical considerations (p-value=0.048). Conclusion: Knowing the attitudes of nurses in a community towards the issue of euthanasia can be an effective step towards a better plan for improving the care of patients with euthanasia. The results of this study showed that naturalistic beliefs were significantly different between the two groups of nurses and students. But there was no significant difference between other aspects of euthanasia attitude and nurses and students; There were also significant differences in the practical considerations between the two groups of men. It is necessary to improve the knowledge of nurses in this field.

Benchmarking of Siemens Linac in Electron Modes: 8-14 MeV Electron Beams

BACKGROUND

Radiation therapy using electron beams is a promising method due to its physical dose distribution. Monte Carlo (MC) code is the best and most accurate technique for forespeaking the distribution of dose in radiation treatment of patients.

MATERIAL AND METHODS

We report an MC simulation of a linac head and depth dose on central axis, along with profile calculations. The purpose of the present research is to carefully analyze the application of MC methods for the calculation of dosimetric parameters for electron beams with energies of 8-14 MeV at a Siemens Primus linac. The principal components of the linac head were simulated using MCNPX code for different applicators.

RESULTS

The consequences of measurements and simulations revealed a good agreement. Gamma index values were below 1 for most points, for all energy values and all applicators in percent depth dose and dose profile computations. A number of states exhibited rather large gamma indices; these points were located at the tail of the percent depth dose graph; these points were less used in in radiotherapy. In the dose profile graph, gamma indices of most parts were below 1. The discrepancies between the simulation results and measurements in terms of Z_max, R₉₀, R₈₀ and R₅₀ were insignificant. The results of Monte Carlo simulations showed a good agreement with the measurements.

CONCLUSION

The software can be used for simulating electron modes of a Siemens Primus linac when direct experimental measurements are not feasible.

Effect of nitrogen sources on some morphological characteristics of in vitro stevia rebaudiana Bertoni

Stevia rebaudiana Bertoni belongs to Asteraceae family that leaves 200-300 times sweeter than sugar. Low seed fertility is one of the most important problems in Stevia production. So, Plant tissue culture is an efficient method for mass propagation of Stevia. In this research, we studied the effect of various concentrations of nitrogen on some morphological traits of stevia under in vitro conditions. We used axillary nodes as explants and they were cultured on Murashige and Skoog (MS) medium containing inorganic nitrogen sources i.e. NH4NO3(0, 825 and 1650 mg/l), KNO3(0, 950 and 1900 mg/l) were observed. The cultures were kept for 4 weeks at a temperature of 25±2°C with a photoperiod of 16/8 hour low light/dark each day. Maximum shoot length (89.33 mm), dry weight of plants (0.10 mg) and leaf fresh weight (0.42 mg) was observed on MS medium with 1650 mg/l NH4NO3 and 950 mg/l KNO3. Minimum shoot length (6.13 mm), root length (6.60 mm), leaf number (4.26), leaf dry weight (0.01 mg), leaf fresh weight (0.05 mg), total dry and fresh weight (0.02 and 0.15 mg) and growth rate was observed on a MS medium without nitrogen sources. Moreover, presence of nitrogen sources increases both shooting and rooting in Stevia rebaudiana Bertoni.

Calculation of Thyroid Dose with Planner System and Evaluation of Thyroid Function after Radiotherapy for Patients with Breast Cancer

BACKGROUND

Much research has widely been conducted into thyroid hormones levels following radiotherapy for breast cancer. Consequently, in this study, we evaluated to relate the rate of thyroid hormones levels with the dose distribution among breast cancer patients.

MATERIAL AND METHODS

Thirty patients were treated with 4-field breast cancer radiotherapy. The dose volume histograms, the volume percentage of the thyroid absorbing respectively 20, 30, 40 and 50 Gy were then estimated (V20, V30, V40 and V50) together with the individual average thyroid dose over the whole gland derived from their computed tomography-based treatment plans. Then, in serum samples triiodothyronine [T3], thyroxine [T4], thyroid-stimulating hormone [TSH] of the patients were measured before and after radiotherapy.

RESULTS

There were no significant differences in thyroid hormones levels before and after radiotherapy for patients with breast cancer (P value >.05).

CONCLUSION

On the balance, we understood that thyroid stimulating hormones levels did not change before and after cancer breast radiotherapy.

Calculation of Thyroid Dose with Planner System and Evaluation of Thyroid Function after Radiotherapy for Patients with Breast Cancer

BACKGROUND

Much research has widely been conducted into thyroid hormones levels following radiotherapy for breast cancer. Consequently, in this study, we evaluated to relate the rate of thyroid hormones levels with the dose distribution among breast cancer patients.

MATERIAL AND METHODS

Thirty patients were treated with 4-field breast cancer radiotherapy. The dose volume histograms, the volume percentage of the thyroid absorbing respectively 20, 30, 40 and 50 Gy were then estimated (V20, V30, V40 and V50) together with the individual average thyroid dose over the whole gland derived from their computed tomography-based treatment plans. Then, in serum samples triiodothyronine [T3], thyroxine [T4], thyroid-stimulating hormone [TSH] of the patients were measured before and after radiotherapy.

RESULTS

There were no significant differences in thyroid hormones levels before and after radiotherapy for patients with breast cancer (P value >.05).

CONCLUSION

On the balance, we understood that thyroid stimulating hormones levels did not change before and after cancer breast radiotherapy.

Skin Dosimetry in Radiotherapy of Breast Cancer: a Comparison between EBT and EBT3 Radiochromic Films

OBJECTIVE

Radiochromic EBT3 film is a later generation of radiochromic films. The aim of this study is to compare EBT and EBT3 radiochromic films in radiotherapy fields of breast cancer.

METHODS

A RANDO phantom was irradiated by a 6 MV Siemens Primus linac with medial and lateral fields of radiotherapy of breast cancer. Dosimetry was performed in various points in the fields using EBT and EBT3 films. Films were scanned by a Microtek color scanner. Dose values from two films in corresponding points were compared.

RESULTS

In the investigation of calibration, net optical density (NOD) of EBT radiochromic is more than the EBT3 radiochromic film. The highest percentage difference between NODs of two films is related to 0.75 Gy and equals to 14.19%. The lowest value is related to 0.2 Gy dose and is equal to 3.31%. The highest percentage difference between two films on the RANDO phantom in breast cancer fields is 13.51% and the minimum value is equal to 0.33%.

CONCLUSION

From the comparison between the two films, most of the points show differences in dose in the measurements in fields of breast cancer radiotherapy. These differences are attributed to the thickness of the active layers, the overall thickness of the films, and the difference in the calibration fitted functions. The advantage of EBT film over EBT3 is a higher sensitivity; on the other hand EBT3 film allows to use its both sides in the scanning process and it is a new version of this film type.

Freeman-Sheldon syndrome: a case report

Freeman-Sheldon syndrome is a rare hereditary disorder characterised by three basic abnormalities, namely microstomia, camptodactyly with ulnar deviation of the fingers, and clubfoot. The majority of these patients have microstomia and dental crowding, making oral hygiene difficult and increasing the risk of caries. Treatment of these patients requires a coordinated effort by a team of specialists, including a paediatrician, an anaesthesiologist, a plastic surgeon, a paediatric dentist, and an orthodontist. Herein, we describe dental problems of a child with Freeman-Sheldon syndrome and the treatment procedures performed.

Towards proposition of a diagnostic reference level for mammographic examination in the greater Khorasan Province, Iran

Although, over the past few years, the application of mammography has risen up sharply in Iran, very little, if any, has been reported of the extent of patient's dose from this type of imaging. The purpose of this study was to establish local diagnostic reference level (DRL) arising from mammography in the great Khorasan province of Iran. It is generally assumed that the glandular tissue is the most vulnerable type of breast tissue. Therefore, the mean glandular dose (MGD) has been widely accepted as the most appropriate dosimetric quantity to predict the risk of radiation-induced cancer. Literary, DRL for mammography is defined as the 75th percentile of MGD distribution. In Khorasan province, 7 out of 40 centres were randomly selected. In this work, 100 patients were studied. Thermoluminescence dosimeters have been used to measure entrance surface doses (ESDs). Since, it is difficult to directly measure MGD, Monte Carlo model-based conversion factors were utilised to conclude MGD from ESD. The results have revealed that patients dose is varied widely. The measured ESDs ranged from 0.74 to 19.81 mGy for the craniocaudal (CC) view and 1.20 to 25.79 mGy for the mediolateral oblique (MLO) view. The average MGDs per image were 0.88 and 1.11 mGy for CC and MLO views, respectively. Based on the internationally adopted definition, DRL arising from mammography tests for Khorasan is 1.33 mGy. Implementation of a dose reduction programme is suggested because of the large variations observed in patient MGD values. In this study, the DRL value is significantly lower than the corresponding values suggested by other researchers elsewhere.

Effect of renal transplantation on sperm quality and sex hormone levels

OBJECTIVE

To assess the effect of successful renal transplantation on semen variables, sexual function and sex hormone profiles in a clinical trial.

PATIENTS AND METHODS

Thirty patients on haemodialysis underwent renal transplantation; before and after surgery, their sperm density, motility and morphology were analysed, follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin and testosterone levels measured and compared, and sexual function assessed using an abbreviated version of the International Index of Erectile Function (IIEF), with a successful outcome defined as a level of satisfaction of 4 or 5 on a 5-point scale. The paired t-test was used to assess the statistically significance of differences in all analyses.

RESULTS

Sperm motility improved significantly (P < 0.001) but there were no significant changes in morphology or density (P = 0.33 and 0.068, respectively). Testosterone levels increased and FSH, LH and prolactin decreased significantly (P < 0.05) after renal transplantation. The IIEF showed that of the 30 patients, 14 were impotent before surgery and only six remained so afterward (P < 0.05).

CONCLUSION

Although sperm morphology and density did not improve after renal transplantation, there were highly significant changes in sperm motility. Hormonal levels in patients on haemodialysis improved after transplantation and returned to nearly normal; sexual function was also significantly better. Further studies are needed to confirm these results.