Barriers and facilitators of readiness for hospital discharge in patients with myocardial infarction: a qualitative study: quality improvement study

Background

Readiness for hospital discharge (RHD) in patients with myocardial infarction (MI) is a key concept in the discharge process. This study was conducted to explain the barriers and facilitators of preparation for discharge in patients with MI.

Materials and methods

A qualitative study was conducted using conventional content analysis from April 2021 to 2022. Data collection was done in a targeted manner through semi-structured interviews until the data saturation stage. Nineteen participants (11 patients, 3 family members, and 5 healthcare team) were interviewed. Data analysis was done in eight steps according to the suggested steps of Graneheim and Lundman. MAXQDA18 software was used for coding.

Results

From the interviews, 348 primary codes, 11 sub-categories, and 5 categories were extracted. Finally, after continuous analysis and comparison of interviews, codes, and categories, two themes including "supporting platform" and "caring atmosphere" were extracted, which were the result of the participants' experience and understanding of the barriers and facilitators of RHD. The supporting platform included "family support" and "social support" and the caring atmosphere included "care gaps" and "professional healthcare team performance".

Conclusion

The results of this study indicate several factors affecting RHD in heart attack patients. According to the results of the study, the participation of the patient, family, healthcare team, and community in creating RHD is recommended. It is also suggested to pay attention to these factors in care and treatment planning to help improve health and control complications and prevent re-hospitalization in these patients.

Effect of family-centered care on the anxiety levels among family members of patients undergoing cardiac surgery: a randomized controlled trial

Background

The present study aims to determine the effect of family-centered care on anxiety levels among family members of patients undergoing cardiac surgery.

Materials and methods

This study was a randomized clinical trial study that was conducted on the families of Iranian cardiac surgery patients. In the intervention group, family-centered care was implemented, and the content of the intervention included providing informational and emotional support to the family member and the family member's participation in patient care according to the set framework.

Results

A total of 144 family members of patients undergoing cardiac surgery were included in this study. Among the 144 family members, 71 were in the intervention group, and 73 were in the control group. The changes in the state anxiety score before and after the intervention were significant between the two groups, and the changes were higher in the control group (P=0.043). Also, there was no significant difference in the changes in trait anxiety before and after the intervention between the two groups (P>0.05).

Conclusion

In general, the high prevalence of anxiety in patients' families has negative functional consequences on both patients and their families. To reduce the level of anxiety, special attention should be paid to knowing the effective factors and appropriate coping methods. Nevertheless, it is important to note that additional research is warranted to delve deeper into this matter in future studies.

Translation and validation of the Persian version of the perception to care in acute situations (PCAS-P) scale in novice nurses

BACKGROUND

Novice nurses providing care in acute conditions should have satisfactory performance. Accurate and appropriate evaluation of the performance of novice nurses in providing care in acute situations is essential for planning interventions to improve the quality of patient care. This study was conducted to translate and evaluate the psychometric properties of the Persian version of the Perception to Care in Acute Situations (PCAS-P) scale in novice nurses.

METHODS

In this methodological study, 236 novice nurses were selected by the convenience sampling method. 17-item scale PCAS-P was translated into Persian by the forward-backward process. Then, this version was used for psychometric evaluation. For this purpose, face validity, content validity, and construct validity were assessed using confirmatory factor analysis. Internal consistency and stability reliability were calculated. The data were analyzed using SPSS and AMOS software.

RESULTS

The PCAS-P scale maintained the meaning of the original English version and was clear, explicit, and understandable for novice nurses. Confirmatory factor analysis showed that this Persian version is consistent with the proposed model and confirmed the fit of the three-factor model. The values of Cronbach's alpha coefficient, McDonald's omega, Coefficient H, and average inter-item correlation were excellent for the overall scale and its dimensions, and the three latent factors had good convergent and discriminant validity. Additionally, the average measurement size was 0.944 ICC (95% CI 0.909 to 0.969).

CONCLUSION

The PCAS-P scale is valid and reliable for measuring novice nurses' perception of acute situations.

Death Anxiety and Related Factors Among Iranian Critical Care Nurses: A Multicenter Cross-Sectional Study

The aim of this study is to investigate death anxiety (DA) and related factors among critical care nurses. Using a cross-sectional research design, 325 critical care nurses in eight hospitals in Iran enrolled in the study. Multiple logistic regression analysis showed that deputy head nurse (OR = 18.299; CI: 1.764-189.817; p = .015), shift morning fixed (OR = 8.061; CI: 1.503-43.243; p = .015), surviving parents (OR = 3.281; CI: 1.072-10.037; p = .037), number of children (OR = 1.866; CI: 1.157-3.010; p = .011), years of working experience (OR = 1.143; CI: 1.048-1.246; p = .003), number of end-of-life patient care in the last 3 months (OR = .900; CI: .828-0.977; p = .012), age (OR = .809; CI: .732-.893; p < .001), CCU nurses (OR = .250; CI: .100-.628; p = .003), and mild stressful life events (SLEs) (OR = .167; CI: .046-.611; p = .007) were significantly related to high DA. Therefore, nurse managers and policymakers should pay special attention to these related factors in developing programs to maintain and promote the health of critical care nurses to improve the quality of nursing care.

Psychometric evaluation of the heart failure somatic perception scale in Iranian heart failure patients: a cross-sectional study

Background

This study aimed to evaluate the psychometric evaluation of heart failure somatic perception scale (HFSPS) in Iranian heart failure patients.

Materials and methods

A total of 220 heart failure (HF) patients were enroled in the study. Data gathering was conducted via consecutive sampling from August 2022 to April 2023. Face validity, content validity, construct validity, and internal consistency were used to evaluate the validity and reliability of the Persian version of the HFSPS. Construct validity was done through confirmatory factor analysis and convergent validity. Convergent validity between HFSPS and symptom status questionnaire-heart failure was measured using Pearson's correlation coefficient. Cronbach's alpha and Macdonald's omega coefficient were used to evaluate the reliability of instruments.

Results

A total of 220 HF patients participated in this study. Their mean age was 66.46 (SD=11.40). Among the participants, 70% were men. The results of the confirmatory factor analysis evaluation showed the goodness of fit indices of the final HFSPS model after modification was within an acceptable range (χ2=306.18 P<0.001, Minimum Discrepancy Function Divided by Degrees of Freedom=2.47, Comparative of Fit Index=0.91, Tucker-Lewis index=0.90, Adjusted goodness of fit index=0.81, Parsimonious norm fit index=0.70, root mean square error of approximation=0.082). Convergent validity between HFSPS and symptom status questionnaire-heart failure indicated a positive and significant correlation. Cronbach's alpha coefficient in the HFSPS was 0.868, and McDonald's omega coefficient in the HFSPS was 0.832.

Conclusion

Overall, the Persian version of the HFSPS was determined to be a reliable and valid scale among Iranians with HF.

Factors Improving Oncology Nurse Role Performance in Providing Pediatric Palliative Care: A SWOT Analysis

OBJECTIVE

Palliative care is provided by an interdisciplinary team in which, nurses play an important role, and improving their role performance can be effective in providing high-quality care. This study aimed to explore the factors related to improving oncology nurses' role performance in providing pediatric palliative care.

METHODS

This qualitative study was conducted using semi-structured interviews with 22 nurses, physicians, hospital supervisors, children, and their parents from September 2022 to January 2023. Data analysis was performed based on conventional content analysis proposed by Elo and Kyngas using MAXQDA 2020. Finally, subcategories of each main category were summarized in the SWOT analysis matrix.

RESULT

Data analysis led to the extraction of 1250 codes, three main categories (nurse-related factors, child and family-related factors, and organizational factors), five generic categories, and 32 subcategories that were ultimately classified in the SWOT analysis matrix.

CONCLUSION

This study showed that oncology nurses' role performance in providing palliative care is influenced by many internal and external factors. In this regard, in order to improve their role performance, increasing knowledge among nurses, nursing students, and the community on integrating pediatric palliative care topics into the nursing curriculum, fair access to palliative care services, drug accessibility, financial support, and further research are recommended.

Clinical Decision Making in Forensic Nursing: A Cross-Sectional Study From an Emergency Nursing Perspective

BACKGROUND

Appropriate clinical decision making (CDM) is very important for emergency nurses when working with forensic patients with violence-related injuries and can improve patient outcomes. Therefore, it is essential for emergency nurses to have the basic skills to make the right clinical decisions when working with forensic patients.

AIM

The aim of this study was to evaluate the CDM of emergency nurses when caring for forensic patients.

METHODS

This study was conducted using a cross-sectional design. Nurses working in the seven emergency departments of Rasht hospitals, Guilan Province, Iran, were recruited to take part in the study. Data collection was performed via census sampling from September to November 2019. Data were collected via a two-part questionnaire developed by the researcher(s) that addressed (a) demographic characteristics and (b) simulated scenarios that assessed their CDM in caring for forensic patients.

FINDINGS

One hundred ninety-two emergency nurses participated in this study. The mean score of CDM in forensic nursing was moderate (56.46; 95% CI [54.49, 58.43]). Of the participants, 60.42% of the emergency nurses had moderate CDM knowledge related to forensic nursing, whereas only 2.8% had desirable knowledge of CDM. There was a statistically significant relationship between CDM in forensic nursing and the history of encountering forensic patients ( p = 0.008).

CONCLUSION

CDM scores regarding emergency nurses' knowledge of forensic nursing were moderate. Knowledge of and CDM in forensic nursing is very important and provides high-quality safe care for forensic patients.

IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE

This study highlights the importance of additional education and professional development in forensic nursing, for emergency nurses, and should be considered further by nursing administrators and nursing educators.

Effect of Topical Sesame Oil on the Severity of Pain in Patients With Limb Trauma: A Randomized Controlled Trial

Objective

The purpose of this study was to investigate the effect of topical use of sesame oil on pain severity in patients with limb trauma.

Methods

A placebo-controlled randomized controlled trial was conducted on 120 patients with nonpenetrating upper and lower limb traumas admitted to the trauma emergency department. The patients were allocated to either the sesame oil group or the placebo group using the stratified random sampling technique based on trauma size and age. Depending on the trauma area, sesame or placebo oil were poured on the trauma site and massaged for 5 to 7 minutes. The intervention was repeated twice a day for 3 days at home. Pain severity was measured using the numeric pain scale before intervention on the first day and 30 minutes after each intervention for 3 days, twice a day. Data were analyzed using descriptive and analytical tests including the independent t test, χ² test, Fisher exact test, Mann-Whitney U test, Friedman test, and multiple linear regression analysis. The significance level was set at 0.05.

Results

The decreasing trend of pain was significant in both the intervention and placebo groups (P < .001). Comparison of the trend of changes in pain scores between the 2 groups showed that the mean changes of pain severity were higher in the intervention group compared with the placebo group in all assessments. There was a significant difference in the rate of analgesic consumption in the intervention group compared with the placebo group (P < .001). However, there was no significant difference between the 2 groups regarding pain severity. Pain reduction was negatively associated with body mass index (b = -0.091, P = .003), amount of received pain medication (b = -0.001, P = .039), and area of trauma (b = -0.002, P = .039). Pain reduction was greater in male patients than female patients (b = 0.676, P = .015). The effect of sesame oil on pain changes was not significant. No adverse side effects were reported.

Conclusion

This study showed that despite less use of analgesics in the intervention group than in the placebo group, sesame oil did not have any statistically significant effects on the severity of limb trauma pain. Further research is needed regarding the effect of topical sesame oil application on pain as a safe and uncomplicated intervention.

A Systematic Review of Death Anxiety and Related Factors Among Nurses

This systematic review aimed to summarize the evidence regarding death anxiety (DA) and related factors among nurses. Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) databases were extensively searched using purpose-related keywords from the earliest to October 5, 2021. A total of 6819 nurses were included in 31 studies. The DA of nurses based on the Templer's Death Anxiety Scale was moderate. Factors such as personal anxiety, frequency and severity of job stress, burnout, dying patient avoidance behavior, euthanasia, sex, mental health status, social desirability, attitude toward the elderly, humor, social maturity, psychological hardiness, quality of life, lack of social activity, self-efficacy, coping with death, and life satisfaction were associated with nurses' DA. Therefore, nursing policymakers can promote nurses' health to improve the quality of nursing care by considering these related factors.

Information Seeking Behavior on COVID-19 Among Older Adults: A Cross-Sectional Study in Northern Iran

This study aimed to assess the information-seeking behavior about COVID-19 among older adults in northern Iran. Two hundred-fifty three older adults living in Rasht, northern Iran, were enrolled in a cross-sectional study. Most older adults obtained information about COVID-19 from television, friends, and acquaintances. They relied less on special patient associations and the Ministry of Health telephone system. The use of social networks, the Ministry of Health telephone system, the Ministry of Health text message system, and friends and acquaintances for obtaining information about COVID-19 were significantly higher in people aged 60 to 70 years than in people aged >70 years. The use of newspapers/magazines to get information about COVID-19 was significantly higher in men than women. The use of websites, social networks, physicians, other health care workers, friends and acquaintances, newspapers/magazines, and special patients' associations for obtaining information about COVID-19 was significantly higher in people with tertiary education than in others. Older adults were more satisfied receiving information about COVID-19 from nurses and physicians. Therefore, it is recommended that policymakers and health managers pay special attention to developing health programs and social media programing to educate older adults about COVID-19 and access to the right media for accurate information.

Impacts of Occupational Cognitive Failure and Subjective Workload on Patient Safety Incidents among Intensive Care Units Nurses

BACKGROUND

Life-saving treatments and high-quality care techniques increase the opportunity for patient safety incidents in Intensive care unit.

AIMS

This descriptive correlation study aimed to determine the impacts of occupational cognitive failure and subjective workload on patient safety incidents among intensive care units nurses.

METHODS AND MATERIAL

One hundred seventy-six nurses working in intensive care units were included using census sampling. The data collection tools consisted of demographic and occupational data, standard questionnaires of subjective workload (NASA-TLX) and occupational cognitive failure (OCFQ), and a question about frequency of patient safety incidents. Data analysis was performed using Mann-Whitney and Kruskal-Wallis, Spearman rank correlation coefficient, and logistic regression tests.

RESULTS

Occupational cognitive failure (OR = 1.043), subjective workload in dimension of "performance" (OR = 0.982), age (OR = 0.947), and gender (OR = 3.726) were important predictive variables of patient safety incidents.

CONCLUSIONS

Nursing mangers and policymakers can consider the factors identified for staffing nurses and development of patient safety programs.

Water on Fire: The Patients' Lived Experience of Primary Percutaneous Coronary Intervention

Background:

The success of a coronary angioplasty in the treatment of myocardial infarction is affected by patients’ experiences. However, the experiences of the people with an emergency angioplasty have remained unknown.

Objective:

This study was conducted to explore the patients’ experiences of an emergency angioplasty.

Method:

This study was performed using the qualitative research method and interpretive phenomenological approach. Nine patients under emergency angioplasty were selected using purposeful sampling. A total of 11 deep and semistructured interviews were performed with the patients. The data were analyzed using van Manen method.

Results:

Five subthemes of “diagnosis shock,” “being in an emergency situation,” “trying to self-control,” “the need for reassuring care,” and “stability” formed the structure of the patients’ experiences under the main theme of “water on fire”. Water on fire was the participants’ main perception of the emergency angioplasty. Patient-centered interactions and meeting the care, supportive, and educational needs of the patients in the case of diagnosis shock lead to a pleasant experience of returning to life.

Conclusion:

The findings of this study may have implications for care of patients undergoing emergency cardiovascular interventions.

Survey of stress and coping strategies to predict the general health of nursing staff

BACKGROUND

Nurses are often faced with the variety of work-related stress which could affect their physical and mental health. Coping strategies play an important role in reducing stress and consequently increasing the health and well-being. This study was conducted to investigate the role of stress and coping strategies to predict the general health of nursing staff.

SUBJECTS AND METHODS

An analytical cross-sectional design was carried out on 318 nurses working in governmental health centers of Guilan University of Medical Sciences, the North of Iran, in 2017. Data were collected through multistage cluster sampling using self-report questionnaires and demographic characteristics. The study instruments included Hospital Job Stress, Coping Strategies, and General Health Questionnaires. For analysis of data, descriptive statistics and regression test were applied using SPSS software version 19.

RESULTS

The results revealed that the highest mean score (47.71 ± 7.88) of different dimensions of coping strategies was related to task-oriented strategy. Furthermore, the results indicated that stress and coping strategies together could explain around 2.5% of variance of general health (ΔR²= 0.025). However, based on the statistically significant level, the results revealed the coping strategies as the predictor of general health (P = 0.002, beta = 0.094).

CONCLUSIONS

The results highlight the importance of considering coping strategies for predicting general health in nurses. Regarding the inevitability of some stressors in the nursing profession and the need to prevent stressful effects, workshops as an effective training method to reduce staff stress should be on the agenda of managers.

The Effectiveness of Local Combined Cold-Hot Application on Bruising of Enoxaparin Sodium

Introduction: Bruising is one of the most common adverse events following administration of enoxaparin sodium, which can lead to unpleasant consequences such as reduced access to various sites for injection, joint complaints, and reduced satisfaction of patients from the treatment and care provided. Therefore, in order to find ways to reduce this complication, the aim of this study was to compare the effectiveness of local combined cold-hot application on bruising caused by subcutaneous injection of enoxaparin sodium. Methods: This randomized controlled trial was conducted from July to December 2018. 74 patients hospitalized in Poursina Hospital in Rasht were selected according to inclusion criteria and assigned to intervention group 1 (37 persons) and intervention group 2 (37 persons) by randomized block design. In each intervention group, the left side of the abdomen was treated as control (without intervention) and the right side was treated with cold pack (intervention group 1) or cold-hot pack (intervention group 2). Data collection was done by two-part tools, including individual and clinical data, and related records of bruising. Evaluation of the incidence and severity of bruising was performed at 24, 48, 72 hours after the first injection. Data were analyzed by SPSS version 22 using descriptive and inferential statistics (Independity Test, Friedman, Wilcoxon, Mann-Whitney, Kolmogorosimerno). Results: The majority of research samples were men (79.7%). The mean age of the patients was 21 ± 48 years. The mean and standard deviation of bruising in intervention group 1 at 24, 48 and 72 hours after injection was 24.44±1.09, 4.49±1.04 and 4.35±1.14, respectively. The mean and standard deviation of bruising in intervention group 2 at 24, 48 and 72 hours after injection was 1.65±0.63, 1.49±0.65, and 0.88±0.43, respectively. Differences in bruising size were statistically significant (P<0.001). Conclusion: The findings of this study showed that use of local cold-hot pack compared to cold pack is more effective regarding the size of bruising in place of enoxaparin sodium injection, which is clinically important.

What are the predictor variables of social well-being among the medical science students?

CONTEXT

Individuals with social well-being can cope more successfully with major problems of social roles. Due to the social nature of human life, it cannot be ignored to pay attention the social aspect of health.

AIMS

The purpose of this study was to identify variables that predict the social well-being of medical students.

SETTINGS AND DESIGN

A descriptive-analytical study was conducted on 489 medical science students of Gilan Province, the North of Iran, during May to September 2016.

SUBJECTS AND METHODS

The samples were selected using quota sampling method. Research instrument was a questionnaire consisting of two parts: demographic section and Keyes social well-being questionnaire.

STATISTICAL ANALYSIS USED

Data analysis was done using SPSS software version 19 and with descriptive and inferential statistics (t-test, ANOVA, and linear regression).

RESULTS

The results showed that majority of the students had average social well-being. Furthermore, a significant relationship between the academic degree (P = 0.009), major (P = 0.0001), the interest and field's satisfaction (P = 0.0001), and social well-being was seen. The results of linear regression model showed that four variables (academic degree, major, group membership, and the interest and field's satisfaction) were significantly associated with the social well-being (P < 0.05).

CONCLUSIONS

The findings demonstrate that the different effects of the demographic factors on social well-being and the need for further consideration of these factors are obvious. Thus, health and education authorities are advised to pay attention students' academic degree, major, group membership, and the interest and field's satisfaction to upgrade and maintain the level of their social well-being.

Factors associated with quality of life in patients undergoing coronary angioplasty

OBJECTIVE

Percutaneous coronary intervention has been effective in increasing longevity of patients with cardiovascular disease. However, the evidence shows that the quality of life after the intervention is still lower than optimal level. The quality of life can be affected by various factors. The aim of this study is to determine the quality of life and its related factors in patients undergoing coronary angioplasty.

METHODS

This cross-sectional study was performed on 106 patients undergoing coronary angioplasty during 2015-2016. This study population included all patients who referred to a cardiac clinic in Rasht, Iran, were passed 3 months after their angioplasty. Research samples met the inclusion criteria and were willing to participate to the study, were selected gradually (continually). Research tools were a self-structured questionnaire regarding factors associated with the quality of life and the MacNew quality of life questionnaire. Data were collected through asking patients questions and using patient's medical records. Data analysis was conducted using descriptive and inferential statistics.

RESULTS

The results of multivariate linear regression analysis showed that independent variables of age (P = 0.0001), the number of diseased vessels (P = 0.0001), and the number of comorbidities (P < 0.05) were the most important factors associated with the quality of life.

CONCLUSION

Health-care professionals can play an effective role in promoting the quality of life of patients undergoing coronary angioplasty by modifying lifestyle based on the related factors and to provide comprehensive care programs, especially for elderly.

Keeping up with the caravan of life: Successful aging strategies for Iranian women

Background

Because of improving life expectancy in the world in recent times, the focus has shifted to the issue of the quality and nature of life and how to assist successful aging (SA) rather than increasing physical survival and lifespan. SA is a multidimensional, relative, and context-dependent concept with different paths and outcomes. The purpose of this qualitative study was to explore older women's strategies for SA in a specific context.

Methods

Following a grounded theory design approach, we conducted semi-structured individual interviews with 21 women between the ages of 28 and 96 years. We analyzed the data from interviews, written narratives, and field notes using the grounded theory approach.

Results

We identified four categories: prevention of threats, internal self-control against threats, coping with threats, and optimizing the passage of time according to opportunity. These described the strategies for SA when encountering with age-related changes. Utilizing these strategies, the women accompanied the caravan of life in the context of threats and opportunities.

Conclusions

The findings suggest that SA is a continuous process in confronting changes related to age. The identified strategies can help to promote SA by familiarizing older women with the threats and opportunities of life and training them in how to use these strategies.