Patient education among nurses: bringing evidence into clinical applicability in Iran

The Relationship between Social Capital and Self-Efficacy in Women with Gestational Diabetes Mellitus: A Cross Sectional Study

Background

Self-efficacy is one of the most likely determinants of glucose self-management and self-monitoring by diabetic patients. Also, social capital is one of the effective social factors that may affect health behaviors. The aim of this study was to evaluate the relationship between social capital and self-efficacy in women with gestational diabetes mellitus (GDM).

Methods

This descriptive-analytical cross-sectional study was conducted on 212 women with GDM in two diabetes center in Mazandaran, north of Iran, from April to July 2019. Patients' social capital and self-efficacy levels were measured using the Social Capital Questionnaire (SCQ) and Confidence in Diabetes Self-Care Scale questionnaire, respectively.

Results

Among eight dimensions of social capital, the highest and the lowest mean scores were related to proactivity (21.3) and tolerance of diversity (5) dimensions. The mean (standard deviation=SD) of self-efficacy total score was 40.7(18.2), indicating moderate self-efficacy. Pearson correlation coefficient indicated that there was significant positive relationship between all dimensions of social capital and self-efficacy (p˂0.05). In addition, the results of multiple regression analysis indicated that community participation, neighborhood connections, family and friends' connections, tolerance of diversity and work connections, explained 55% of the variance in self-efficacy in women with GDM (p˂0.05).

Conclusion

The results highlighted a significant positive relationship between social capital and self-efficacy in women with GDM. Improving women’s social capital may enhance their self-efficacy in controlling GDM.

A Validation Study of the Korean Version of the Nurses' Patient Education Questionnaire

This study aimed to investigate the internal consistency reliability and construct validity of the Korean version of the Nurses’ Patient Education Questionnaire. An accurate assessment of nurses’ perceived patient education competency is required, and these needs assessment results can provide the evidence for designing a continuing education to empower and equip nurses with optimal competency for patient education. A cross-sectional study was used to which a convenience sample of 262 hemodialysis unit nurses in the Republic of Korea. In the exploratory factor analysis, the questionnaire consisted of 26 items belonging to seven factors: (1) nurse belief and knowledge; (2) documentation of patient education activities; (3) collegial teamwork; (4) educational environment; (5) interdisciplinary cooperation; (6) education foundation; and (7) health care organization, all of which accounted for 70.2% of the variance. The internal consistency reliability was 0.91 for the overall scale and each factor at 0.70 to 0.77. The questionnaire provides a valid and reliable instrument to assess nurses’ patient education competency.

Nurses' knowledge, skills and personal attributes for competent health education practice: An instrument development and psychometric validation study

AIM

To develop and psychometrically test the Nurse Health Education Competence Instrument for assessing nurses' knowledge, skills and personal attributes concerning competent health education practice.

DESIGN

A psychometric instrument development and validation study.

METHODS

A four-step approach was used: Step 1) operational definition based on an up-to-date concept analysis and experts' judgement; step 2) item generation and content validation by expert panel and target population; step 3) item analysis based on acceptability, internal consistency and face validity; and step 4) psychometric evaluation based on construct validity, criterion validity, internal consistency and stability, conducted from January -February 2019 with 458 hospital-care nurses.

RESULTS

The operational framework and expert groups showed good content validity, resulting in the first version. From the initial 88-item pool, 58 items were retained after item analysis. Exploratory factor analysis revealed three scales concerning the cognitive (three-factor solution with 23 items), psychomotor (two-factor solution with 26 items) and affective-attitudinal (one-factor solution with nine items) competency domains, which respectively accounted for 58%, 53% and 54% of the variance. Known-group study demonstrated significant differences by years working in the service and training received in health education, providing evidence for the measure's sensitivity. The three scales correlated positively with the criterion variable. Overall Cronbach alphas for the cognitive, psychomotor and affective-attitudinal scales were 0.95, 0.95 and 0.90, respectively. Intraclass correlation coefficients were >0.70.

CONCLUSIONS

The newly developed Nurse Health Education Competence Instrument is an original and tested self-reporting psychometric tool, being the first to identify nurses' knowledge, skills and attributes necessary for planning and assessing health education practice competency.

IMPACT

The instrument permits measurable insights into nurses' perceptions regarding their health education competence and related educational needs. This study provides a valid and specific learning tool that is appropriate to use both in clinical practice and in nursing education programmes.

Exploring Iranian obese women's perceptions of barriers to and facilitators of self-management of obesity: A qualitative study

BACKGROUND

Despite the clinical importance of self-management for obesity, poor compliance or noncompliance with the treatment regimen is a prevalent and persistent problem concerning people with obesity.

AIMS

The aim of this study was to explore Iranian obese women's perceptions regarding the barriers to and facilitators of self-management of obesity.

MATERIALS AND METHODS

In this qualitative study, the participants were selected through purposeful sampling and the data were collected using semistructured interviews and focus groups between July 2017 and September 2018. Nineteen participants between the age range of 28-50 years and mean age of 38.56 years were interviewed. A focus group with seven participants was conducted to reach data saturation. All the interviews and the focus group were transcribed verbatim and the data were analyzed using constant comparative method.

RESULTS

The perceived barriers to obese women's self-management for obesity were identified and classified into four main categories: (I) restrictions, (II) the pressures of being in the group, (III (temptation, (IV) resonators. In addition, seven main categories emerged as facilitators of obese women's self-management for obesity: (I) achieving self-awareness, (II) positive consequences for weight loss success, (III) positive outcomes of exercise and physical activity, (IV) peers experience, (V) correct and logical program, (VI) autonomy and empowerment, and (VII) having supporting umbrella.

CONCLUSION

This qualitative research provided a range of facilitators and barriers to self-management of obesity perceived by an obese woman to improve our understanding of the complex nature of self-management of obesity. Healthcare providers may consider this issue while designing and implementing appropriate interventions to upgrades woman's ability for self-management of obesity.

Occupational Burnout and Its Related Factors Among Iranian Nurses: A Cross-Sectional Study in Shahroud, Northeast of Iran

BACKGROUND

Good physical and mental health of employees is one of the major characteristics of a healthy organisation.

AIM

Due to the importance of occupational burnout and its potentially negative consequences, the aim of this study was to assess occupational burnout and its related factors among Iranian nurses.

METHODS

In this cross-sectional study, 205 nurses who were working in two educational hospitals affiliated with Shahroud University of Medical Sciences were included. Forty-two of the nurses were male, and 163 were female (mean age: 31 years). Maslach Occupational Burnout Inventory, demographic and job characteristics questionnaires were completed for each nurse. Questionnaires were then collected, and data were analysed statistically by SPSS, version 22.

RESULTS

In the assessment of occupational burnout, the highest level was observed in emotional exhaustion and then in personal performance. There was a significant difference between the frequency of nurses' emotional exhaustion domain in terms of gender (P < 0.05), so that, women suffered more from emotional exhaustion. There was a significant difference between the frequencies of nurses' performance in terms of marital status (P < 0.05) so that married people had more personal performance disorder.

CONCLUSION

The results of this study showed that nurses suffered from low occupational burnout. Female gender, sleeping disorders, awakening at night and employment in stressful wards such as the emergency ward was associated with a higher level of occupational burnout in nurses.

The prevalence of post-traumatic stress disorder among emergency nurses: a cross sectional study in northern Iran

Background and objective: Posttraumatic stress disorder (PTSD) is one of the anxiety disorders which occurs in response to facing events and accidents accompanied by fear, frustration, and terror. Nurses who worked in the emergency departments witness unpleasant accidents and are exposed to stress and violence more than others. The aim of this study was to investigate the prevalence of PTSD among Iranian nurses working in the emergency department.

Materials and Methods: In this cross-sectional study, all nurses working in the emergency department of educational hospitals affiliated with Mazandaran University of Medical Sciences were included through census method (n = 131). Each of the participants in this study responded to the questionnaires individually. The first part of the questionnaire captured demographics, while the second part was the Civilian Mississippi Scale for PTSD, which was used to investigate the extent of PTSD in this study. Data were analyzed using SPSS version 22.

Results: In this study, 131 respondents were included. In the classification of age, nurses with 20-30-year- old had the maximum frequency (41.2 %,). Most nurses in the study (93.1%, n = 122) had a bachelor’s degree in nursing and 84 were married. The prevalence of PTSD in emergency nurses was 82.96%, which was higher in nurses with shorter working background and nurses with lower levels of education. Further, the average score of PTSD was higher in married nurses.

Conclusion: The results of this study revealed the high prevalence of PTSD among nurses who worked in emergency department. Therefore, it seems that designing and providing supportive and educational services to emergency nurses can be effective for preventing and managing this disorder, which probably can improve their performance.

Exploring the Experiences of Iranian Women Regarding Obesity Self-Management: A Qualitative Study

BACKGROUND

Despite the high and growing prevalence of obesity in Iran and a variety of interventions by the healthcare providers control the problem, and it is still a prevalent health problem among Iranian women.

AIM

The aim of this study is to explore the perspective of obese Iranian women in the process of self-management regarding the facilitating factor in self-management of obesity.

METHODS

In a qualitative study, the participants were selected through purposeful sampling, and the data were collected using semi-structured interviews and focus group (n = 25) between July 2017 and September 2018. All the interviews were transcribed verbatim and the data were analysed using constant comparative method.

RESULTS

Supporting the umbrella was the main category found in the present study. The participating obese individuals found "support" as the main factor with an outstanding effect on motivating, incentivising and keeping diet in long-term. This category contains subcategories: self-help; family, friends, and peers' support; and medical team's support.

CONCLUSION

The findings suggested the critical role of support in obesity self-management process. This critical factor improves our perception of the multi-aspect and complicated nature of obesity self-management. Moreover, policymakers and providers of health services can utilise this finding in the design of care plans with higher chance of success.

Exploring the Human Factors Affecting Health Service Managers: A Qualitative Study

BACKGROUND

In recent decades, managing health-service systems has faced multiple challenges. Identifying and resolving these challenges promote the efficiency and effectiveness of hospital activities.

AIM

The present study aimed to explore the human factors affecting health service managers.

MATERIAL AND METHODS

In this qualitative study, in-depth unstructured interviews were conducted with 29 employees who were in close contact with the health service managers. All the interviews were transcribed verbatim. Data were collected using purposeful sampling and were analysed using conventional content analysis via MAXQDA software.

RESULTS

A group of 29 participants were interviewed (male 65.5%, female 34.4%). "Managing managers" has been identified as the primary theme with four supporting secondary themes including the inappropriate appointment of managers, the impact of human and social needs of managers, influential employees, and disrupting organisational communications. These are the challenges faced by managers in managing human resources in health-service organisations.

CONCLUSION

Results showed that employees manage their managers within the organisation so that they can prevent managers from concentrating on their management affairs and tasks resulting in the distortion of management practices. The results of this study can help the key policy makers and planners in health-service organisations to guide the organisation to pursue its goals through appointing appropriate managers and identifying influential employees.

Effects of Face-To-Face and Online Training on Self-Care of Middle-Aged and Elderly People with Type 2 Diabetes: A Comparative Study

BACKGROUND:

Self-care training is one of the strategies used to control diabetes. There is some ambiguity about the appropriate method for educating middle-aged and older adults about self-care.

AIM:

This study aimed to compare the effects of face-to-face and online training on self-care levels in middle-aged and older adults with type 2 diabetes.

MATERIAL AND METHODS:

In a randomised clinical trial, 84 middle-aged and older adults with type 2 diabetes who had been referred to the Diabetes Clinic of Esfarayen in Iran, were evaluated. Patients who meet the inclusion criteria were randomly assigned into two groups. Diabetes self-care education (DSCE) was provided using a face-to-face training method in one group and using online training method in the other group. The summary of diabetes self-care activities (SDSCA) questionnaire was completed at baseline and 1 month after training.

RESULTS:

The mean and standard deviation of self-care scores before and 1 month after training were 43.16 ± 14.94 and 65.76 ± 10.65 in the face-to-face training group, and 37 ± 10.75 and 56.82 ± 12.06 in the online training group, respectively. The differences in the self-care scores were significant both before and after the intervention in the two groups (p < 0.05). Although the difference was greater in the face-to-face training group than in the online training group, it was not statistically significant (P > 0.05).

CONCLUSION:

Both face-to-face and online training had a similar effect on the self-care levels in middle-aged and older adults with type 2 diabetes. Therefore, both training methods could be used as effective techniques to meet the needs and educational requirements of middle-aged and older adults with type 2 diabetes.

Exploring the Experiences of Oncology Nurses about the Factors Facilitating their Presence at the Bedside of Patients with Cancer: A Qualitative Study

BACKGROUND

The presence of nurses at patients' bedside is regarded as an indication of the quality of care. There is not enough evidence on facilitators of nurses' presence at cancer patients' bedside.

AIM

The present study aimed to investigate nurses' experiences of factors facilitating their presence at patients' bedside in oncology ward.

SUBJECTS AND METHODS

In this qualitative study, data were collected using purposeful sampling and semi-structured individual interviews with 25 oncology nurses from two teaching hospitals in Sari, Northern Iran, between 2016 and 2017. Interviews were digitally recorded, handwritten, coded, classified, and analyzed using conventional content analysis approach.

RESULTS

Data analysis led to the development of three main categories and seven subcategories. The first category, namely, "leverage spirituality" with two subcategories (motivational beliefs and religious motives). "Being with patient with compassion and commitment" is the second category with two subcategories (sense of altruism and compassionate care and adherence to the profession). The third category is "effective communication" with three subcategories (initial methods being patient, soothing communication, and intimate communication).

CONCLUSION

The results of this study showed that nurses' spiritual beliefs, kindness, and professional commitment and establishing human-friendly relationships with the patient and family would help the nurses of the oncology unit to have a more effective presence in the patients' bed. It seems that further studies are needed to examine the facilitators of the presence of oncology nurses on patients' bedside based on severity of illness.

Factors Related to Breast Cancer Screening in Women in the Northern Part of Iran: A Cross-Sectional Study

BACKGROUND

Breast cancer is the most common type of cancer in women and affects many women around the world each year. Breast cancer screening is one of the best strategies that can be used to reduce the death rate from the disease. Different factors influence the breast cancer screening rate.

AIM

This study aimed to investigate the factors that affect the screening of women for breast cancer in the northern part of Iran.

MATERIAL AND METHODS

This cross-sectional study was conducted in the Mazandaran Province of Iran in 2016 on 1,165 women who participate in breast cancer screening programs, using a cluster-sampling method. A valid and reliable researcher-made questionnaire was used to collect the data. The collected data were analysed using descriptive and inferential statistics via SPSS 21.

RESULTS

In this study, 62% of the women had a history of breast self-examinations, 41.1% had breast examinations by healthcare staff, and 21.7% received mammography. The woman's age, age at first marriage, age at onset of sexual intercourse, occupation, spouse's occupation, household income, health status, history of infertility, smoking, and decision-maker on issues of sexual and reproductive health (SRH) were the best predictors of participation in screening for breast cancer (P < 0.05).

CONCLUSION

To encourage participation in breast cancer screening programs, women should be encouraged to seek preventive care. Also, factors that.

The Efficacy of Acceptance and Commitment Therapy (ACT) Matrix on Depression and Psychological Capital of the Patients with Irritable Bowel Syndrome

BACKGROUND:

Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders, worldwide. Psychological disorders are common among patients with IBS.

AIM:

This study aims to investigate the efficacy of acceptance and commitment therapy (ACT) matrix on depression and psychological capital of patients with IBS.

MATERIAL AND METHODS:

In a quasi-experimental study, a total number of 30 patients with IBS were selected using convenience sampling. Those patients who meet the inclusion criteria were randomly assigned to control and experimental groups (15 patients in each group). Data were collected using the Beck Depression Inventory (BDI) and the Psychological Capital Questionnaire (PCQ). The experimental group was subjected to the acceptance and commitment therapy (ACT) amtrix, but the control group do not receive this treatment. Questionnaires were completed before (pre-test) and after (post-test) the intervention by patients in two groups. All patients in two groups responded to the questionnaires and returned them to the researcher. Data were analyzed using chi-square test, independent t-test, analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA).

RESULTS:

Analyzing the data showed that there were significant differences regarding depression and psychological capital between experimental and control group, before and after the study (p < 0.05).

CONCLUSION:

Using ACT matrix is a useful modality to improve the depression and psychological capital among patients with IBS.

Rocky Road Ahead Of Nursing Presence in the Oncology Care Unit: A Qualitative Study

BACKGROUND:

Cancer patients need not only well-planned treatment, but also comprehensive nursing care provided with compassion, competence, and conscience. Nursing presence is an essential part of the care process in all nursing interventions.

AIM:

This study aimed to identify the barriers to the nursing presence in oncology care units.

MATERIALS AND METHODS:

A qualitative content analysis study was carried out with the participation of 27 nurses who were chosen by purposive sampling. The data collection instruments were semi-structured interviews and observation. The interviews were recorded and transcribed, and then coded and analysed by the Graneheim and Lundman’s content analysis methodology. The criteria proposed by Guba and Lincoln were used to ensure the validity of the research.

RESULTS:

From the data analysis, the researchers were able to obtain a primary theme labelled “Rocky road ahead of nursing presence” and two subthemes labelled “Difficult and stressful work environment” and “Dysfunctional rules and regulations” with several subcategories including “exposure to violence”, “shortage of nursing staff”, “inattention to the needs of nurses”, “organizational unfairness”, “excessive paperwork”, and “need for detailed documentation”.

CONCLUSION:

There are numerous challenges ahead of achieving satisfactory nursing presence and quality care in the oncology care units. The findings highlight the key role of organisational conditions in the nursing presence and the dire need to pay further attention to the motivational factors.

Improving Nursing Care Documentation in Emergency Department: A Participatory Action Research Study in Iran

BACKGROUND:

Standardization of documentation has enabled the use of medical records as a primary tool for evaluating health care functions and obtaining appropriate credit points for medical centres. However, previous studies have shown that the quality of medical records in emergency departments is unsatisfactory.

AIM:

The aim of this study was improving the nursing care documentation in an emergency department, in Iran.

MATERIAL AND METHODS:

This collaborative action research study was carried out in two phases to improve nursing care documentation in cooperation with individuals involved in the process, from February 2015 to December 2017 in an affiliated academic hospital in Iran. The first phase featured virtual training, an educational workshop, and improvements to the hospital information system. The second phase involved the recruitment of human resources, the implementation of continuous codified training, the establishment of an appropriate reward and penalty system, and the review of patient education forms.

RESULTS:

The interventions improved nursing documentation quality score of 73.20%, which was the highest accreditation ranking provided by Iran’s Ministry of Health and Medical Education in 2017. In other words, this study caused a 32% improvement in the quality of nursing care documentation in the hospital.

CONCLUSION:

The appropriate practices for improving nursing care documentation are employee participation, managerial accountability, nurses’ adherence to documentation standards, improved leadership style, and continuous monitoring and control.

The Effect of Self-Management Educational Program on Pain Intensity in Elderly Patients with Knee Osteoarthritis: A Randomized Clinical Trial

BACKGROUND

Osteoarthritis is one of the chronic diseases that greatly affect the health and life quality of individuals.

AIM

This study aimed to determine the effect of self-management educational program on the pain intensity of the elderly patients with knee osteoarthritis.

METHODS

In a randomised clinical trial, a total of 82 elderly patients with knee osteoarthritis were randomly divided into intervention and control groups. The intervention group received six sessions of self-management group education, while the control group received only the routine care during this period. In both groups, patients' pain intensity, with a visual analogue scale (VAS), were assessed before, immediately after and eight weeks after the start of the study.

RESULTS

The mean pain intensity scores of the intervention and control groups were not significantly different before the intervention (P = 0.9), but after the intervention, the mean pain intensity score in the intervention group (3.61 ± 2.36) was significantly lower than that of the control group (4.93 ± 2.00), (P < 0.0001).

CONCLUSION

Implementation of a self-management program for the patients with knee osteoarthritis is useful in reducing their pain intensity and can be used as one of the effective methods for their empowerment.

Exploring Iranian β-Thalassemia major patients' perception of barriers and facilitators of adherence to treatment: A qualitative study

Background

Despite the clinical importance of adherence to treatment in β-Thalassemia Major (β-TM) patients, poor adherence remains a prevalent and persistent problem in these patients.

Objective

The aim of this study was to explore Iranian β-TM patients’ perception regarding the barriers and facilitators of adherence to their treatments.

Methods

In this qualitative study, data were collected using purposeful sampling and semi-structured interviews with 18 β-TM patients, 3 family members and 5 healthcare professionals (total=26) in Sari, northern Iran, between August 2015 and May 2017. Data were analyzed using conventional content analysis with the support of MAXQDA software. All the interviews were transcribed verbatim. Data were coded and grouped under specific categories.

Results

We identified and classified the perceived barriers of patients’ adherence to treatment into six main categories including: (I) long distance challenges, (II) delayed occurrence of complications, (III) fatigue of healthcare providers, (IV) staff workload, (V) insufficient follow-up of healthcare workers, and (VI) busy everyday life. Also, nine main categories emerged as facilitators including: (I) concern of appearance changing, (II) outcomes of treatment, (III) good awareness, (IV) parental monitoring, (V) fear of complications, (VI) social activity, (VII) marriage as a facilitator, (VIII) friendly interaction with the medical staff, and (IX) trusting the medical staff.

Conclusion

Our findings provide a broad range of context-specific facilitators and barriers to treatment adherence perceived by Iranian β-TM patients. These factors improve our understanding of the complex and multifactorial nature of adherence to treatments. Health care providers can use these findings in designing and implementing appropriate interventions to promote β-TM patients’ adherence to treatment.