The Effect of Spiritual Group Therapy on the Quality of Life and Empowerment of Women with Breast Cancer: A Randomized Clinical Trial in Iran

This randomized clinical trial was carried out on 74 women with breast cancer between May 2015 and April 2016 in the south of Iran. The patients were selected using a simple sampling method and randomly divided into an intervention (n = 30) and a control (n = 37) group. Five spiritual therapy sessions were conducted for the intervention group. Each session lasted one hour. The quality of life and empowerment of the patients were measured before and one month after the intervention. To collect data, four instruments were used, including a demographic information form, the European Organization for Research and Treatment of Cancer QOL questionnaire Cancer-30 (EORTC QLQ C-30), EORTC QLQ Breast-23 (EORTC QLQ-BR23), and the Cancer Empowerment Questionnaire (CEQ). After the intervention, a difference was observed between the groups concerning the mean score of general health (P = 0.016) and emotional function (P = 0.029), but there was no significant difference between the groups concerning the mean score of empowerment (P = 0.62). Thus, it appears that spiritual group therapy can improve the quality of life of this group of patients.IRCT registration number: IRCT 2014050417546N2.

Designing and psychometric properties of the hospitalized patients' spiritual needs questionnaire (HPSNQ) in the medical-surgical hospital setting

BACKGROUND

The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings.

METHODS

This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1.

RESULTS

The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96.

CONCLUSIONS

The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings.

Care self-efficacy in adolescents with mental disorders: A qualitative study

BACKGROUND

The promotion of health in adolescents with mental disorders depends on their levels of self-care empowerment. Self-efficacy is a significant prerequisite for successful self-management and behavior change in adolescents with mental disorders. The present study was conducted to explain the concept of care self-efficacy in adolescents with mental disorders.

MATERIALS AND METHODS

This qualitative study was carried out using the conventional content analysis approach. Semi-structured interviews (n = 34) were conducted with adolescents having mental disorders, their families, and healthcare providers. The participants were selected from neurology and psychiatry clinics affiliated with University of Medical Sciences using the purposeful sampling method in 2021. Data were analyzed according to Graneheim and Lundman method.

RESULTS

According to the findings of content analysis, four main themes were derived from the data: "health information-seeking behavior," "adaptation of life to the disease and treatment conditions," "adaptive coping," and "social self-care."

CONCLUSION

Based on the findings, the promotion of adaptive styles and social support is effective in acquiring social competencies. As a result, policymakers are suggested to design health-oriented educational programs based on care self-efficacy principles to promote health in adolescents with mental disorders.

Live experience of nursing students with internship program: A phenomenological study

BACKGROUND AND AIM

The internship is a program for transition of nursing students to the clinical setting. This study was conducted to describe and interpret the experiences of nursing students from the internship program.

MATERIALS AND METHODS

This was an interpretative phenomenological study following Van Menen's approach in six steps. Twelve nursing students were selected from 12 different universities in Iran from April to August 2020. Data was collected through 15 in-depth interviews (three supplementary interviews) over the course of 25-90 min and verbatim transcriptions. Data were analyzed with MAXQDA version 10 software. The researcher used four Guba and Lincoln criteria to obtain a rigorous study.

RESULTS

In this study, three main themes and eight subthemes were extracted. The main themes included "professional identity development," "moving toward professional self-efficacy," and "developing coping strategies for workplace adversities." The subthemes were "promoting the cognition of profession," "acceptance among colleagues as a nurse," "accepting professional roles," "self-awareness of weaknesses in patient care," "self-reliance," "advancing clinical skills," "adopting effective coping strategies," and "avoiding tension in clinical settings."

CONCLUSION

Nursing internship students have experienced moving toward professionalization with professional identity and self-efficacy development, and they succeeded in clinical challenges by learning coping approaches.

Development and assessment of validity and reliability of a checklist to evaluate the Circulating and Scrub Skills of Operating Room Novices (CSSORN checklist)

BACKGROUND

Assessment of circulating and scrub skills is an important issue in operating room (OR) programs. However, there is a lack of well-designed tools that are specifically developed for this purpose. Hence, this study aimed to develop and determine the validity and reliability of a checklist to measure the circulating and scrub skills of OR novices.

MATERIALS AND METHODS

This cross-sectional methodological study was conducted among 124 OR technology students who were selected during three consecutive academic years (2019-2020 to 2021-2022). The developed checklist was evaluated with face validity, content validity (quantitative and qualitative), construct validity (known-groups validity), criterion-related validity (concurrent and predictive validities), internal consistency (Kuder-Richardson 20, KR-20), and inter-rater reliability (intra-class correlation coefficient, ICC). Known-groups validity was evaluated by comparing the difference between the checklist scores of first-semester and third-semester students using independent samples t-test. Additionally, concurrent and predictive validities were evaluated by ICC through measuring the correlation between the total score of checklist and grades of a multiple-choice test and two clinical apprenticeship courses, respectively. Data were analyzed in the Statistical Package for Social Sciences software.

RESULTS

After reconciling the preliminary checklist in terms of face and content validities, a checklist with 17 sub-scales and 340 items called "Circulating and Scrub Skills of Operating Room Novices (CSSORN)" was developed. Regarding the known-groups validity, the third-semester students had higher scores compared to the first-semester students (p < 0.001 in most sub-scales). Besides, the total score of checklist showed a significant correlation with the criteria of concurrent and predictive validities (ICC = 0.64, ICC = 0.72; P < 0.001). The KR-20 for the entire checklist was 0.90 (range: 0.60-0.93). The ICC for inter-rater reliability was also 0.96 for the entire checklist (range: 0.76-0.99, P < 0.001 in all sub-scales).

CONCLUSION

The CSSORN had appropriate validity and reliability to be used for measuring the circulating and scrub skills of OR novices. To shed light on the findings, further testing of this checklist on larger populations and in different contexts is suggested.

The effects of mobile-based education on nurse self-concept among nursing students: an embedded mixed methods study

OBJECTIVES

This study evaluates the effects of mobile-based education (MBE) on nurse self-concept (NSC) among nursing students.

METHODS

This embedded mixed methods study was conducted in 2020-2021 in a main quantitative phase and a supplementary qualitative phase. In the quantitative phase, a quasi-experimental study with the Solomon four-group design was conducted on 117 second-year nursing students of Shiraz University of Medical Sciences, Shiraz, Iran. 70 students in the first (C1: n=37) and the second (C2: n=33) semesters of the 2020 academic year were respectively considered as the control groups, and 40 students in the first semester of the 2021 academic year considered as the experimental groups (I1: n=20 and I2: n=20). Participants in the experimental groups received NSC-related MBE through an Android application, while their counterparts in the control groups received no NSC-related MBE. Cowin's Nurse Self-Concept Questionnaire was used to assess the NSC. In the qualitative phase, six students from the experimental groups were purposively selected and interviewed through face-to-face semi-structured interviews. Moreover, two focus group discussions were held with a six-person and a five-person group of students from the experimental groups.

RESULTS

While the mean scores of NSC and its dimensions did not significantly change in the C1 group, the posttest mean scores of them in the E1 group were significantly greater than the corresponding pretest values (p<0.05), expect for the care dimension (p=0.586). Moreover, except for the care dimension (p>0.05), the posttest means scores of NSC and its other dimensions in the E1 and the E2 groups were significantly greater than the C1 and the C2 groups, respectively (p<0.05). Analysis of the qualitative data resulted in the generation of the main theme of multidimensional growth and development with three main categories, namely development of coping strategies, knowing professionalization strategies, and development of managerial potentials.

CONCLUSIONS

NSC-related MBE is effective in improving nursing students' NSC.

Nurses' patient safety competency, a predictor for safe care in psychiatric wards?

PURPOSE

This study examined the relationship between patient safety competence and safe care from the viewpoints of nurses working in psychiatry wards.

DESIGN AND METHODS

The present descriptive correctional study was conducted in two psychiatry hospitals in Iran in 2020. All the nurses were selected as the study participants using the census sampling method (N = 209).

FINDINGS

Nurses' patient safety competency was at a low level (2.54 ± 0.52), but nurses' safe care was at a moderate level (242.08 ± 61.32). A strong positive relationship was found between the patients' safety competency and nurses' safe care (p = 0.001, r = 0.84).

PRACTICE IMPLICATIONS

Nursing managers should support nurses by providing the required resources and operational strategies to improve their competency and safe care in providing quality care.

The Prevalence of Misophonia and Its Relationship with Obsessive-compulsive Disorder, Anxiety, and Depression in Undergraduate Students of Shiraz University of Medical Sciences: A Cross-Sectional Study

BACKGROUND

Misophonia is a severe emotional response to repetitive sounds. This disorder may limit a person's communication, reduce his/her ability, or disrupt his/her social and personal life. This study aimed to determine the prevalence of Misophonia and its relationship with obsessive-compulsive disorder, anxiety, and depression in undergraduate students of Shiraz University of Medical Sciences.

METHODS

The present study is an analytical descriptive study conducted in October 2020. The study samples consisted of 390 undergraduate students of Shiraz University of Medical Sciences. A relative and systematic sampling method was used. In this study, demographic questionnaire, misophonia questionnaire (A score of 7 or higher is considered as misophonia), Beck anxiety questionnaire, Beck depression questionnaire, and Maudsley obsessive-compulsive inventory questionnaire were used, and the data were analyzed using SPSS 24 software. In this study, chi-square test was used to examine the relationship between the variables. Due to the non-normality of the data, the Spearman correlation coefficient was used for data analysis. The significance level was considered equal to and less than 0.05.

RESULTS

Of the 390 participants in the study, 93 (23.8%) had experienced misophonia. Among these 93 students, 37 (39.8%) had obsessive-compulsive disorder, 8 (8.6%) suffered anxiety, and 9 (9.7%) were depressed. There was a significant and direct relationship between misophonia and obsessive-compulsive disorder,anxiety and depression respectively(P&lt;0.001).

CONCLUSION

Due to the prevalence of misophonia among students and its direct relationship with obsessive-compulsive disorder, anxiety and depression, we recommend that future studies should be conducted to find the ways to prevent and reduce the incidence of misophonia.

Psychometric analysis of Persian version of patient safety competency self-evaluation in psychiatric wards

BACKGROUND

Assessment of the patient safety competency is necessary for the growth of nursing and safe care profession as well as evaluation of the nurses' educational needs. The present study was conducted to determine psychometric properties of the Persian version of the patient safety competency self-evaluation (PSCSE) tool in Iranian psychiatric wards.

MATERIALS AND METHODS

All nurses (n = 209) working in two psychiatric hospitals of Kerman, Iran, were included in the present cross-sectional study using census method. This tool contains 41 items: six items are related to knowledge, 14 items deal with attitude, and 21 items are about skill dimension. Psychometric properties of the questionnaire including its content and face validity were also examined. The factor structure of the questionnaire was evaluated using exploratory factor analysis. The internal consistency and reliability were assessed by test-retest method with an interval of 14 days. Cronbach's alpha and corrected item-total correlation were used to measure reliability.

RESULTS

The content validity index was 0.65 and the content validity ratio was 0.89. Item 14 was removed from the skill domain because it was not related to the psychiatric ward. According to the results of factor analysis, there was a significant relationship between the questions and the relevant factors. The correlation coefficient for test-retest with 14 days interval was intraclass correlation coefficient = 0.92 for the whole instrument and 0.89, 0.89, and 0.92 for the domains of knowledge, attitude, and skill, respectively. The internal consistency coefficient (Cronbach's alpha) of the whole tool was 0.95 and 0.95, 0.79, and 0.95 for the domains of knowledge, attitude, and skill, respectively. Finally, PSCSE Questionnaire was obtained with 40 items in dimensions of knowledge (6 items), attitude (14 items), and skills (20 items).

CONCLUSION

Persian version of the nurses' competency tool in ensuring patient safety in psychiatric wards has acceptable psychometric characteristics.

Spiritual needs of mothers having children with cancer: A qualitative study

BACKGROUND

Diagnosing cancer, as a life-threatening event, in children and adolescents stops the normal course of life for all family members. Spirituality, which plays an essential role in coping with illness and death, can increase resistance against psychological crises induced by cancer diagnosis and treatment. This study aims to discover the spiritual needs of mothers having children with cancer aged 1-12 years old.

MATERIALS AND METHODS

In this qualitative study, the conventional content analysis approach was used. The research environment was three pediatric oncology wards of Amir Hospital in Shiraz, Iran. Data were collected from September 2019 to March 2020 through face-to-face semi-structured in-depth interviews. Fifteen participants including 12 mothers and 3 nurses were interviewed through purposive method considering maximal variation. The interviews were recorded, transcribed, and subjected to a qualitative analysis. Credibility, dependability, confirmability, and transferability of data were confirmed.

RESULTS

The mean (± standard deviation) age of the mothers was 35.76 (±5.96) years old. The spiritual needs of the mothers were classified into three categories, including religious well-being, existential well-being, and growth and excellence as well as seven subcategories. Religious well-being included subcategories of direct and indirect connection with God, existential well-being included subcategories of need for hope, multifaceted support, and rethinking, growth, and excellence consisted of subcategories of devoting yourself and surrender.

CONCLUSION

Mothers of children with cancer face important spiritual needs. Therefore, it is necessary for the treatment team to identify these needs and use them to provide appropriate spiritual care.

Assessing the Expectations and Perceptions of Nursing Students regarding the Educational Services in a School of Nursing and Midwifery Based on the SERVQUAL and Kano Models: A Case Study

This study determined the gap between student expectations and perceptions to achieve a relatively accurate description of student satisfaction. Student expectations and perceptions regarding educational services across a number of different dimensions were evaluated using SERVQUAL model, and the nature of each educational factor was determined using the Kano model. Three characteristics of 30 educational services indicators were placed in the cluster of students' basic needs, 26 characteristics were placed in the performance and one-dimensional needs cluster, and one characteristic was placed in the neutral needs cluster. No characteristics were put in the cluster concerning the motivational needs of students.

Effect of group-based logotherapy on imprisoned women’s level of hope: a randomized controlled trial (RCT)

Purpose

Female prisoners are a vulnerable group in society, often exposed to emotional deprivation and violent experiences and in need of support and attention due to mental health problems. The purpose of this study is to find out whether logotherapy, as an existential approach that emphasizes finding the true meaning in life, can affect imprisoned women’s level of hope, as well as investigating the relationship between participants’ criminological and demographic factors.

Design/methodology/approach

This study comprised a clinical trial with pre-test and post-test, carried out in two groups of intervention and control. The research environment for the study was the Prison Training Center of Shiraz. In total, 90 imprisoned women participated in the study, with the intervention group attending 10 sessions of group logotherapy. Two questionnaires, the Miller Hope scale and demographic and criminological information questionnaires were used for assessment. Participants were evaluated in three periods before, immediately after and one month after the intervention.

Findings

The results showed that logotherapy had a significant effect on increasing the feeling of hopefulness (p = 0.001). Therefore, using the logotherapy approach in other vulnerable groups is recommended.

Originality/value

This study can be a basis for further research due to limited studies on the mental health of women prisoners in the country.

Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial

Background

Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available.

Objective

This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group.

Methods

An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention.

Results

A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95% CI –17.44 to –8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95% CI –9.20 to –4.21, P<.001, d=0.88 and trait anxiety: 95% CI –8.50 to –4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95% CI 1.28 to 2.82, P<.001).

Conclusions

This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context.

Trial Registration

Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882

Empowering health volunteer's through participatory action research in a comprehensive healthcare center

Background

Health volunteers act as the link between the society and the healthcare system and are a symbol of people’s participation in the health maintenance and promotion. Despite the important role of health volunteers in the health system, it seems that they experience several problems. The aim of this study was empowering health volunteers through an action research.

Methods

This participatory action research was conducted through two continuous cycles of reflection and acting for change over 20 months, in a comprehensive health center in Southern of Fars province in Iran. Participants included 25 health volunteers; two instructors and an academic researcher as facilitator. In the first cycle the participants discovered the challenges of health volunteers, prioritized them, designed an action plan, and implemented it. At the end of this cycle, evaluation was done with the participants’ cooperation. The second cycle began with reflecting on the results of the first cycle and then after designing and implementing second action plan, final evaluation was done.

Results

Qualitative content analysis in the first phase led to the emergence of four categories, including role confusion, inadequate volunteer training, deficits in attracting and keeping volunteers, and being unfamiliar to the public. After the implementation of the action plan the participants learned through reflection and immersing in action. Finally, quantitative and qualitative data showed improvement of knowledge and performance, satisfaction, effectiveness of programs and improvement in volunteer’s competence.

Conclusions

Clarification of volunteers’ roles, supporting volunteers to improve their knowledge and skills with coherent planning based on their educational needs, are appropriate management plans to attract and retain volunteers. By presenting their services to the society, they will be empowered and motivated to continue.

Emotional and behavioral problems of 9–18-year-old girls and its relationship to menarche age

Background

Adolescence is associated with rapid changes in behavioral patterns which affect the functioning of the person in adulthood. The purpose of this research was to study the emotional and behavioral problems of 9–18-year-old girls and their relationship to menarche age. This cross-sectional study was done on girls aged 9–18 years old in Shiraz city. A cluster sampling method was used to select about 2000 students in 2015. Then, a questionnaire including demographic characteristics and strengths and difficulties (SDQ) was completed for each of them. The SPSS software was used to analyze the collected data via descriptive statistics and chi-square tests.

Results

Among the 2000 tested samples, the highest mean and standard deviation (4.2 ± 2.25) were related to emotional symptoms. Most of them (960 individuals = 48%) scored abnormally. The mean and standard deviation was 15.61 ± 5.89, and the highest value was 33. The highest mean and standard deviation (16.69 ± 5.4) ranged from 17 to 18 years old in 289 subjects. There was a significant relationship between the age of menarche and emotional and behavioral problems (p = 0.001). Most individuals (638 subjects) (46%) had abnormal emotional and behavioral problems in the menarche age of 11–12 years old.

Conclusion

Emotional symptoms were the most common emotional-behavioral problems of adolescents. There was a significant relationship between the menarche age and emotional and behavioral problems. It is necessary to be familiar with the problems of adolescent girls during adolescence and the way to deal with their problems.

The Relationship between Anxiety and Self-Esteem in Women Suffering from Breast Cancer

Background:

Breast cancer is the most common cancer in women worldwide that has great impact on their lives. Women with breast cancer are at increased risk for anxiety and low self-esteem.

Objective:

The purpose of this study was to explore the relationship between anxiety and self-esteem in women suffering from breast cancer.

Materials and Methods:

In this descriptive correlational study, all 261 women diagnosed with nonmetastatic breast cancer referred to cancer care clinics in winter 2016 were assessed. Data were gathered using demographic information inventory, Spielberger's State–Trait Anxiety Inventory and Rosenberg's Self-Esteem Scale, and were analyzed using SPSS statistical software (version 22). Descriptive statistics, the t-test, ANOVA, the Pearson correlation and the Spearman's correlation were also used.

Results:

The mean ± standard deviation (SD) age of participants in the study was 48.33 ± 10.837 years. The mean score of state and trait anxiety was 46.29 ± 11.745 and 46.61 ± 10.936, respectively. The mean ± SD score of self-esteem was 18.38 ± 5.08. The study results show an indirect correlation between anxiety and self-esteem in women suffering from breast cancer (r = −0.690).

Conclusions:

According to the considerable influences of anxiety and self-esteem on other aspects of physical, psychological, and social health, it is suggested that health-care professionals pay more attention to the self-esteem and psychological state of women diagnosed with breast cancer besides other medical treatments. Screening strategies for detecting psychiatric disorders in breast cancer patients and planning of effective interventions to promote self-esteem and reduce anxiety and its consequences are recommended.

Effect of Cardiac Rehabilitation on Hope Among Cardiac Patients After Coronary Artery Bypass Graft Surgery

PURPOSE

Following coronary artery bypass graft (CABG) surgery, some patients experience psycho-mental problems such as hopelessness. The Phase 2 cardiac rehabilitation (CR) program is an important element of the secondary prevention program in treating patients with cardiovascular disease (CVD). The present study aimed to determine the effect of the Phase 2 CR program on the level of hope in cardiac patients after CABG surgery.

PATIENTS AND METHODS

A clinical trial was conducted from July 2017 to late January 2018 at the Heart Surgery Centre, Al-Zahra Hospital, Shiraz, Iran. The target population was patients who sought CR therapy after CABG surgery. A total of 104 cardiac patients were recruited and equally divided into control and intervention groups. The intervention group received 20 sessions of Phase 2 CR program combined with education and counselling during 8 weeks. The control group only received routine observations and education. The data were collected pre- and post-intervention using a demographic form and the Miller Hope Scale (MHS). Descriptive statistics were expressed as percentages, frequency distribution, mean and standard deviation. Paired t-test and independent t-test were used for statistical inference. Data were analyzed using the SPSS statistical software (version 23.0) and P values <0.05 were considered statistically significant.

RESULTS

There was no significant difference in the mean score of hope between the control and intervention groups before the intervention. However, a significant difference between the groups was observed post-intervention (P<0.001). The results showed a significant difference in the mean score of hope between pre-intervention (182.36±23.07) and post-intervention (216.94±23.05) in the intervention group (P<0.001), whereas the difference in the control group was not significant (P=0.095). The measured post-intervention effect size was high (1.05).

CONCLUSION

The Phase 2 CR program combined with education and counseling increased hope in CVD patients after CABG surgery.

An Assessment of the Assertiveness among Students of Jahrom University of Medical Sciences

Introduction:

One of the most important attitudes which can affect personal, professional and social operation of individual, especially medical students is assertiveness.

Material and methods:

The samples of this research consist of 412 students of Jahrom University who are studying in Doctoral, Nursing, Technician of operation room and technician of Narcosis. Ratus Assertiveness test was used for gathering data.

Results:

The score of assertiveness was between 73/8-173.82.3% of students were unassertive and 17/7% was assertive. The highest rate of assertiveness was observed in the students of Narcosis (121.44±19.19) and the lowest rate was seen among doctoral students (113.30±14.64).

Conclusion:

The results reveal the prevalence of unassertiveness in the students of Jahrom University. The low assertiveness score in the male students is clear. Also students whose fathers are highly educated and also students who have better economic situation, have higher score.

[Factors affecting nursing students' professional self-concept in Iran: a qualitative study]

INTRODUCTION

Professional self-concept is a contextualized multidimensional concept that describes the subjective experiences and feelings of nurses with regard to nursing roles. Professional self-concept starts to develop during the academic years. Yet, there is still limited understanding about the factors affecting nursing students' professional self-concept, which is a potential problem. Poor professional self-concept negatively affects nurses' clinical practice, job satisfaction, and retention in the profession.

AIM

This study aimed to explore factors affecting Iranian nursing students' professional self- concept from the perspectives of nursing students, nursing instructors, and hospital nurses.

METHODS

This exploratory qualitative study was carried out from June 2018 to April 2019. Participants were four hospital nurses, three clinical nursing instructors, and four nursing stu- dents who were purposively selected from the Shiraz University of Medical Sciences, Shiraz, Iran. Data were gathered via in-depth semi-structured interviews and were analyzed via con- ventional content analysis proposed by Graneheim and Lundman.

FINDINGS

In total, 610 primary codes were generated and grouped into eleven subthemes and five main themes. The main themes of the study were professional instructors, competent nur- ses, informed choice of nursing profession, difficulties of nursing profession, and congruence between students' personal-professional values and nursing profession.

CONCLUSION

Professional self-concept is affected by different personal, educational, envi- ronmental, and social factors. Nursing instructors, hospital managers, and nurse managers can use the findings of this study to support nursing students, promote their professional self-con- cept, and ensure their retention in the profession.

The Experiences of Multiple Sclerosis Patients' Family Caregivers at the First Hospitalization of Their Patients: A Qualitative Study

BACKGROUND AND AIM

Being diagnosed with multiple sclerosis is usually accompanied by emotional trauma for patients and their families. The chronic, progressive, and unpredictable nature of the disease spells the patients' long-term need for care from their families. As soon as a diagnosis is made, family caregivers are faced with many challenges. The present study aims to identify family caregivers' experiences at the first hospitalization of their patients.

MATERIALS AND METHODS

The present study is a work of qualitative research and uses the conventional content analysis approach. It lasted from July 2019 to March 2020. The subjects were selected via purposeful sampling. To collect data, the researchers conducted in-depth, semi-structured interviews with 18 family caregivers of patients with multiple sclerosis. The collected data were analyzed using MAXQDA 2007.

RESULTS

Analysis of the data yielded three themes: peaceful environment, need for continuing full support, and religion-based coping strategies.

CONCLUSION

The findings of the present study can be used to develop support programs that address family caregivers' problems and needs to assist them in accepting and coping with the conditions of their patients, thereby increasing the quality of care provided to patients with multiple sclerosis.

Job Satisfaction Challenges Of Nurses In The Intensive Care Unit: A Qualitative Study

Background

Job satisfaction is an important factor in health care settings. This concept is not a single factor; rather, it is the product of factors such as the conditions and relationships that govern the workplace, the organizational system of employment, and social, cultural, and economic factors. Therefore, awareness of its related factors is important for medical staff including nurses in special units and nursing managers. The aim of the present study was to investigate job satisfaction challenges in intensive care unit (ICU) nurses.

Methods

This was a qualitative study using conventional content analysis approach. This study was performed in a general ICU of Amol City, Iran. Thirteen nurses employed in the ICU were recruited until data saturation was reached. Research data were collected through interviews, a focus group and field notes. Findings were analyzed using a conventional method.

Results

According to data analysis, 6 themes including "nursing education", "organizational resources", "management", "multiple occupational stresses", "professional performance" and "professional identity" were developed.

Conclusion

This study provided better and clearer understanding of job satisfaction challenges of nurses working in an ICU. The findings of this research can be helpful in developing management programs for understanding the factors affecting job satisfaction of nurses and job satisfaction promotion.

Relationship between occupational burnout and demographic variables among nurses in Jahrom, Iran

Introduction

Occupational burnout is a psychological syndrome caused by the accumulation of work-related stress and characterized by intolerance, high levels of emotional exhaustion, depersonalization, and the perception of low personal accomplishment. The present study aimed to evaluate the relationship between occupational burnout and all demographic variables among the nurses in Jahrom, Iran.

Methods

The present descriptive-analytical study was carried out during 2016 among nurses employed at Motahari Hospital and Peymanieh Hospital, both affiliated to Jahrom University of Medical Sciences (Iran). Based on the inclusion criteria, a total of 250 participants were selected. The data collection instruments included a demographic questionnaire and the Maslach burnout inventory. The data were analyzed using the SPSS statistical software (version 16.0) by descriptive statistics and Spearman's test.

Results

Among the participants, 223(89.2%) nurses suffered from a moderate to high level of occupational burnout. There was a significant correlation between personal accomplishment and age (r=0.21, P=0.002) and education level (r=-0.16, P=0.01). Additionally, income level had a significant correlation with emotional exhaustion (r=-0.38, P=0.001), depersonalization (r=-0.3, P=0.001), and personal accomplishment (r=0.35, P=0.001). A significant relationship was also found between sex and depersonalization (r=-0.15, P=0.02). However, there was no significant relationship between occupational burnout subscales and the number of children, type of hospital ward, type of employment, and marital status (P>0.05).

Conclusion

A significant positive correlation was found between the subscales of occupational burnout and younger age, low income, high education, and male nurses.

Job satisfaction and related factors among Iranian intensive care unit nurses

Objectives

The aim of this study is to determine the levels of job satisfaction and to collect information about the factors affecting job satisfaction of Iranian ICU hospital nurses.

Results

The participants included 124 nurses working in the ICU section of hospitals in the city of Amol in Iran, who were selected by census method. The instruments for gathering the information included Demographic Information Questionnaire and also the Minnesota Satisfaction Questionnaire. The results revealed that the average score of job satisfaction among ICU nurses was 2.50 ± 0.51. Also job satisfaction among women was higher than men (P = 0.03, t = 0.4). One way analysis of variance showed a significant relation between job satisfaction level with employment status and overtime work. Also older nurses had higher levels of job satisfaction. Hospital directors and managers, can use the results of this study in order to have a deeper understanding of job satisfaction among nurses, and the factors affecting it.

Impediments to the formation of intensive care nurses' professional identify

BACKGROUND

Nurses face challenges regarding professional identify. Being unaware of these challenges and not owning positive professional identify leads to a lack of self-confidence. Thus, nurses face problems in interpersonal communication and lose their attachment to their profession. Few studies have engaged with impediments to forming positive professional identity in relation to intensive care nurses.

OBJECTIVE

The purpose of this study is to investigate the impediments to forming positive professional identity in nurses working in intensive care unit.

RESEARCH DESIGN

In this study, the conventional content analysis method was used in order to obtain the impediments to forming positive professional identities in nurses. Data were collected through 15 semi-structured interviews and 2 focus group interviews from March 2015 to June 2016. Purposive sampling was used and participants were recruited until data saturation was reached; they were then analyzed using the conventional content analysis method.

PARTICIPANTS AND RESEARCH CONTEXT

In total, 24 intensive care unit nurses from one hospital in Northern Iran were selected through purposive sampling.

ETHICAL CONSIDERATION

This study was approved by the Ethics Committee of Shiraz University of Medical Sciences.

FINDINGS

Four main themes of professional identity challenges were extracted from the analysis of the data: neglect of professional status of nursing; distrust of nursing knowledge; unprofessional performance; and low professional attraction.

DISCUSSION AND CONCLUSION

Nurses stated that the neglect of the professional status of nursing and distrust of nursing knowledge have always been a hindrance in forming a positive professional identity. They also mentioned that unprofessional performance and low professional attraction are the other influencing factors in this regard. Thus, detecting these factors can guide nurses and their managers towards creating positive professional identity, and as a result, will improve their job satisfaction, professional advancement, and durability.

Operating room nurses' perception of professional values

BACKGROUND AND SIGNIFICANCE OF RESEARCH

Nurses' awareness of professional values and how those values affect their behaviors is an integral part of nursing care. There is a large body of research on nursing professional values, however, a careful survey of the available literature did not yield any studies investigating the status of professional values in operating rooms.

OBJECTIVE

This study aims to investigate the perception of operating room nurses of university hospitals toward professional values.

RESEARCH PLAN

In this cross-sectional study, data were collected using Schank and Weis's Nurses Professional Values Scale-Revised. The collected data were analyzed in SPSS version 16.

PARTICIPANTS AND SETTINGS

The 513 participants of the study consisted of operating room nurses and nurse anesthetists from six university hospitals.

ETHICAL CONSIDERATIONS

This study has been approved by the ethics committee of the university.

FINDINGS

The mean total professional values score of the operating room staff was found to be 100.84 ± 15.685, which indicates that the participants had a positive perception toward observance of nursing professional values in practice. The results showed that the participants considered the domains of justice and activism as, respectively, the most and the least important. The operating room staff's overall professional values scores were not found to correlate significantly with their ages, professional experience, university majors, or attendance at ethics workshops. However, a significant difference was found between the professional values scores of the female and male staff. The professional values scores of the operating room nurses and the nurse anesthetists were not significantly different (p value = 0.494).

CONCLUSION

Operating room staff's awareness of professional values is essential to providing care to patients based on professional principles. Accordingly, there is need for programs to raise operating room nurses' awareness of their professional duties and improve their professional performance.

Patients’ perception of dignity in Iranian general hospital settings

Background:

Dignified care is one of the main objectives of holistic care. Furthermore, paying attention to dignity as one of the fundamental rights of patients is extremely important. However, in many cases, the dignity of hospitalized patients is not considered. Dignity is an abstract concept, and comprehensive studies of the dignity of Iranian patients hospitalized in general hospital settings are limited.

Objective:

The aim of this study was to explore the concept of dignity from the perspective of patients hospitalized in general hospital settings in Iran.

Research design:

This study takes a qualitative approach. Data were gathered using individual, semi-structured interviews. Qualitative content analysis was the method used to analyse and interpret the data. The criteria suggested by Guba and Lincoln were used ensure the trustworthiness of the study.

Participants and research context:

A total of 14 hospitalized patients in general hospital settings in Shiraz participated in this study.

Ethical considerations:

The Research Ethics Committee of the Shiraz University of Medical Sciences approved the protocol of the study and the ethical principles were followed throughout.

Findings:

The findings of this study revealed four main themes – ‘respectful atmosphere’, ‘patient privacy’, ‘preservation of authority’ and ‘receiving attention’ – and 10 categories.

Discussion:

Patients need to be hospitalized in a respectable environment in which their privacy is preserved and paid attention, providing them with sufficient authority in terms of medical decisions and their life-related issues. The dignity of hospitalized patients will be preserved under these conditions.

Conclusion:

Patients hospitalized in general hospital settings need to retain their dignity. This can contribute to the optimal therapeutic outcomes for them. Therefore, it is suggested that a cultural, professional and institutional background, in which all components of the patient’s dignity are protected and emphasized, should be provided.

The Effect of Self-Care Education on Emotional Intelligence and HbA1c level in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Clinical Trial

BACKGROUND

The role of Emotional Intelligence (EI) in glycemic control in type 2 Diabetes Mellitus (DM) has not been fully understood. The present study aimed to investigate the effect of self-care education on EI and hemoglobin glycosylated (HbA1c) in patients with type 2 diabetes.

METHODS

In this randomized controlled clinical trial, 48 patients with type 2 DM referred to Shahid Motahari Diabetes Center in 2015 were divided into an intervention and a control group using block randomization. The study data were collected using Bar-On questionnaire and blood testing immediately and two months after the intervention. The educational content was presented to the intervention group through 1-1:30-hour sessions held once a week for 8 continuous weeks. The control group, however, only received the clinic's routine cares.

RESULTS

The results showed a significant difference in the mean level of HbA1c in the intervention group before and two months after the intervention (P=0.003). However, this difference was not significant in the control group. Moreover, the mean of EI was higher in the intervention group compared to the control group (P=0.08).

CONCLUSION

Self-care education improved the HbA1c level and EI among the patients with type 2 DM. Therefore, it is recommended that health care providers, specially nurses, should train the diabetic patients for self-care, which can lead to better glycemic control. Trial Registration Number: IRCT201408188505N7.

Challenges faced by health volunteers in comprehensive health centers in the southwest of Iran: A qualitative content analysis

Introduction:Health volunteers are employed to execute governmental health promotion programs in most countries around the world. The present study aimed to assess the challenges of health volunteers program to provide a better understanding of the present situation. Methods:This study was conducted using a qualitative approach. 14 participants were selected purposively selected from two comprehensive health care centers in the southwest of Iran. The data were collected through 14 semi-structured interviews, 2 observations, and 3 diaries and analyzed using content analysis. Results:Data analysis resulted in emergence four themes, namely role confusion, the inefficiency of volunteers training, the inefficiency of attraction and maintenance of volunteers, and being unknown to people. Unfertilized capacity is the main theme extracted from all themes. Conclusion:Health volunteers' perfect accomplishment of roles will have a positive impact on the provision of primary healthcare services and health objectives. Hence, comprehensive planning based on the needs of health volunteers will change them into a strong arm in the health system. Thus, managerial support and precise planning seem to be necessary for facing these challenges.

Evaluating the Effectiveness of a Continuing Education Program for Prevention of Occupational Exposure to Needle Stick Injuries in Nursing Staff Based on Kirkpatrick's Model

BACKGROUND

Nurses are the most vulnerable group that are faced with occupational injuries caused by exposure to needle stick injuries. This study evaluated the effectiveness of a continuing education program about the prevention of occupational exposure to needle stick injuries in the nursing staff, based on the Kirkpatrick model.

METHODS

In this study, 120 nurses were selected in the experimental and control groups. A continuing education program for experimental group was performed. After the education program, its effectiveness has been evaluated across four levels (Reaction, Learning, Behavior, Results) of the Kirkpatrick model. Data analysis was conducted using Pearson's correlation coefficient, chi-square test, paired t-test, independent samples t-test, and descriptive statistics. The data were analyzed using the SPSS statistical software (V. 22).

RESULTS

The mean score for knowledge in the experimental group improved significantly from 8.32 ± 2.17 to 13.98 ± 1.2 (p < 0.05). The experimental group of 24 nurses (40%) were exposed to needle stick injury before education, but this number was reduced to 9 (15%) after intervention. The chi-square test showed a significant difference (P = 0.013). However in the experimental group, 15 nurses (25%) were exposed to blood and body fluids before intervention, but again it was reduced to 6 (10%) after education. The chi-square test showed a significant difference (P = 0.002).

CONCLUSION

The results from the execution of continuing education program showed that through designing training programs and raising awareness in nursing personnel, we can reduce occupation exposure to needle stick injuries.

Hospitalized adolescents' perception of dignity: A qualitative study

BACKGROUND

Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents' recovery. However, many studies have been conducted on exploring the concept of the patients' dignity from the adult patients and fewer studies still have explored the dignity of young people.

OBJECTIVE

This study explores the hospitalized adolescents' perception about dignity.

RESEARCH DESIGN

A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents' dignity.

PARTICIPANTS AND RESEARCH CONTEXT

Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13).

ETHICAL CONSIDERATIONS

Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees.

FINDINGS

Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication.

DISCUSSION AND CONCLUSION

Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent's identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses.

A web-based anger management program for parent-female adolescents' conflicts: a cluster randomized controlled trial

Objective This cluster randomized control trial was performed to evaluate the effectiveness of a web-based anger management program for mother-female adolescents' conflicts. Methods Eight out of 23 high-schools in District Two of Shiraz, Iran were chosen using random cluster sampling and randomly assigned to an intervention and a control group (each group consisted of four schools). The conflict tactics scale was filled out by all eligible third grade high school students in both groups and 140 students who had the scores higher than 30 were randomly selected; 70 adolescents in the intervention group participated in an 8 week intervention, while 70 adolescents in the control group did not undergo any intervention. Data collection was performed at the end of the intervention and 1 month later. Results The results of the t-test revealed no statistically significant differences between the study groups regarding the total conflict tactics scores (p = 0.935) or any of the three subscales before the intervention (p > 0.05). However, a significant difference was observed between the two groups in this regard immediately and 1 month after the intervention (p < 0.05). The results of repeated measure analysis of variance (ANOVA) demonstrated a significant difference between the intervention and control groups regarding the conflict scores and its subscales during the three study periods and groups (F = 79.43, p < 0.001). Conclusion This study highlighted the importance of applying a web-based anger management program in decreasing mother-female adolescents' conflicts. Similar studies are recommended to be conducted on the issue.

The effect of Self-Management Training on Self-Efficacy of Cirrhotic Patients Referring to Transplantation Center of Nemazee Hospital: A Randomized Controlled Clinical Trial

BACKGROUND

Cirrhosis is a chronic and progressive disease that causes various complications for patients due to disturbance of the liver's usual function. Self-efficacy refers to an individual's belief in one's ability to perform the necessary behaviors to achieve one's goals. Self-management is also an important criterion for long-term change in behavior. The present study aimed to investigate the effect of self-management training on self-efficacy of patients suffering from liver cirrhosis.

METHODS

This randomized controlled clinical trial was conducted on 74 patients with liver cirrhosis randomly assigned to an intervention (receiving self-management training) and a control group (routine care) from 2012 to 2013. The data were collected in the transplantation center affiliated to Shiraz University of Medical Sciences. Self-management training was performed in six 90-minute sessions twice a week. Besides, the intervention group was followed up for a month via telephone. Levo self-efficacy questionnaire was filled out by the patients before, immediately after, and one month after the intervention. Then, the data were entered into the SPSS statistical software (v. 16) and analyzed using independent t-test, Chi-square test, and repeated measures ANOVA.

RESULT

At the beginning of the study, no statistically significant difference was found between the two groups regarding self-efficacy (P=0.18). However, the total score of the questionnaire and those of all its dimensions significantly improved in the intervention group immediately and one month after training self-management skills (P<0.001). The mean score of self-efficacy was 102.24±7.79 and 76.78±9.49 in the intervention and control groups, respectively. On the other hand, no statistically significant difference was observed in the control group's self-efficacy immediately and one month after the intervention (P=0.6).

CONCLUSION

The results showed that the self-management program resulted in improvement of self-efficacy in the patients with liver cirrhosis. Therefore, this supportive strategy could be useful in patients with chronic illnesses for improvement of care and prevention of complications.

Adequate Resources as Essential Component in the Nursing Practice Environment: A Qualitative Study

INTRODUCTION

Attracting and retaining well qualified nurses to develop healthcare systems and ensure patient safety is a global concern. In this regard, the quality of the practice environment plays a crucial role.

AIM

To explore Iranian nurses perception on the key constituents of the nursing practice environment.

MATERIALS AND METHODS

This study was conducted using a qualitative approach. Twelve participants were purposively selected from five teaching hospitals in Shiraz, Iran. Data was collected through semi structured interviews, and analysed using qualitative content analysis.

RESULTS

Data analysis led to the extraction of two categories of 'adequate staff', with two subcategories of balanced workload and well qualified nurses, and 'adequacy of physical resources', with subcategories of equipment adequacy and appropriate physical structure as key elements of the nursing practice environment.

CONCLUSION

Imbalanced workloads, inappropriate nurse-patient ratios, and inadequate physical resources negatively affected nurse's perceptions of the quality of the nursing practice environment. The findings provide baseline data for health policymakers in different national and global areas to remodel the practice environment. The improvement of the practice environment, with adequate staffing levels and appropriate allocation of physical resources, is achievable to resolve this challenge and thus improve outcomes.

Efficacy of Bowen Theory on Marital Conflict in the Family Nursing Practice: A Randomized Controlled Trial

Family plays an important role in health and illness, and preparing the nurses to assess and improve the family functioning and relationship based on a theoretical framework is of critical importance. This randomized controlled trial was performed to evaluate the effectiveness of Bowen system theory on marital conflict in the family nursing practice. A total of 42 couples referring to the family court of Shiraz, Iran were randomly assigned to either the intervention (receiving eight 90-minute sessions of Bowen systemic family therapy) or the control group (receiving no interventions). Outcomes were measured before, after and after one month of the follow up by marital conflict questionnaire and analyzed using repeated measure ANOVAs and t-test. The study results revealed no statistically significant differences between the study groups regarding the total marital conflict scores (t = 2.8, p = .935) or any of the seven subscales of conflict before the intervention (p > .05). However, a significant difference was observed between the two groups in this regard immediately and one month after the intervention (p < .05). The results demonstrated a significant difference between the intervention and control groups regarding the conflict scores and its subscales during the three study periods and groups (F = 79.43, p < .001). This study highlighted the importance of applying Bowen systemic family therapy by nurses in decreasing marital conflicts. Similar studies with larger sample sizes and longer follow-ups are recommended to be conducted on the issue.

Comparison between the effects of muscle relaxation and support groups on the anxiety of nursing students: A randomized controlled trial

OBJECTIVE

To compare the effects of the two methods of muscle relaxation and support group on the anxiety levels of the nursing students.

METHODS

In this randomized controlled trial, 150 nursing students who met the inclusion criteria were divided into three equal groups-muscle relaxation, support group, and control-using the permuted-block randomization method. The experimental groups received 5 sessions of intervention, while the control group did not receive any intervention at all. Using Spielberger's inventory, the researchers measured the anxiety levels of all three groups before and after the intervention.

RESULTS

The results showed that both methods had a significant impact on anxiety levels of the nursing students; however, a comparison between their effects revealed that muscle relaxation had been more effective than support group.

CONCLUSIONS

Considering the seriousness of the issue of anxiety for nursing students, it is important that measures be taken to reduce anxiety in this group.

Pattern of menarche age (normal, early and late) and its relationship with some demographic characteristics in girls and their parents

BACKGROUND

Menarche age is an indicator of a girl's puberty besides the clinical assessment of detecting deviations. This study aimed to search the pattern of menarche age (normal, early and late) and its relationship with some demographic characteristics in girls and their parents.

METHODS

This cross-sectional study was done on girls aged between 9 and 18 years old in Shiraz city. About 2000 students were selected through cluster sampling. Data collection was done by applying a demographic information form. Finally, the data were analyzed using SPSS software.

RESULTS

About 1386 students (69.3%) had the history of menarche (at least once). The mean age of menarche was 12.26±1.11 years in Shiraz. The menarche age of the girls ranged from 9 years (as the least) to 15 (as the maximum). The prevalence of late menarche was 1.1%. In addition, no early menarche was reported. There was no relationship between menarche age and economic status, birth order and number of children, but a significant relationship was found between the parents' education, house status, and the lifestyle of parents.

CONCLUSION

The mean menarche age has been decreasing in cities. Therefore, it seems necessary for the families to be aware about the influence of time, trend and affecting factors on menarche; this helps them to make good decisions when educating their teenagers.

Physical and Mental Health of Patients Immediately After Discharge From Intensive Care Unit and 24 Hours Later

Background:

Monitoring the health status of patients discharged from intensive care units is a crucial method of service evaluation.

Objectives:

This study aimed to assess the physical and mental health status of patients immediately after discharge from the ICU and 24 hours later.

Patients and Methods:

This descriptive comparative study was conducted on 104 patients discharged from the ICUs of a referral trauma center in Shiraz, Southwest Iran. Physical parameters, including respiratory rate, need for supplemental oxygen, heart rate, blood pressure, and need for cardiac monitoring, were assessed. Hospital anxiety and depression scale (HADS) was used for mental health evaluation. The mental and physical status of patients were assessed before ICU discharge and 24 hours later; data were recorded in information forms and were analyzed using SPSS statistical software version 17.

Results:

At the time of discharge, the respiratory rate of 28% of the participants was more than 24 minutes, and 95.2% received supplemental oxygen. However, after 24 hours these values decreased to 10% and 21.6%, respectively. The mean heart rate and systolic blood pressure were within the normal range at both time points. Additionally, 63% of the patients had anxiety scores above 11 at both time points, reflecting high anxiety. The number of patients who reported depression increased from 58.7% at ICU discharge to 69.6% after 24 hours.

Conclusions:

Despite the considerable improvement in most of the patients’ physical condition in the first 24 hours after discharge from ICU, a significant number of them remain at risk for the development of adverse effects from this transition. The high prevalence of mental health disorders in these patients reveals the necessity to conduct follow-up consultations.

Reinforcement Behavior Therapy by Kindergarten Teachers on Preschool Children's Aggression: A Randomized Controlled Trial

BACKGROUND

Aggression is a kind of behavior that causes damage or harm to others. The prevalence of aggression is 8-20% in 3-6 years old children. The present study aimed to assess the effect of training kindergarten teachers regarding reinforcement behavior therapy on preschoolers' aggression.

METHODS

In this cluster randomized control trial, 14 out of 35 kindergarten and preschool centers of Mohr city, Iran, were chosen using random cluster sampling and then randomly assigned to an intervention and a control group. All 370 kindergarten and preschool children in 14 kindergarten were assessed by preschoolers' aggression questionnaire and 60 children who obtained a minimum aggression score of 117.48 for girls and 125.77 for boys were randomly selected. The teachers in the intervention group participated in 4 educational sessions on behavior therapy and then practiced this technique under the supervision of the researcher for two months. Preschoolers' aggression questionnaire was computed in both intervention and control groups before and after a two-month period.

RESULTS

The results demonstrated a significant statistical difference in the total aggression score (P=0.01), verbal (P=0.02) and physical (P=0.01) aggression subscales scores in the intervention group in comparison to the control group after the intervention. But the scores of relational aggression (P=0.09) and impulsive anger (P=0.08) subscales were not statistically different in the intervention group compared to the controls.

CONCLUSION

This study highlighted the importance of teaching reinforcement behavior therapy by kindergarten teachers in decreasing verbal and physical aggression in preschoolers.

TRIAL REGISTRATION NUMBER

IRCT2014042617436N1.

Effect of Orem Self-Care Program on the Life Quality of Burn Patients Referred to Ghotb-al-Din-e-Shirazi Burn Center, Shiraz, Iran: A Randomized Controlled Trial

BACKGROUND

Advances in treatment and critical care have largely improved the survival following burns; therefore, the importance of quality of life in burn patients is an issue beyond question. The aim of this study was to determine the effects of Orem self-care program on Quality of Life of burn patients.

METHODS

A randomized clinical trial study was conducted on 110 eligible burn patients who were selected using easy sampling method and allocated randomly into two groups of experiment and control. The instrument for data collection was a questionnaire, containing demographic and burn information and burn-specific health scale-brief (BSHS-B) questionnaire. For the experiment group, 5 sessions of theoretical training and 75-90 minutes of practical training were accomplished. The quality of life of the patients with burns was assessed in three phases by the BSHS-B questionnaire. The data were analyzed in SPSS-17 using Chi-square test, Fisher's exact test, Independent t-test and repeated measurement multivariate test.

RESULTS

After one month and two months of the use of self-care model, the quality of life of the cases improved from 73.33% to 83.78% and 98.12%, respectively (P<0.001). But the changes in the quality of life of the patients in the control group were not statistically significant (P>0.05).

CONCLUSION

Based on the obtained results of this study, designing and implementing a self-care program based on Orem's model and the needs of burn patients will improve their quality of life. Therefore, it is recommended that this program should be considered as a part of treatment program for these patients. Trial Registration Number : 2013042112129N1.

Challenges of Nursing Handover

The aim of this study was to explore the challenges of nursing handover process during shift rotation in hospitals. The research had a descriptive exploratory design with a qualitative content analysis approach. To conduct the study, three pediatric wards were selected at first. Data were gathered through a 4-month observation of nursing handovers by recording the oral conversations of nurses during the process and semistructured interviews. Then, qualitative content analysis was used for data analysis. Two major themes and five subthemes emerged through the data analysis. The first and the second themes were a nonholistic approach and poor management, respectively. In general, applying a holistic approach and managing handover situations are recommended for nursing managers to overcome handover challenges. Future focus could be on addressing handover challenges through an action research study.

Living with and caring for patients with Alzheimer's disease in nursing homes

INTRODUCTION

Many of the patients with Alzheimer disease are taken care of in nursing homes. However the literature on the experiences of Iranian formal caregivers of older adults with Alzheimer disease is scarce. This qualitative study explored the caring experiences of formal caregivers in nursing homes that can improve the quality of care and patient's quality of life.

METHODS

This qualitative study used the principles of descriptive content analysis to analyze these data. Our participants included 11 female and 3 male caregivers aged 25 to 38 years who were selected for interviewing based on a purposive sampling method. The data were analyzed with a content analysis method.

RESULTS

Nearly 900 initial codes were extracted and categorized into 6 main themes including "managing difficult behaviors", "dependence on familial care", "continuum of different feelings", "care for a child", "living with the patients" and "not understanding the patients", which was further analyzed in the two subcategories "caring without enough information" and " a dead man moving". conclusion: The care provided by our informants was mainly influenced by attitudes, culture and religious beliefs of caregivers about family attachment and ample driven reward of helping and caring frail or old people in Islam. These cultural and religious beliefs could facilitate provision of care and confrontation with patients' child-like behaviors. It is suggested that employment of trained staff and plans for their continued education can improve the quality of care and the quality of the patient's life.