Predictors of death anxiety among Iranian cancer patients: Contribution of sense of Coherence

BACKGROUND

Death anxiety is a negative consequence of cancer that influences the quality of life of many patients. This study determined the predictors of death anxiety and the contribution of the sense of coherence to this disorder among Iranians with cancer.

METHODS

The present research was a descriptive-analytical study that examined cancer patients referring to one of the educational hospitals in Tehran, Iran. Two hundred eligible patients selected by purposeful sampling filled out a clinical and demographic questionnaire. The data were analyzed by the SPSS 20 software.

RESULTS

The correlational results revealed a negative and significant relationship between death anxiety and a sense of coherence (r = -0.610). Likewise, age, gender, marital status, occupational and economic circumstances, and cancer type were among the variables that correlated with death anxiety and predicted 85% of this psychological state.

CONCLUSION

The researchers recommend mental assessment in oncological care to identify psychological challenges to realize the ultimate goal of palliative care, i.e. improving patients' quality of life.

Development and validation of SALT Triage method to facilitate the identification and classification of patients in Mass Casualty Incidents

BACKGROUND

Mass Casualty Incidents (MCIs) have caused great financial losses. These incidents are referred to a situation in which the number of casualties caused by the accident temporarily increases to such an extent that it is not possible to treat all these patients with the facilities and capacities available in the area. To offer fair and proportionate medical services to all patients, it is necessary to use a process called patient triage. This study aimed to modify the Sort Assess Lifesaving Intervention Treatment/transport (SALT) triage method to simplify the differentiation of patients from green from yellow and gray from red.

METHODS

This is a methodological study with a descriptive cross-sectional approach that by studying the SALT triage method and using the criteria defined in the Reference Standard, facilitates the identification of patients with a minor (Outpatient) and fatal injury (Expectant). Then, using two common and modified SALT triage methods, 100 simulated patients were triaged and the obtained data were evaluated and compared in terms of accuracy and speed.

RESULTS

The improvement made in the SALT triage method was able to reduce 22% of the total triage error of the first nurse and improved 18% in green, 43% in yellow, 15% in red, and 13% in the gray category. In the second nurse, this method was able to reduce 29% of the errors and in the category of green patients, 41%, yellow 47%, red was unchanged, and gray 38% improvement was observed. Furthermore, the average triage rate was 4 and 5 seconds shorter per patient in the first and second nurses, respectively.

CONCLUSIONS

With this modification, the diagnostic power has increased by 22% in the first nurse and 29% in the second nurse. Due to the significant increase in the accuracy of the mSALT (Modified SALT) triage method, this modification can be considered useful and can be used to advance the goals of triage in MCIs.

Evaluation of the Quality of Clinical Education and the Clinical Self-efficacy of Nursing Students during the COVID-19 Pandemic

Background:

Clinical education is the most important part of the education of nursing, operating room, and anesthesia students. During the COVID-19 pandemic and the suspension of clinical training, these students became very concerned. Nursing schools also limited clinical education to create a balance between the educational needs and safety of students. Therefore, the present study aimed to investigate the effect of changing clinical education conditions during the COVID-19 pandemic on the quality of clinical education and the clinical self-efficacy of nursing, operating room, and anesthesia students in Tehran, Iran.

Methods:

This descriptive cross-sectional study was conducted in 2020 on 277 seventh and eighth-semester nursing, operating room, and anesthesia students in Tehran, Iran. Students were selected by simple random sampling using a random number table. The study tools included the demographic questionnaire, the clinical education quality questionnaire, and the clinical self-efficacy questionnaire, which were sent to the participants via WhatsApp and Telegram after confirming their validity and reliability.

Results and Discussion:

64.30% of students were female, and the mean age was 23.59±3.49. The mean of total scores for the quality of clinical education and clinical self-efficacy was equal to 57.38±12.43 and 104.88±23.01, respectively. 57% of students considered moderate the level of the quality of clinical education and 51.60% of them moderate the level of clinical self-efficacy. The total score for clinical self-efficacy had a significant correlation with the quality of clinical education (r=0.12, P-value=0.04).

Conclusion:

The use of new educational methods, planning the course based on the needs of learners and in accordance with the conditions, and increasing the capability and the clinical self-efficacy of nursing students should be considered by nursing professors.

CURB-65, qSOFA, and SIRS Criteria in Predicting In-Hospital Mortality of Critically Ill COVID-19 Patients; a Prognostic Accuracy Study

INTRODUCTION

Outcome prediction of intensive care unit (ICU)-admitted patients is one of the important issues for physicians. This study aimed to compare the accuracy of Quick Sequential Organ Failure Assessment (qSOFA), Confusion, Urea, Respiratory Rate, Blood Pressure and Age Above or Below 65 Years (CURB-65), and Systemic Inflammatory Response Syndrome (SIRS) scores in predicting the in-hospital mortality of COVID-19 patients.

METHODS

This prognostic accuracy study was performed on 225 ICU-admitted patients with a definitive diagnosis of COVID-19 from July to December 2021 in Tehran, Iran. The patients' clinical characteristics were evaluated at the time of ICU admission, and they were followed up until discharge from ICU. The screening performance characteristics of CURB-65, qSOFA, and SIRS in predicting their mortality was compared.

RESULTS

225 patients with the mean age of 63.27±14.89 years were studied (56.89% male). The in-hospital mortality rate of this series of patients was 39.10%. The area under the curve (AUC) of SIRS, CURB-65, and qSOFA were 0.62 (95% CI: 0.55 - 0.69), 0.66 (95% CI: 0.59 - 0.73), and 0.61(95% CI: 0.54 - 0.67), respectively (p = 0.508). In cut-off ≥1, the estimated sensitivity values of SIRS, CURB-65, and qSOFA were 85.23%, 96.59%, and 78.41%, respectively. The estimated specificity of scores were 34.31%, 6.57%, and 38.69%, respectively. In cut-off ≥2, the sensitivity values of SIRS, CURB-65, and qSOFA were evaluated as 39.77%, 87.50%, and 15.91%, respectively. Meanwhile, the specificity of scores were 72.99%, 34.31%, and 92.70%.

CONCLUSIONS

It seems that the performance of SIRS, CURB-65, and qSOFA is similar in predicting the ICU mortality of COVID-19 patients. However, the sensitivity of CURB-65 is higher than qSOFA and SIRS.

The expansion of the role of nurse prescribing in intensive care units in the healthcare system of Iran: a qualitative content analysis

Intensive Care Unit (ICU) nurses prescribe medication for patients in many countries. However, there is still no evidence on the legitimacy of nurse prescribing roles in the healthcare system of Iran. This qualitative study with 30 experts was conducted to explore the experiences regarding the expanding role of prescribing medication by the ICU nurses. Data were collected through 31 individual semi-structured interviews and analyzed using the conventional content analysis method by MAXQDA 10. One major theme, "applicability of prescribing medication by ICU nurses", together with three sub-themes of "facilitators", "potential risks of nurse prescribing" and "the professional pathway", emerged. The use of successful global experiences, patient-oriented healthcare system policies, current culture and positive professional position of nurses, physician shortage, and high capacity of ICU nurses appeared as facilitators to perform the new role in our context. For the expansion of the new role, different professional pathways such as discussion with physicians and special groups with conflicts of interests, training qualified nurses in this area, and gradual development were proposed by the participants. The next step of the research is to prepare a set of standards for the prescription of medication by the ICU nurses in our context.

The Effect of E-Learning Program for COVID-19 Patient Care on the Knowledge of Nursing Students: A Quasi-Experimental Study

Introduction

As COVID-19 is an emerging disease, nursing students have little experience in caring for COVID-19 patients while they will be part of the country’s health system and have the closest relationship with the treatment team.

Objective(s)

Therefore, considering the importance and challenges of nursing students’ education during the COVID-19 pandemic, the present study aimed to investigate the effect of e-learning programs for COVID-19 patient care on nursing students’ knowledge in Tehran, Iran 2021.

Methods

The present quasi-experimental study was performed on 100 nursing students selected by a random sampling method. The demographic and knowledge assessment questionnaires were used to collect data before the intervention. Then, the e-learning program was implemented, in which students participated in three sessions for two weeks, the educational content was provided for the students in the form of text, audio, video, and image files, and questions were asked to them. Data were collected immediately after completing the e-learning program and four weeks later.

Results

The mean age value was 22 ± 1.25, and 61% of participants were female. The total mean score of knowledge immediately after training (22.95 ± 0.30) and one month after training (22.79 ± 0.30) significantly increased compared to baseline time (17.21 ± 0.48). The main effect of time was significant for the total score of knowledge from baseline to immediately after training (B = 5.79) and one-month follow-up (B = 5.63).

Conclusion

The findings of the study showed that the total mean score of the knowledge of students increased significantly in all dimensions after the e-learning program for COVID-19 patient care.

Implications for nursing practice

Considering the effectiveness of the e-learning program for COVID-19 patient care in increasing the knowledge of nursing students, it is necessary to provide more training programs focusing on new scientific findings because increasing nurses’ and nursing students’ knowledge plays a significant role in achieving more skills and promoting community health.

The impact of telecardiology on the outcome of patients with myocardial infarction transported by Tehran’s emergency medical services to selected hospitals of Tehran city

Background & Aim: Clinical outcomes and mortality rate of patients with ST-segment elevation myocardial infarction (STEMI) strongly depend on the time of percutaneous coronary intervention (PCI). One way to reduce the delay in this treatment is to use telecardiology in the prehospital setting. The purpose of this study was for comparison of telecardiology on the first medical contact to balloon time and outcome (size of infarct area, left ventricular ejection fraction, and major adverse cardiac events) of patients with myocardial infarction (MI) transported by Tehran Emergency Medical Services to selected hospitals in Tehran, Iran. Methods & Materials: The present retrospective, comparative study was conducted in 2018 in Tehran city on the medical records of 300 patients with STEMI transported with and without telecardiology (150 records per group). Data for this study included demographic characteristics; how to transport the patients to medical centers, first medical contact to balloon time (FMCTB), and clinical outcomes. Data were analyzed using independent t-test, Fisher's exact test, Chi-square, Mann-Whitney and Kruskal-Wallis test by SPSS software, Version 20. Results: First medical contact to balloon (FMCTB) time, infarction size based on creatine kinase, the patient mortality rate in one month, and repeated PCI in the group transported with telecardiology was significantly lower than that of the group transported without telecardiology (P<0.05). Left ventricular ejection fraction (LVEF) in the first 24 hours, infarction size based on troponin I level, the rate of readmission due to acute coronary syndrome (ACS) and the rate of coronary artery bypass grafting (CABG) were not statistically significant between the two groups (P<0.05). Conclusion: The results of this study showed that the use of telecardiology could reduce the delay in performing PCI and improve some of the clinical outcomes of patients with STEMI. These results can be used to improve the quality of care for patients with STEMI by pre-hospital emergency personnel, physicians and nurses involved in the care of these patients.

Quality of Life in Patients With Liver Cirrhosis: A Systematic Review

Background: Quality of life (QOL) is a powerful phrase that reflects maintaining health and well-being in different societies and cultures, reflecting the positive and negative aspects of people’s lives. Patients with liver cirrhosis (LC) have an undesirable QOL, and this has become one of the most important causes of mortality in the world. Objective: This review article aimed to summarize the results of previous studies on health-related QOL in patients with LC to determine their problems and needs. Methods: This review was conducted using Cochran’s seven-step model. This paper is the result of research on QOL in patients with LC through searches conducted in Google Scholar, PubMed, and Science Direct using the keywords liver cirrhosis, chronic liver disease, quality of life, health-related quality of life, and self-care for articles published between 2012-2018. Ultimately, 11 articles were obtained and analyzed. Results: The results of this review showed that the QOL in patients with LC is poor and is lower than in other populations. Many factors, such as age, gender, and education, influence QOL and should be addressed in order to solve the challenges and problems faced by these patients. Increasing awareness and education are the most important issues for LC patients. Conclusion: QOL in patients with LC is affected by many factors. The lack of awareness about the disease and its complications is considered the biggest problem for these patients. To improve the QOL and care of these patients, nursing care guidelines, awareness raising, and education about the disease and its complications, treatment, and new treatments are needed.

The Relationship Between Work Commitment, Dynamic, and Medication Error

Incidence of medication errors in intensive care unit (ICU) can cause irreparable damage for ICU patients. Therefore, it seems necessary to find the causes of medication errors in this section. Work commitment and dynamic might affect the incidence of medication errors in ICU. To assess the mentioned hypothesis, we performed a descriptive-analytical study which was carried out on 117 nurses working in ICU of educational hospitals in Tehran. Minick et al., Salyer et al., and Wakefield et al. scales were used for data gathering on work commitment, dynamic, and medication errors, respectively. Findings of the current study revealed that high work commitment in ICU nurses caused low number of medication errors, including intravenous and nonintravenous. We controlled the effects of confounding variables in detection of this relationship. In contrast, no significant association was found between work dynamic and different types of medication errors. Although the study did not observe any relationship between the dynamics and rate of medication errors, the training of nurses or nursing students to create a dynamic environment in hospitals can increase their interest in the profession and increase job satisfaction in them. Also they must have enough ability in work dynamic so that they don’t confused and distracted result in frequent changes of orders, care plans, and procedures.

The Effect of Liaison Nurse Service on Patient Outcomes after Discharging From ICU: a Randomized Controlled Trial

Introduction: Recent studies suggest that liaison nurse intervention might be effective to solve the gap between intensive care unit and wards, but little studies are known about the effect of this intervention. The aim of this study was to investigate the effect of liaison nurse service on patient outcomes after discharging from intensive care unit.

Methods: In this single blinded randomized controlled trial, a total of 80 patients were selected by convenience sampling method from two teaching hospitals located in Tehran, Iran. Patients were randomly allocated to either the experimental or the control groups. Patients in the experimental group received post-ICU care from a liaison nurse and patients in the control group received the routine care. After the intervention, patients’ vital signs, level of consciousness, length of hospital stay, need for re-hospitalization in ICU, and satisfaction with care were measure. Data were analyzed by SPSS Ver.13 software.

Results: None of the participants experienced ICU re-hospitalization. According to the result and there were no significant differences between the study groups regarding heart rate, respiratory rate, systolic blood pressure, post-ICU level of consciousness, satisfaction with care, and length of hospitalization in medical-surgical wards. However, the study groups differed significantly in terms of body temperature.

Conclusion: Care services provided by an ICU liaison nurse has limited effects on patient outcomes. However, considering the contradictions among the studies, further studies are needed for providing clear evidence about the effectiveness of the liaison nurse strategy.

A Systematic Review of the Liaison Nurse Role on Patient's Outcomes after Intensive Care Unit Discharge

BACKGROUND

This review focuses on the impact of liaison nurse in nursing care of patient after ICU discharge on patient's outcomes, compared with patients that are not taken care of by liaison nurses. The role of the ICU liaison nurse has transpired to solve the gap between intensive care unit and wards. Therefore, we aimed to review the outcomes of all studies in this field.

METHODS

A systematic review of intervention studies between 2004 and 2013 was undertaken using standard and sensitive keywords such as liaison nurse, intensive care unit, and patient outcomes in the following databases: Science direct, PubMed, Scopus, Ovid, Oxford, Wiley, Scholar, and Mosby. Then, the articles which had the inclusion criteria after quality control were selected for a systematic review.

RESULTS

From 662 retrieved articles, six articles were analyzed in a case study and four articles showed a statistically significant effect of the liaison nurse on the patient's outcomes such as reducing delays in patient discharge, effective discharge planning, improvement in survival for patients at the risk for readmission.

CONCLUSION

Liaison nurses have a positive role on the outcomes of patients who are discharged from the ICU and more research should be done to examine the exact function of liaison nurses and other factors that influence outcomes in patients discharged from ICU.

Iranian nurses' perspectives on factors influencing medication errors

BACKGROUND

Medical errors are one of the major threats for patient safety in all countries. Medication errors are common medical mistakes that can lead to serious consequences and even death of patients.

AIM

The aim of this study was to explore nurses' perspectives of factors influencing medication errors.

METHODS

This qualitative study based on content analysis included 20 nurses (n = 20) with at least 2 years of clinical experience working in a large teaching hospital. The nurses were selected using purposeful sampling. The data were collected using semi-structured interviews and analysed using deductive content analysis approach based on Reason's human error model. Rigor of the data was confirmed by external and member check.

RESULTS

Two themes were identified by the participants: (1) the individual approach including personal and psychological characteristics of nurses, patient medical history and physicians' orders errors; and (2) the cultural and organizational approach including workplace conditions, learning process, risk management strategies, nurses' pharmacological knowledge, inevitable nursing errors and medication error complications.

LIMITATIONS

Concern about the potential consequences related to reporting of the medication errors was the major limitation of this study. Participants' concerns were handled by keeping their identity confidential and anonymous.

CONCLUSION

Results show the importance of planning comprehensive educational programmes and providing constructive feedback in a favourable learning climate.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Findings of this study can be beneficial to managers for nurturing a transparent organizational culture, whereby staff members freely discuss their errors in patient care and seek advice for problem solving.