Communication challenges caused by wearing masks and strategies used by pediatric nurses during the COVID-19 pandemic: A qualitative study

PURPOSE

The COVID-19 pandemic and the use of facemasks have caused many communication challenges for pediatric nurses. The purpose of this study was to investigate these challenges and the strategies that nurses use to overcome them during the nursing care of sick children.

DESIGN AND METHODS

This was a qualitative study using conventional content analysis. The nurses were selected by purpose-based sampling and interviewed semi-structurally between April and June 2023 at the Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the data saturation principle. The report of this research followed the COREQ guidelines.

RESULTS

Twelve nurses were interviewed. The analysis revealed four main categories: "Disturbances in communication", "Disturbances in trust", "Disturbances in providing care", and "Nurses' strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, nurses used solutions such as removing the mask and mitigating the adverse effects of mask usage they used. The central theme of the study was "Humanistic care requires trust-based communication".

CONCLUSIONS

This study highlights the communication challenges faced by pediatric nurses due to mask-wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed innovative strategies to improve communication and build trust with their young patients. Further research is needed to evaluate the effectiveness and feasibility of these strategies.

PRACTICAL IMPLICATIONS

These strategies can be useful for other nurses who work with children in similar conditions. Further research is needed to evaluate the effectiveness and feasibility of these strategies in different settings and populations.

Peer interventions to improve HIV testing uptake among immigrants: A realist review

Background

As a vulnerable group in HIV control programs, immigrants face various obstacles to HIV testing. Despite the effectiveness of peer interventions on health promotion in HIV testing, relatively little is known about how these interventions work. This realist review aims to understand why, how, and under what conditions peer interventions can improve immigrants' HIV testing uptake.

Methods

We followed the steps suggested by Pawson and colleagues for conducting the realist review. To test a initial program theory, we first systematically searched databases of PubMed, Web of Science, Scopus, Embase, and Cochrane, as well as the websites of UNAIDS, World Bank, Global Fund, WHO, and IOM. After data extraction and quality appraisal, data synthesis was conducted to explain the intervention pathways corresponding to context-mechanism-outcome configurations.

Results

Seventeen studies were included in the review. Peer interventions for improving immigrants' HIV testing uptake worked through four pathways: Following the improvement of communications (as a proximal mechanism): 1) increasing awareness, 2) reduced stigma, 3) improved support, and 4) increased access to services could lead to improved HIV testing uptake among immigrants. The identified mechanisms were influenced by three groups of individual/ interpersonal, service delivery, and structural factors.

Conclusion

Peer interventions with multiple strategies to be designed and implemented considering the barriers to HIV testing and also moving beyond one-size-fits-all approaches can successfully improve the immigrants' HIV testing uptake. The refined program theory in this study can help the healthcare providers and policy-makers promote the immigrants' HIV testing uptake and reduce the risk of disease transmission.

Challenges of living with veterans with post-traumatic stress disorder from the perspective of spouses: a qualitative content analysis study

BACKGROUND AND OBJECTIVE

The needs and characteristics of veterans with post-traumatic stress disorder (PTSD) create significant challenges in family life, particularly for spouses. Identifying the nature of these challenges from the perspective of spouses leads to a more comprehensive and profound understanding of their existing problems and can be used for targeted interventions. Therefore, this research was conducted to explore the challenges of living with veterans suffering from PTSD from the perspective of their spouses.

METHODS

This qualitative study used conventional content analysis to explore Challenges of spouses of veterans with post-traumatic stress disorder. Fifteen spouses of veterans with PTSD from the Veterans Affairs Center in Iran between June 2022 and January 2023, were purposively selected to participate in the study. Semi-structured in-depth interviews were conducted to collect data. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using the method proposed by Graneheim and Lundman content analysis method with the support of MAXQDA 2020 software.

RESULTS

The mean age of the participants was 56.74 ± 6.43 years. Through data analysis, seven main categories and sixteen subcategories were identified. These categories included burnout (sleep disturbances, feelings of exhaustion), apathy towards self-care and caring for the veteran (neglecting self-care, lack of interest in continuing care), depression (feelings of hopelessness and being at the end of the line, decreased self-confidence ( Crushed and ignored (being mistreated, having multiple roles), relationship disturbances (Dissatisfaction with marital relationship,isolation and limited social interactions, disconnection from God), financial burden (heavy costs of care, lack of insurance support), and declining social status (negative attitude of the society, suffering from discrimination and inequality).

CONCLUSION

The consequences of PTSD-related injuries in veterans directly and indirectly affect the overall living conditions of their spouses. These spouses experience emotional detachment and constant rejection, leading to a decrease in their resilience against existing stressors and exposing them to disruptive and challenging issues in individual, family, and social dimensions of life that affect their physical and mental well-being. Therefore, these spouses require empowerment and access to social support in dimensions of educational, caregiving, therapeutic, and supportive. It is recommended that health policymakers pay special attention to designing up-to-date interventions to enhance the health of these spouses in physical, mental, spiritual, and social dimensions.

Evaluation of caffeic acid mucoadhesive tablets on minor recurrent aphthous stomatitis: a randomized, double-blind, placebo-controlled clinical trial

BACKGROUND

Oral aphthous stomatitis is a chronic inflammatory condition. Numerous medications have been investigated to treat the symptoms of the disease. However, these days patients prefer herbal medicines due to lower side effects. Considering the anti-inflammatory, analgesic, and anti-oxidant properties of Caffeic acid and its few side effects, the aim of this study was to assess the impact of Caffeic acid on recurrent aphthous stomatitis (RAS). investigating the effect of caffeic acid mucoadhesive tablets on the size and pain intensity of the aphthous lesions.

METHODS

in this double-blinded clinical trial study, 47 patients who met the inclusion criteria were selected by convenient sampling method. The patients were assigned to two groups randomly; the control group (placebo recipients) and the intervention group (Caffeic acid recipients). Patients were followed up for 7 days following the intervention. The diameter of the inflammatory lesion was measured in millimeters, and the pain intensity was recorded based on the VAS scale (Visual Analogue Scale). This trial was approved by the medical ethics committee of Mazandaran University of Medical Sciences (Ethical code: IR.MAZUMS.REC.1401.261) and received IRCT code of IRCT20220815055700N1on 03/09/2022.

RESULTS

the diameter of the lesion in both groups decreased over time, and there was no significant difference between the intervention and control groups, except on the fifth day when the diameter of the lesion was significantly greater in the control group (P = 0.012). From the second day, the control group's average pain intensity was significantly higher than the intervention group's pain intensity (P < 0.05).

CONCLUSIONS

when comparing mucoadhesive tablets containing Caffeic acid and placebo, the findings demonstrated that Caffeic acid has a significant efficacy in reducing aphthous lesions' diameter and pain intensity of the patients and are suggested for palliative oral aphthous lesions treatment since they showed significant anti-inflammatory and analgesic effects on recurrent aphthous stomatitis.

Evaluation of cross-cultural adaptation and validation of the Persian version of the health literacy for school-aged children scale: Methodological study

Background and Aims

Health literacy (HL) is an essential determinant of health in children. Inadequate HL causes problems for individuals and society, such as more hospitalizations, medication errors, poor health, and higher mortality and health care costs. A valid and reliable scale is needed to measure this population's HL. This study evaluated the cross-cultural adaptation and validation of the Persian version of the HL for School-Aged Children (HLSAC) Scale.

Methods

In this methodological research, the HL scale of school-aged children was translated from English to Persian using the Backward-Forward translation protocol. The content validity, face validity, construct validity (Exploratory Factor Analysis [EFA] and Confirmatory factor analysis [CFA]), plus reliability, were evaluated by Internal consistency and stability methods. Two hundred forty samples from south of Tehran were selected by multi-stage sampling method to assess the construct validity. Data analysis was performed using SPSS v24 and Jamovi v2.2.

Results

A qualitative evaluation of face and content validity showed that experts and the target group approved all items on the scale. The results of EFA indicated the existence of one factor, explaining 47.17% of the total variance of the scale. The CFA results showed that the one-factor model of the Persian version of the HL scale for children is almost acceptable. (χ 2/df = 2.94, Root Mean Square Error of Approximation = 0.09, Normed-Fit Index = 0.89, Tucker-Lewis Index = 0.89, Comparative Fit Index = 0.92). Cronbach's alpha coefficient for the whole scale was 0.80, and the Intraclass Correlation Coefficient value for the whole scale was calculated as 0.78 using the single-rating, absolute-agreement, 2-way mixed-effects method.

Conclusion

The study validates the HLSAC Scale, affirming its suitability for assessing HL in Persian-speaking child populations.

Anti-inflammatory and tissue repair effect of cinnamaldehyde and nano cinnamaldehyde on gingival fibroblasts and macrophages

BACKGROUND

Recurrent aphthous stomatitis has a complex and inflammatory origin. Among the great variety of medications it is increasingly common to use herbal medicines due to the adverse side effects of chemical medications. Considering the anti-inflammatory properties of cinnamaldehyde and the lack of studies related to the effectiveness of its nano form; This study investigates the effect of cinnamaldehyde and nano cinnamaldehyde on the healing rate of recurrent aphthous stomatitis lesions.

METHODS

In a laboratory experiment, cinnamaldehyde was converted into niosomal nanoparticles. The niosome vesicles diameter and polydispersity index were measured at 25°C using a dynamic light scattering (DLS) Mastersizer 2000 (Malvern Panalytical technologies: UK) and Zetasizer Nano ZS system (Malvern Instruments Worcestershire: UK). After characterizing these particles, the (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) [XTT] assay was used to assess the toxicity of cinnamaldehyde and nano cinnamaldehyde on gingival fibroblast (HGF) and macrophage (THP-1) cells. By determining the release of TNF-α, IL-6, and TGF-β cytokines using ELISA kits, the level of tissue repair and anti-inflammatory capabilities of these two substances were evaluated.

RESULTS

The size and loading rate of the cinnamaldehyde nanoparticles were established after its creation. The optimized nanovesicle exhibited the following characteristics: particle size of 228.75 ± 2.38 nm, PDI of 0.244 ± 0.01, the zeta potential of -10.87 ± 1.09 mV and the drug encapsulation percentage of 66.72 ± 3.93%. PDIs range was between 0.242-0.274. The zeta potential values at 25°C were from -2.67 to -12.9 mV. The results of the XTT test demonstrated that nano cinnamaldehyde exhibited dose-dependent toxicity effects. Moreover, nano cinnamaldehyde released more TGF-β and had better reparative effects when taken at lower concentrations than cinnamaldehyde.

CONCLUSION

Nano cinnamaldehyde and cinnamaldehyde are effective in repairing tissue when used in non-toxic amounts. After confirmation in animal models, it is envisaged that these substances can be utilized to treat recurrent aphthous stomatitis.

Effect of using a mobile drug management application on medication adherence and hospital readmission among elderly patients with polypharmacy: a randomized controlled trial

BACKGROUND

Adherence to complex drug regimens and polypharmacy are among the challenges of old age, which may negatively affect their motivation to continue drug therapy or lead to incorrect drug consumption. The present study was conducted to evaluate the effect of using a mobile drug management application on medication adherence and hospital readmission among polypharmacy older adults.

METHODS

In this randomized controlled trial study conducted in 2022, with Trial Registration Number (IRCT20191231045966N1) (18/07/2021), 192 Iranian older adults with polypharmacy were selected according to the inclusion criteria and allocated to case and control groups using the block randomization method. The data collection tools included a demographic questionnaire, case report form, and Morisky Medication Adherence Scale. The intervention was done using a mobile drug management application. Drug adherence was measured at baseline and both with hospital readmission were measured after 8 weeks. The collected data were entered into the SPSS software version 22 and analyzed using descriptive (frequency, percentage, mean, standard deviation) and inferential (Chi-square, Fisher's exact test, independent t-test) statistics.

RESULTS

The case and control groups were homogeneous in terms of demographic variables and drug adherence level before the intervention. A significant difference was found in the drug adherence level after using the app (p < 0.001). Moreover, a significant difference was found in adverse events, including re-hospitalization due to disease aggravation, re-hospitalization due to error in medication consumption, falling, hypo or hypertension, and hypo or hyperglycemia, and medication use accuracy between the groups after the intervention (p < 0.05).

CONCLUSION

The results showed that using a mobile drug management application that meets the specifications of older adults can improve drug adherence, reduce the adverse events and pave the way for a better disease period management.

Investigating the psychometric properties of the Persian version of the attitude scale for cancer screening

BACKGROUND

Individual attitude is an essential component in facilitating people's participation in adopting cancer screening behaviors. People's attitudes toward cancer screening should be evaluated with a valid and reliable scale. Therefore, this study investigated the psychometric properties of the Persian version of the attitude scale for cancer screening.

METHOD

In this psychometric study, the Farsi version of the attitude scale for cancer screening was prepared from English to Farsi using the Backward-Forward method. Then content, face, and construct validity, plus reliability, was evaluated by Internal Consistency and Stability methods. Construct validity was investigated using Exploratory Factor Analysis with a sample of 246 adults referring to health centers in the south of Tehran. Data analysis was done using SPSS V24 software.

RESULTS

All items received an acceptable Content Validity Ratio. The content Validity Index was confirmed for all items with a value greater than 0.79. In the qualitative review of content and face validity, all items were confirmed. Unlike the original version of the scale, which was a single factor, the results of Exploratory Factor Analysis indicated the existence of 2 factors explaining 63.84% of the total variance of the scale. Reliability based on Cronbach's alpha coefficient for the whole scale was 0.88, and Intraclass Correlation Coefficient for the entire scale was calculated for scale reliability using the single-rating, absolute-agreement, 2-way mixed-effects method as 0.84.

CONCLUSION

This study confirmed the validity and reliability of the Persian version of the attitude scale for cancer screening with two factors (Willing Attitude and Unwilling Attitude). Therefore, it can be a suitable and valid scale to evaluate the attitude of the community for cancer screening.

Development, implementation, and evaluation of neonatal thermoregulation decision support web application

OBJECTIVES

Thermoregulation is important for all age groups, and in neonates, it is considered a crucial event to adapt to extrauterine life. Therefore, using systems that provide frequent reminders in different ways in the field of thermoregulation can help thermal stability in neonates. The present study aimed to develop, implement, and evaluate a neonatal thermoregulation decision support system (DSS) as a web application.

METHODS

The present research was a multi-method study because it included the three phases of development, implementation, and evaluation of the neonatal thermoregulation decision support web application. In the system designing phase, the waterfall model is used. The second and third phases of the study, implementation, and evaluation, were conducted as a quasi-experimental study.

RESULTS

The results of this study were presented in two parts: the developed web application, and the results of the evaluation of the web application. The results of the statistical tests revealed that the use of the web application had a positive and significant effect on both the adjustment of the temperature of the incubator (maintaining the neutral temperature) and the maintenance of the temperature of the neonate's body (p = 0.000).

CONCLUSIONS

These results indicate that a nurse's sensitization and guidance with a neonatal thermoregulation decision support system can help to effectively neonate thermoregulation and the nurse has brought the temperature care close to the standard care based on the conditions of each neonate.

Organisational challenges of pain management in neonatal intensive care unit: a qualitative study

OBJECTIVES

Despite credible evidence, optimal neonates' pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing challenges vary depending on the context, and investigating them can help to improve the quality of care. The study aimed to explore organisational challenges to neonates' pain management in the NICU.

METHODS

This qualitative study included 31 nurses and physicians in the NICU of Children's Hospital, Tabriz, Iran. Data collection was done through individual and focus group interviews. For data analysis, we used conventional content analysis.

RESULTS

The identified challenges included organisational culture (poor interprofessional collaboration and low parental participation), organisational structure (lack of unified approach in relieving pain and limited supervision for pain management) and organisational resources (lack of time due to high workload and inadequate educational programmes).

CONCLUSIONS

Many organisational factors consistently affect neonatal pain management. Adopting some approaches to enhance the cooperation of treatment team members, holding educational programmes, proper organisational supervision and implementing a unified neonatal-based pain management programme could improve neonatal pain management.

Experience of individuals with unconsummated marriage in Iran: A qualitative content analysis

Background

Sex is one of the important aspects of marriage and a way of expressing intimacy. Unconsummated marriage is a common problem whose prevalence is about 1.5% in Iran and can significantly influence marital life.

Objective

This study aimed to assess the unconsummated marriage in a qualitative mode to offer new and beneficial solutions resulting from a better understanding.

Materials and Methods

In this qualitative study, conventional content analysis was used. Data collection and analysis were done from April 2013 to April 2014 with 11 women and 5 men participating, who were referred to the sexual disorders clinic of Tehran Psychiatric Institute and Rasool Akram hospital of Tehran, Iran. The researchers examined the files of people referred to these clinics with the diagnosis of unconsummated marriage. Our tool for data collection was a semi-structured interview. 2 experienced faculty psychiatrists recorded all the information based on standards for reporting qualitative research guidelines. Data were analyzed using qualitative technique and coding. Guba and Lincoln criteria was used for data validity.

Results

The codes of the participants' experiences were classified into 6 main categories, which include self-concept, intrapersonal factors, partner's problem, preparedness for sex, emotional relationship between couples, and the effects of unconsummated marriage on the participant's life.

Conclusion

Significant experiences among women included excessive anxiety toward the society and their spouses, and among men were weakness and guilt. Being unable to have sex negatively affected their view of life and caused great harm to their self-perception. Participants personality traits and their self-concept, and attitude toward their partners were important issues.

Weight Management Challenges in Nulliparous Women Being Overweight or Obese Due to Pregnancy: A Qualitative Study

Background

Getting overweight after pregnancy is a common phenomenon and getting back to pre-pregnancy weight in the postpartum period is a major concern for mothers. This study aimed to explain the challenges in performing post-pregnancy weight-management behaviors in nulliparous women being overweight and obese due to pregnancy.

Methods

The present qualitative study was conducted with the conventional qualitative content analysis method based on Granheim and Landman's approach from October to December in 2021. In this study, participants were 15 women who referred to comprehensive health service centers in Tehran, Iran; they were purposefully selected according to the inclusion criteria. Data were collected through individual, in-depth, and semi-structured face-to-face interviews and simultaneously analyzed using the MAXQ Data version 10 software.

Results

The mean age of the participants was 25.93±3.21 years. Data analysis resulted in three main categories: 1) failure to adhere to calorie-restricted diets, 2) inability to engage in physical activity, and 3) lack of adequate social support.

Conclusion

Women with obesity due to pregnancy face many challenges to improve their weight-control behaviors. As such, improving healthy behaviors not only requires relevant stakeholders' commitment, but also demands women, their families and communities' intention to engage in healthy behaviors.

Experiences of patient education among people affected by cardiovascular disease: a qualitative study based on Andragogy model

BACKGROUND

Patient education is a key component of patient care, positively affecting health promotion and self-care ability. In this regard, an extensive body of research supports the use of the andragogy model in patient education. The study aimed to explore the experiences of people with cardiovascular disease in patient education.

METHODS

This qualitative study involved 30 adult patients with cardiovascular disease who were hospitalized or had a history of hospitalization. They were purposively recruited with maximum variation from two large hospitals in Tehran, Iran. Data were gathered by conducting semi-structured interviews. Data collection was done by conducting semi-structured interviews. Then, the data were analyzed using directed content analysis and a preliminary framework based on six constructs of the andragogy model.

RESULTS

Data analysis resulted in the development of 850 primary codes, which were reduced to 660 during data reduction. These codes were grouped into nineteen subcategories under the six primary constructs of the andragogy model, i.e., need-to-know, self-concept, prior experience, readiness for learning, orientation to learning, and motivation for learning. The most common problems in patient education were associated with self-concept, previous experience, and readiness for learning components.

CONCLUSION

This study provides valuable information about the problems of patient education for adults with cardiovascular disease. Correction of the issues identified can improve care quality and patient outcomes.

The effects of virtual logotherapy on health-promoting lifestyle among single-parent adolescent girls during the coronavirus disease 2019 pandemic: a randomized clinical trial

Single-parent adolescents are vulnerable individuals and it is necessary to improve their health, particularly during epidemics. This study aimed to investigate the effects of virtual logotherapy (VL) on health-promoting lifestyle (HPL) among single-parent adolescent girls during the COVID-19 pandemic. This single-blind randomized clinical trial was conducted on 88 single-parent adolescent girls recruited from the support organization for vulnerable individuals in Tehran, Iran. They were randomly allocated to a control and an intervention group through block randomization. Participants in the intervention group received VL in three-five person groups in 90 min biweekly sessions. The Adolescent Health Promotion Short-Form was used to assess HPL. Data were analyzed using the SPSS software (v. 26.0) and through the independent-sample t, Chi-square, Fisher's exact, and Mann-Whitney U tests. There was no significant difference between the intervention and the control groups respecting the pretest mean score of HPL (73.58±16.74 vs. 72.80±9.30; P=0.085). However, the posttest mean score of HPL in the intervention group (82 with an interquartile range of 78-90) was significantly more than the control group (71.50 with an interquartile range of 63.25-84.50) (P=0.001). Moreover, after adjusting the effects of the significant between-group differences respecting pretest mean scores, the pretest-posttest differences of the mean scores of HPL and all its dimensions in the intervention group were significantly more than the control group (P<0.05). VL is effective in significantly improving HPL among single-parent adolescent girls. Healthcare authorities are recommended to use VL for health promotion among single-parent adolescents.Trial registrationThis research was registered (17/05/2020) in the www.thaiclinicaltrials.org with registration number: TCTR20200517001.

Relationship between emotional elder abuse and developmental function of the family

AIM

This study aimed to assess the relationship between emotional elder abuse and the developmental function of the family.

DESIGN

Community-based correlational cross-sectional study was conducted.

METHODS

Data were collected on 265 older adults from July to October 2019 in Tehran-Iran. The samples were selected by simple random sampling and they completed self-report tools: demographic information, emotional elder abuse developmental function in the family. Data analysis was performed using descriptive and inferential statistics and SPSS software v.16.

RESULTS

Mean score of the developmental function in the family was 67.38 (SD = 3.22, range = 0-129). There was a significant negative correlation between the total score of developmental function in the families and emotional elder abuse. Moreover, there was a relationship between the subscale of care and regulation, being attracted to human relationships, purposeful exchange, and creating representatives and ideas with emotional elder abuse.

The impact of distance education on readmission of patients with heart failure: A systematic review and meta-analysis

AIM

To estimate the effect size of distance education on the readmission of patients with heart failure.

DESIGN

This study was a systematic review and meta-analysis.

METHOD

Both Persian and English interventional studies focused on investigating the effectiveness of any form of distance education interventions on the readmission of patients with heart failure were retrieved from the main databases: Embase, PubMed, Scopus, Web of Science, SID, and Google Scholar. Two independent teams screened the articles for eligibility. The Cochrane Risk of bias tool was implemented to evaluate the studies' quality. A random-effects model was applied to pool the effect sizes, I² was calculated to examine heterogeneity, and Meta-regression was used to investigate the source of heterogeneity. The proposal was registered in the PROSPERO database (no. CRD42020187453).

RESULTS

Articles 8836 were retrieved, and 11 articles were selected. Nine studies investigated the effect of distance education on readmission with <12-month follow-up (RR: 0.78 [95% CI 0.67-0.92]) and the I² of 0.00%; and four studies examined the effect of distance intervention on readmission with 12-month or more follow-up (RR: 0.89 [95% CI 0.73-1.09]) and the I² of 71.59%.

Prevention of radiotherapy-related oral mucositis with zinc and polyherbal mouthwash: a double-blind, randomized clinical trial

BACKGROUND

A significant percentage of head and neck cancer (HNCs) patients receiving RT experience oral mucositis (OM). This study aimed to evaluate the effect of the polyherbal (containing chamomile, peppermint oil, Aloe vera, and honey) and zinc mouthwashes in comparison to the control (chlorhexidine) and placebo groups for prevention of radiation-induced OM.

METHODS

This study was a double-blinded randomized clinical trial, conducted on 67 patients with HNCs undergoing radiotherapy. The eligible participants were randomized to receive either one of the following; zinc sulfate, polyherbal, chlorhexidine (Vi-one 0.2% CHX), or placebo mouthwash for 6 weeks. Follow-up evaluation of oral hygiene and the checklists of OM and the intensity of pain were filled out according to WHO assessment tool, Oral Mucositis Assessment Scale (OMAS), and Visual Analog Scale (VAS) in all the participants weekly for seven consecutive weeks.

RESULTS

The results of present clinical trial demonstrated that the use of either zinc sulfate or polyherbal mouthwash significantly reduced the scores of OM and the severity of pain during weeks 2 to 7 after consumption compared with the CHX or placebo mouthwashes (P < 0.05). According to the post hoc analysis and compared with the placebo, a significantly better result was reported for zinc sulfate and polyherbal mouthwashes at weeks 2 to 7, but not for the CHX mouthwash.

CONCLUSION

This study showed that the use of zinc sulfate or polyherbal mouthwashes is effective in prevention of both OM severity scores and pain related to OM intensity at weeks 2 to 7 following consumption in HNCs patients. Trial registration IRCT20190123042475N1 and IRCT20190123042475N2. Registration date: 2019-06-09, 2019-07-26.

Care providers' experiences regarding barriers to maternal participation in neonatal pain management

BACKGROUND

Mothers' involvement in the pain management of infants admitted to the intensive care unit can alleviate the infants' pain. Despite International guidelines, maternal involvement in neonatal pain management is low. Hence, investigating the perspectives of care providers (CPs) on barriers to maternal participation can be helpful in developing practice guidelines.

AIMS

The purpose of this study was to investigate the experiences of CPs on barriers to maternal involvement in neonatal pain management in the intensive care unit.

DESIGN

In this study, a qualitative design based on the content analysis approach was used.

METHOD

We included 24 nurses and physicians in the neonatal intensive care unit from February to September 2020. Data were collected through conducting 11 individual interviews and two focus group discussions with eight and five participants, respectively.

RESULTS

Three main categories and seven sub-categories were found, including maternal barriers (inadequate emotional readiness and unfamiliarity with role), CPs' barriers (time pressure, fear of family-care provider tension, and insufficient knowledge), and organizational barriers (neglected joint decision-making and restricted organizational participative policies).

CONCLUSIONS

The identified barriers could be classified into those related to mothers, care providers, and organizations. The lack of appropriate interaction and cooperation between parents and care-providers can affect the emergence of barriers related to the mothers and staff.

RELEVANCE TO CLINICAL PRACTICE

There is a lack of knowledge regarding neonatal pain management in the health care team and mothers. Educating mothers and CPs about the benefits and ways of mothers' participation can increase readiness and capabilities. Providing clear guidelines about family-centred care and promoting parent-CPs' interactions can increase the mothers' participation.

Perceived Stress and Psychological Distress among Nurses during the COVID-19 Pandemic

The advent of COVID-19 has significantly affected healthcare workers’ mental health. This study was conducted to investigate the perceived stress and its relationship with psychological distress among nurses who took care of patients with the COVID-19 disease. This cross-sectional study was performed on 180 nurses in Ardabil province in 2020. Data were collected online through two standard questionnaires, making use of the Cohen Perceived Stress Scale and the Kessler Psychological Distress Scale (K10). Then, data were analysed based on descriptive and analytical statistics using SPSS software version 19 as well as independent t-tests, Spearman’s correlation coefficient, and multiple linear regression tests. The results of the Spearman’s correlation test indicated that there was a significantly positive correlation (rho = 0.79) between perceived stress and psychological distress (P <0.001). After adjusting the effects of other variables using a multiple linear regression test, the beta correlation coefficient was calculated, and the obtained value of 0.766 was regarded as statistically significant (P <0.001). Moreover, 63.9% of the nurses experienced moderate perceived stress, and 72.6% experienced severe mental disorders. The results of this study demonstrate that high perceived stress is considered as a strong predictor of psychological distress, and also the majority of the nurses working in frontline wards have experienced severe psychological distress. Therefore, it is recommended to take into account the workplace stress and prepare the ground (e.g., through preparing education, identifying at-risk individuals, as well as providing psychotherapy services and social support) to reduce the stress and promote the nurses’ mental health.

An Eco-Friendly and Hopeful Promise Platform for Delivering Hydrophilic Wound Healing Agents in Topical Administration for Wound Disorder: Diltiazem-Loaded Niosomes

Purposes

Calcium channel blockers, such as diltiazem (DLZ), are important drugs for wound repair treatment. This current study used an ultrasonic method to increase the cutaneous delivery of (DLZ) niosomes.

Methods

The impact of the cholesterol:surfactant ratio on the DLZ-loaded niosome formulations was investigated. Differential scanning calorimetry (DSC), powder X-ray diffraction (PXRD), scanning electron microscopy (SEM), attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy, drug release, skin sensitivity, animal wound repair model, and histopathological assessment were applied to investigate the characteristics, morphology, and therapeutic effectiveness of the DLZ noisome.

Results

The results showed that changes in the cholesterol:surfactant ratio can influence the zeta potential and the size of the niosome. The maximum entrapment efficiency was observed to be about 94% when the cholesterol content in the formulation was high. The DLZ release studies revealed that the niosomal formulation was released slowly over the course of 24 h. Macroscopic observations of the wound demonstrated that wound closure in the DLZ-niosome-treated group and the commercial brand was equal and higher than in the other groups (gel base, placebo gel, and negative control). Pathological studies described that the wound repair in the DLZ-niosomal gel group was greater than in the other treatment. All the preparations tested for cutaneous irritation on Wistar rats showed the DLZ niosomal gels to be non-irritating.

Conclusion

The findings of this study revealed that the prepared DLZ-niosome could be used as a possible nano-vesicle for DLZ cutaneous delivery thus potentially opening up new prospects for the treatment of wound disorders.

Nurses' healing presence: A panacea for the comfort of acute coronary syndrome patients in CCU, A qualitative study

AIM

The study aimed to explain the acute coronary syndrome (ACS) patients' perception of the nurse's healing presence in their comfort in the critical care unit.

DESIGN

This descriptive qualitative study was conducted from December 2020 to September 2021.

METHODS

Twenty-seven ACS patients were purposively selected from a cardiovascular university Hospital, Iran. Data were collected through semi-structured interviews (45-60 min). Data analysis was performed based on the contractual content analysis method of Graneheim and Lundman.

RESULTS

In the data analysis, the main theme 'nurses' healing presence' includes two categories: 'Nurse-patient communication' with two subcategories and the category 'Compassionate care' with three subcategories.

Validity and reliability of the Persian version of the Short-Form Adolescent Health Promotion scale: Methodological study

Background and Aim

Assessing health promotion among adolescents is vital to identify healthy and unhealthy behaviors and to evaluate health promotion interventions. This study aimed to determine the validity and reliability of the Persian version of the Short-Form Adolescent Health Promotion scale.

Methods

Three hundred and twenty-seven adolescents were recruited through a multistage sampling method in this methodological study. The original version of the Adolescent Health Promotion scale was translated from English to Persian using the Backward-Forward translation protocol. Then, the scale's validity and reliability, including the face, content, construct validity, and reliability indices, were evaluated. The statistical analysis was performed using SPSS software version 24.

Results

The mean CVI and CVR were 0.99. The exploratory factor analysis revealed four factors covering 42.57% of the total variance. The factor loading order of the items did not exactly correspond to the order obtained in the English version of the scale's validity and reliability analysis. The obtained factors called included: life appreciation, stress management, nutrition, and health responsibility. In the current study, both Cronbach's ɑ and the intraclass correlation coefficient were calculated at 0.84 and 0.99.

Conclusion

The Persian version of the Adolescent Health Promotion scale developed in the present study is acceptable for the validity of the content, face, and reliability. However, the construct validity of this scale should be checked in other samples.

The effectiveness of telehealth interventions for people with multiple sclerosis: A systematic review and meta-analysis protocol

Objective

Multiple sclerosis (MS) is a chronic neurological condition that significantly impacts the quality of life of affected individuals. Telehealth interventions (TIs) have emerged as a promising avenue for providing healthcare services remotely, potentially improving outcomes and enhancing the quality of life for people with MS. This systematic review aims to assess the impact and efficacy of TIs on outcomes of people with MS by synthesizing and comparing outcomes from related randomized controlled trials.

Methods

The systematic review protocol will involve searching electronic databases (PubMed, Web of Science, Scopus, EMBASE, CENTRAL), gray literature resources, and key journals from 1997 to June 2023 for keywords related to Telehealth and MS. The collection of research-related articles will be followed by the removal of duplicates before they are included in the study. During the screening stage, the titles and abstracts of the articles will be reviewed, and irrelevant articles will be excluded. The full text of relevant articles will be independently evaluated by two researchers, and data will be extracted from the final articles. The findings will be classified and recorded in an extraction table. The risk of bias will be assessed using the Cochrane Collaboration tool. The data will be analyzed using STATA version 14.2. The PROSPERO ID for this study is CRD42023450081.

Discussion

This study aims to address the current knowledge gap by investigating the comparative effectiveness of TIs. The findings of this research will provide valuable insights and evidence regarding the effectiveness of these interventions, assess their feasibility and accessibility, examine patient outcomes, identify research gaps, and offer guidance for clinical practice and policy-making.

Relationship of Identity Styles and Coping Strategies With Marital Adjustment in Nurses

Objectives Nursing profession is a stressful job. Nurses need to use appropriate coping strategies to maintain their focus on patient care and having marital adjustment and solving personal problems. The relationship between nurses’ identity styles with their used coping strategies and marital adjustment is not clear yet. Therefore, this study aims to determine the relationship of identity styles and coping strategies with marital adjustment in nurses. Methods This descriptive correlational study with cross-sectional design was conducted on 221 married nurses working in public hospitals in Rasht, Iran who were selected by a stratified random sampling method. Data were collected using the Billings and Moos’ coping responses inventory (CRI), Berzonsky’s identity styles inventory (ISI), and Locke-Wallace marital adjustment test (MAT). Data were analyzed in SPSS software, version 23. Results The mean MAT score was 111.68 ±11.97. The mean ISI score was 100.31±12.27. The mean CRI score was 38.58±7.25. Marital adjustment had a significant correlation with informational (r=0.14, P=0.03) and normative (r=-0.17, P=0.01) identity styles and problem-focused coping strategy (r=-0.15, P=0.03). Multiple regression analysis showed that only identity styles and working hours could explain 20% of changes in marital adjustment of nurses. Conclusion The marital adjustment of married nurses in Rasht, Iran is at a favorable level. Their informational and normative identity styles and working hours can predict their marital adjustment.

HIV, migration, gender, and drug addiction: A qualitative study of intersectional stigma towards Afghan immigrants in Iran

HIV-related stigma has been identified as a major barrier to the diagnosis, prevention, and treatment of HIV among immigrants. The intersection of HIV with other forms of stigma can lead to greater inequality in health outcomes and access to health services. This study aimed to improve the understanding of HIV stigma towards Afghan immigrants in Iran through an intersectional perspective. The data were collected using 25 semi-structured interviews with the following three groups: Afghan immigrants who were diagnosed with or at risk of HIV infection due to injection drug addiction or having multiple sexual partners (n = 8), HIV service providers (n = 8), and policymakers/managers/experts (n = 9). Thematic analysis was used for data analysis. The participants described different manifestations of stigma (internalized, anticipated, perceived, experienced stigma, and discrimination) associated with HIV and interlocked with other aspects of stigma, including migration, gender, and drug addiction. According to the results, the intersection of different layers of stigma should be taken into account while designing and implementing HIV prevention and treatment programmes. It was also recommended to conduct the necessary interventions such as comprehensive HIV education, social support, as well as peer and outreach services to reduce stigma and discrimination based on the immigrants' needs as well as cultural and social values.

Preparation and In-vitro evaluation of ketoconazole-loaded niosome (ketosome) for drug delivery to cutaneous candidiasis

Background: Recently, niosomes are becoming popular in drug delivery. The current work aimed to investigate the characteristics, cellular safety, and antifungal activity of ketoconazole-loaded niosome (ketosome). Methods: Ultrasonic approach was employed to prepare ketosome including cholesterol, nonionic surfactant and ketoconazole. The size characteristics and morphological features of ketosome and physicochemical properties of ketoconazole in ketosomes were evaluated using dynamic light scattering (DLS), differential scanning calorimetry (DSC), powder x-ray diffractometer (PXRD), scanning electron microscopy (SEM), and attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy. Also, the dissolution rate, cellular safety test and antimycotic properties of ketosome were examined. Results: According to the results, the particle size of the ketosome decreased from 491.400±10.622 to 121.300±7.274 nm by the increment of cholesterol. According to further research, changes in the cholesterol:surfactants ratio can modulate the zeta potential from -27.866±1.069 to -12.500±1.153 mV. The highest entrapment of ketoconazole was about 87% when the cholesterol concentration in the ketosome was high. Ketosome with the maximum cholesterol:surfactants ratio showed the fastest drug release. Furthermore, the cell viability assay revealed that the ketosome had lower cytotoxicity in comparison with pure drug. The cell viability of the ketosome was estimated to be about 90% (HGF cell line). The ketosome had a lower MIC than the pure drug when tested against Candida albicans. Conclusion: The results of this study revealed that the optimized ketoconazole-loaded niosome could be used as a possible nanovesicle for ketoconazole drug delivery, potentially opening up new ways for the management of cutaneous candidiasis complaints.

Aspects Influencing Access to HIV/AIDS Services among Afghan Immigrants in Iran: A Qualitative Study

BACKGROUND

A successful response to the risk of human immunodefficiency virus (HIV) infection among immigrants requires improved access to HIV prevention, diagnosis, and treatment services. However, most immigrants face significant challenges in accessing HIV/AIDS services. The aim of this study was to explore the aspects influencing access to HIV/AIDS services among Afghan immigrants in Iran.

METHODS

This was a qualitative study using conventional content analysis that was conducted from June 2018 to April 2020 in Tehran, Iran. Purposeful sampling method was performed. We conducted 25 semi-structured interviews with three groups of stakeholders including Afghan immigrants infected with or at risk of HIV (n=8), service providers (n=8), and policymakers/managers/experts (n=9). Inductive qualitative content analysis was applied according to the Granheim and Lundman method. Data were analyzed using Open Code software version 4.03.

RESULTS

Aspects influencing access to HIV/AIDS health services were categorized into 3 themes (that were extracted from 9 categories): 1. Cultural aspects (cultural similarities and differences, values and beliefs); 2. Psychosocial aspects (social support, stigma and discrimination); and 3. Service delivery related aspects (awareness, health services coverage and integrity, health services financing, accessibility, and continuity of care).

CONCLUSION

The findings suggest that efforts to improve Afghan immigrants' access to HIV/AIDS health services in Iran need to consider the cultural aspects, increasing HIV awareness, providing support, reducing stigma and discrimination, and improving health services coverage, integrity, financing, and continuity of accessible services.

Critical care nurses' experiences on dishonesty: A qualitative content analysis

BACKGROUND

Providing information to patients is an essential aspect of care. The way in which such information is transmitted is also important and is affected by different variables. The perceptions of dishonest nursing staff have not been sufficiently discussed to date.

AIM

The purpose is to explore the reasons for dishonesty in transmitting information to patients.

DESIGN AND METHOD

In this qualitative content analysis study, data were collected using semi-structured interviews with Twelve Iranian Critical Care Nurses from January 2020 till August 2020. Data were analyzed according to Graneheim and Lundman approach.

ETHICAL CONSIDERATION

The research protocol was authorized by the Ethics Committee of the Medical Sciences University of Tehran (Register number: 95-04-99-33485).

RESULTS

The findings indicated that dishonesty in giving information to the patients has many reasons. Although lying is not compatible with ethical care, working conditions sometimes forced nurses to hide the truth.

DISCUSSION AND CONCLUSION

Nurses believed honesty was an integral aspect of professional practice, but situational specifics have an effect on whether the truth is told or withheld. Finally, the nurses noticed a big gap between what they want to tell and what they were doing in practice.

Exploring challenges among Iranian family caregivers of seniors with multiple chronic conditions: a qualitative research study

Background

It is believed that seniors with multiple chronic diseases are in dire need of support from their family caregivers; however, it can impose a significant burden on these caregivers. Therefore, it is imperative to take into account caregivers’ needs, as covert patients, along with the needs of patients; besides, it is necessary to develop supportive and health promotion programs for them. There is a critical gap in the knowledge about health problems related to family caregivers of the growing population of these senior citizens. The present study aimed to explain the challenges imposed on family caregivers of seniors with several chronic diseases in Iran.

Methods

This study was conducted based on the conventional qualitative content analysis method. For this purpose, 13 family caregivers of seniors with several chronic diseases were selected using the purposive sampling method. The study population included those referred to two health centers and outpatient clinics of two public hospitals in Khorramabad, Iran. Data were collected through semi-structured interviews. Data analysis was performed along with data collection using inductive thematic analysis proposed by Elo and Kyngäs. Besides, Guba and Lincoln’s criteria were used to ensure the trustworthiness of the data.

Results

The analysis of the obtained data led to the identification of challenges of family caregivers of the older patients with multiple chronic diseases; these challenges were classified into six main categories, including the impact of caregiving on family relationships, disruption of social relationships, disruption of personal and occupational plans, physical health-related issues, negative emotions, and dealing with the high costs of care.

Conclusions

Given that family caregivers may face several challenges while taking care of seniors with multiple chronic diseases, healthcare providers should design and plan various interventions based on such challenges using a caregiver-centered approach.

The effect of participating in support groups on relocation stress syndrome in residents of a nursing home: A single-blind randomized clinical trial

Background & Aim: Relocation stress syndrome is one of the consequences of moving someone to a nursing home; it causes unbearable feelings of loneliness, anxiety, and depression. However, it can be prevented by conducting proper and timely nursing interventions. The present study aimed to examine the effect of participation in support groups on relocation stress syndrome in residents of nursing homes. Methods & Materials: In this single-blind randomized clinical trial, 32 elderly residents of Kahrizak nursing home were randomly assigned to control and intervention groups. The intervention included holding support groups. Demographic information questionnaires, the short form of Geriatric Depression Scale (15-GDS), Geriatric Anxiety Scale (GAS), and the short form of University of California, Los Angeles, UCLA loneliness scale (ULS-8) were used to collect data. The data were then analyzed using statistical tests in SPSS software version 16. Results: There was no statistically significant difference between the mean scores of loneliness, depression, and anxiety between the two groups in the pre-test (p> 0.05). The results of the ANCOVA test to compare the mean scores of loneliness, depression, and anxiety in the post-test with controlling pre-test scores revealed that the intervention was effective on depression (p<0.001) and anxiety (p= 0.003), but it had no effects on loneliness (p= 0.156). Conclusion: The development and implementation of support group programs for the elderly in a nursing home could improve the outcomes of relocation stress syndrome in terms of depression and anxiety. Nonetheless, it had no effects on the outcome of loneliness. Therefore, it is recommended to implement this intervention for the elderly in a nursing home if the cost-benefit analysis is positive.

The achievement of Nursing Practice Today based on the Scopus CiteScore metrics

The article's abstract is not available.

Satisfaction with life, depression, anxiety, and stress among adolescent girls in Tehran: a cross sectional study

OBJECTIVE AND BACKGROUND

Mental health is a widespread field that entails variables such as the presence of positive feelings like satisfaction with life and lack of negative emotions like depression, anxiety, and stress. This research aimed to study the prevalence of depression, anxiety, stress, and satisfaction with life as dimensions of adolescent girls' mental health in Tehran.

METHODOLOGY

The population considered in this cross-sectional study consisted of adolescent girls in the last grade of high school in Tehran. Research samples were selected using multi-stage sampling. The sample size in this study was 491 and the research tools used were standardized questionnaires. Descriptive and inferential statistics included Spearman, ANOVA, and regression tests were used.

FINDINGS

More than half of the adolescents experienced common symptoms of depression, anxiety, and stress. About 30% of adolescents were dissatisfied with life to some extent. Satisfaction with life was negatively correlated with age, depression, anxiety, and stress. Age and depression were predictor variables of life satisfaction based on the regression model.

CONCLUSION

A considerable percentage of adolescents suffered some form of depression, anxiety, and stress symptoms and were notably dissatisfied with life. Regarding the importance of satisfaction with life in having a joyful life and its role in initiating depression, anxiety, and stress, our findings highlight the need for interventions to prevent depression, anxiety, and stress and enhance life satisfaction among adolescents.

Concordance of the cardiovascular patient education with the principles of Andragogy model

Background

Patient education is a critical aspect of patient care and is considered a vital part of self-care (especially in patients with cardiovascular disease (CVD)) and health promotion. The literature supports incorporating the principles of the andragogy model (adult learning) into patient education. This study aimed to determine the concordance of the CVD patient education with the principles of the andragogy model.

Methods

This cross-sectional survey was conducted on 384 adult CVD patients from 2 selected hospitals of Tehran. The sampling method was convenient, and the data collection tool was a researcher-made questionnaire based on the principles of the andragogy model. Data were analyzed using SPSS16 statistical software.

Results

The mean age of the patients was 55.69 ± 13.01 years old. Frequency of distribution of the patients who, in total, selected the items of 4 or 5 for respecting the principles of andragogy model was as follows: 68.16% for the motivation, 66.29% for the need, 66.03% for the orientation, 54.16% for the experiences, 51.55% for the self-concept, and 44.65% for the readiness principle.

Also, three principles of motivation (77.37) need (74.97), and orientation (74.78) had the highest mean, respectively, in terms of adhering to this model. But the most common problems in patient education were related to the principles of readiness (64.35), self-concept (68.19), and experiences (77.71) with the lowest mean.

Conclusions

The findings of this study provided valuable information on the flaws in patient education, including ignoring and disrespecting the principles of adult education. Correcting these detected defects and providing feedback to health professionals can improve the quality of patient education programs and patient satisfaction. Also, it empowers healthcare providers, patients, and families through effective education strategies.

Psychometric properties of the Persian version of the Cultural Competence Scale in Clinical Nurses

AIM

Cultural competence is a crucial component of nursing competency, and a valid and reliable scale is needed to measure it. This study was conducted to investigate the psychometric properties of the Persian version of the Cultural Competence Scale among Iranian clinical nurses.

DESIGN

A methodological design was used.

METHODS

The scale was translated into Persian, and its content, face and construct validity, and reliability were examined.

RESULTS

Two items with a content validity ratio of 0.6 were removed. In the case of the content validity index, one item with a content validity index lower than 0.70 was removed. The mean content validity index for the scale was reported as 0.99. All 31 items with an impact score index higher than 1.5 were approved. The exploratory factor analysis revealed four factors explaining 59.92% of the total variance. Cronbach's alpha and the intraclass correlation coefficient were calculated at 0.95 and 0.94, respectively.

The Experiences of Intensive Care Nurses in Advocacy of COVID-19 Patients

The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses’ statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients’ values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients’ voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients’ values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients.

Stakeholders’ Perceptions of Challenges in the Public Health Nursing Practicum: A Qualitative Study

Background: Community health nurses have an important role to play in promoting public health. This study attempted to explore the stakeholders’ perceptions of challenges in the public health nursing practicum in Iran. Methods: This qualitative study was carried out in some schools of nursing and health centers in Iran from October 2015 to September 2017. Twenty-three participants, including faculty members of public health nursing, nursing students, home nurses, experts in health centers, and nursing education policymakers were selected by purposeful sampling. Data were collected using individual interviews and were analyzed by Lundman and Graneheim’s method of content analysis. Results: Three themes resulted from the data analysis, including organizational challenges (with sub-categories of “inappropriate implementation of the curriculum due to lack of authority”, “the treatment-centeredness of health care system”, and “limited fields for nursing practicum”), educational challenges (with sub-categories of “shortcomings of educational curricula” and “the duration and time of practicums”), and workforce challenges (with sub-categories of “the financial burden of public health nursing practicum”, “lack of job position for public health nurses”, and “factors related to the role of instructors”). Conclusion: Senior managers, community health center administrators, and educational planners can use the challenges and barriers raised in this study to make more appropriate planning for the training of nursing students in public health nursing practicum.

Psychometric evaluation of the nine-item heart failure self-care behavior scale (9-EHFScBS)

Background & Aim: Self-care in patients with heart failure can improve multiple outcomes and reduce mortality. Measuring self-care requires valid and reliable tools. This study aimed to determine the psychometric properties of the 9-items European Heart Failure Self-Care Behavior Scale. Methods & Materials: The present study is a psychometric evaluation. The original version of the tool was translated from English to Persian using the standard Backward-Forward method. The questionnaire's validity was assessed using face, content, criterion (the Self-Care of Heart Failure Index v.6 as a criterion), and construct validity.  An exploratory factor analysis approach was used to construct validity with a sample of 216 patients with chronic heart failure referred to Dr. Shariati and Imam Khomeini Hospital's heart clinics in Tehran; and Ayatollah Mousavi Hospital in Zanjan. The reliability of the questionnaire was evaluated by internal consistency and stability methods. Results: After the validation process (validity and reliability), all 9 items of the questionnaire were approved and remained. The content validity index of the total content of the questionnaire was calculated to be 0.96. Based on factor analysis, only one factor was confirmed for the questionnaire. The correlation between the present questionnaire and the Self-Care of Heart Failure Index v.6 was positive and significant (p<0.001, r=0.753). Internal consistency (α=0.728) and stability (0.897) of the questionnaire were also confirmed. Conclusion: The European Heart Failure Self-Care Behavior Scale is valid and reliable for measuring Iranian patients' self-care behaviors with heart failure.

The Impact of Motivational Interview on Self-Efficacy, Beliefs About Medicines and Medication Adherence Among Adolescents with Asthma: A Randomized Controlled Trial

PURPOSE

This study aimed to determine the impact of MI on self-efficacy, beliefs about medicines and medication adherence among adolescents with asthma.

METHOD

This randomized controlled trial conducted on 52 adolescents with asthma referring to the Pediatric Medical Center in Tehran, Iran. They were randomly assigned to the control and intervention groups. The educational intervention consisted of 3 one-hour sessions per week, which was held individually in the areas of medication adherence, beliefs about medicines and self-efficacy. Four validated questionnaires including demographic characteristics, medication adherence, self-efficacy and beliefs about medicines were completed by self-report both before the MI and 40 days after the end of the intervention.

RESULTS

In the baseline, the two groups were homogeneous in terms of demographic characteristics and outcome measures. At the post-test, the mean scores of the three outcome measures in the intervention group were reported higher compared to the scores in the control group (p < 0.05). The difference between the mean scores in medication adherence, beliefs about medicines and self-efficacy in the post-test between the two groups, even with the elimination of the effect pre-test scores, were significant (p < 0.05).

CONCLUSIONS

The results of this study showed that MI can be effective in improving medication adherence, beliefs about medicines, and self-efficacy.

PRACTICE IMPLICATIONS

The primary goal in the treatment of patients with asthma is asthma control by using corticosteroids. MI is one of the interventions that can simultaneously provide motivation, readiness, beliefs about medicine and self-efficacy for behavioral changes (medication adherence) in patients with asthma.

Health care staff support for mothers in NICU: a focused ethnography study

BACKGROUND

Mothers of premature newborns in the neonatal intensive care unit (NICU) have complex needs and require a significant amount of support during the NICU admission. However, little is known about mothers' support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers support needs in the NICU. This study aimed to explore health care staff and mothers' experiences of meeting the mothers' support needs in the NICU.

METHODS

A focused ethnographic approach was adopted. Observations and interviews with 21 mothers, 18 nurses, and five physicians were undertaken over a seven months period. Qualitative data analysis was conducted using the Roper and Shapira (2000) five-step framework.

RESULT

Two main themes of "insufficient provision of the mothers' support needs" (subthemes: inadequate accompany of the mothers in care, assigning monitoring and care to the mothers, inadequate sharing of medical the information) and "supporting the mothers in certain circumstances" (subthemes: reassuring the mothers, supporting the mothers with reduced functional capacity, providing information) were obtained.

CONCLUSION

The mothers experienced a gap between expected and actual support provided by health care staff. Although, the health care staff believed that mothers' support was a necessity, it was not their main concerns, and they considered workload as a barrier for the mothers support in the NICU.

"Applying Intersectionality in designing and implementing health interventions: a scoping review"

BACKGROUND

Given the potential of intersectionality to identify the causes of inequalities, there is a growing tendency toward applying it in the field of health. Nevertheless, the extent of the application of intersectionality in designing and implementing health interventions is unclear. Therefore, this study aimed to determine the extent to which previous studies have applied intersectionality and its principles in designing and implementing health interventions.

METHODS

The title and abstract of the articles which were published in different databases e.g. PubMed, Web of Science, Proquest, Embase, Scopus, Cochrane, and PsychInfo were screened. Those articles that met the screening criteria were reviewed in full text. The data about the application of principles of intersectionality, according to the stages heuristic model (problem identification, design & implementation, and evaluation), were extracted through a 38-item researcher-made checklist.

RESULTS

Initially, 2677 articles were found through reviewing the target databases. After removing the duplicated ones and screening the titles and abstracts of 1601 studies, 107 articles were selected to be reviewed in detail and 4 articles could meet the criteria. The most frequently considered intersectionality principles were "intersecting categories" and "power", particularly at the stages of 'problem identification' as well as 'design & implementation'. The results showed that "multilevel analysis" principle received less attention; most of the studies conducted the interventions at the micro level and did not aim at bringing about change at structural levels. There was a lack of clarity regarding the attention to some of the main items of principles such as "reflexivity" as well as "social justice and equity". These principles might have been implemented in the selected articles; however, the authors have not explicitly discussed them in their studies.

CONCLUSIONS

Given the small number of included studies, there is still insufficient evidence within empirical studies to show the implication of intersectionality in designing and conducting health interventions. To operationalize the intersectionality, there is a need to address the principles at various stages of health policies and interventions. To this end, designing and availability of user-friendly tools may help researchers and health policymakers appropriately apply the intersectionality.

Psychometric evaluation of the perceived access to health care questionnaire

BACKGROUND AND OBJECTIVE

Access to health care is a universal concern. Therefore, this study was conducted to develop a questionnaire to assess the Perceived Access to Health care based on Penchansky and Thomas's definition of access and the assessment of its psychometric properties.

METHOD

The initial questionnaire contains 31 items developed based on a deductive approach with an extensive review of the related literature. Content validity, face validity, construct validity, internal consistency, and instrument reliability were further examined. Data analysis was conducted using SPSS software version 24, R software version 4, and lavaan package.

RESULTS

The initial questionnaire was examined using qualitative content validity, and the necessary modifications were applied to each item. The content validity ratio (CVR) was approved in 30 items with a value greater than 0.78, and one item with a CVR value lower than 0.78 was removed. In the case of the content validity index (CVI), 29 items were approved with a CVI value of greater than 0.79, and one item with a CVI value between 0.70 and 0.79 was revised. In qualitative face validity, all items were approved by a panel of experts and the participants. All 30 items with an impact score index higher than 1.5 were approved for the next steps. The confirmatory factor analysis results showed that the six-factor model of access to health care has an appropriate fit. Cronbach's alpha coefficient for the questionnaire was calculated 0.86. The value of Cronbach's alpha for the dimensions of availability, accessibility, affordability, accommodation, acceptability, and awareness were 0.61, 0.76, 0.66, 0.60, 0.80, and 0.76, respectively. The Intraclass Correlation Index (ICC) value for reliability (test-retest) of the whole instrument was calculated 0.94 using the two-way mixed absolute agreement method.

CONCLUSION

The success of health programs depends on eliminating barriers to access to provided health care services. One of the most critical barriers to understanding access is a perception of limited access. This questionnaire might be used further to understand perceived health care access in different global contexts.

Experiences of Iranian Pediatric Nurses in Providing Care to Hospitalized Children of Different Language Backgrounds: A Qualitative Study

INTRODUCTION

Communication is one of the main foundations of providing care. Nurses have encountered patients from different languages due to globalization and mobilities within and between countries. This study aimed to explore the Iranian pediatric nurses' experiences in providing care for children of different language backgrounds.

METHODOLOGY

In this conventional qualitative content analysis study, 15 pediatric nurses were selected through purposive sampling from four specialty pediatric hospitals in Tehran, Iran. Data were collected via in-depth semistructured face-to-face interviews and concurrently analyzed via conventional content analysis.

RESULTS

Data analysis resulted in 132 primary codes, which were reduced to 95 during constant comparison and categorized into 34 subcategories, six main categories, and the main theme emerging from the categories was "language as a barrier in providing effective nursing care."

DISCUSSION

This study suggests that language differences between pediatric nurses and hospitalized children may make nursing care less effective and act as a barrier to achieving patient care goals.

Prevalence and patterns of self-medication with antibiotics among visitors of central polyclinic of Kabul, Afghanistan

Objectives

Self-medication with antibiotics is a common public health problem worldwide. It is the main driving factor for the development of microbial resistance. The world is facing the challenge of losing effective antibiotics. The study aim is to determine the prevalence and related factors of self-medication with antibiotics among visitors of a clinic in Kabul, Afghanistan.

Methods

A cross-sectional questionnaire-based survey on a sample of 384 consecutively selected visitors of the Central Polyclinic of Kabul, Afghanistan, was conducted.

Key findings

Approximately 34.9% of the sample self-medicated with antibiotics in the past 12 months. Amoxicillin was the most common antibiotic used for self-medication. The sore throat was a common health problem, and previous experience was the source of recommendation for self-medication. The most common reasons for self-medication with antibiotics were cost-saving, previous experience and lack of time.

Conclusions

Self-medication with antibiotics was prevalent among visitors to the clinic. Patterns of self-medication with antibiotics indicate the inappropriate practice of medicines. Pharmacists, friends and family approve the self-medication with antibiotics.

The study of Iranian children and adolescents' physical activity: a systematic review and meta-analysis

OBJECTIVES

This systematic and meta-analysis review was conducted to determine the status of Iranian children and adolescents' physical activity.

CONTENT

All the related articles which were published in the major databases, including Pubmed, Scopus, Web of Science, Embase, Magiran, SID from the beginning of 2010 to the end of 2019, were reviewed by researchers. The Newcastle-Ottawa scale was also used to evaluate the quality of articles. Moreover, I ² index and chi-square were used to assess the heterogeneity between the results.

SUMMARY

490 articles were found as a result of the search in the selected international and local databases, where finally, 10 articles were included into the meta-analysis after the elimination of the duplicated articles and applying inclusion and exclusion criteria. The results indicated that 29.5% of the girls were considered active according to WHO criteria (16.1-42.8: 95% CI) and also 20.5% of the boys (7.3-33.7: 95% CI).

OUTLOOK

Overall, this study's findings showed that a large percentage of Iranian children and adolescents do not achieve the level of physical activity recommended by the World Health Organization. This can lead to undesirable consequences for this group of population that is considered as the human capital of any country; consequently, it seems necessary to take basic measures at the micro and macro levels in order to reduce such problems in the society.

Impact of using question prompt list on shared decision making in the cancer patient: A systematic review

Background & Aim: Shared decision making belongs to the continuum between the two decision-making paradigms of the paternalistic perspective and the client’s complete independence. Various interventions, including the Question Prompt List have been developed to facilitate patients’ participation in counseling. This study aims to investigate the effects of question prompt list on shared decision making among cancer patients. Methods & Materials: For this study, the researchers performed a systematic review of the manuscripts available in Embase, PubMed, Scopus, and Web of Science databases which were published until January 2021. And then, the eligible studies investigating the effect of question prompt list on shared decision making were included in the study. The quality of the studies was assessed using the Cochrane risk of bias tool. Results: Two eligible papers were included in the study, and it was reported that question prompt list was provided before the patients’ consultation with the physician. Both studies have used OPTION 12 to measure shared decision making. The two articles reported that patient communication aid and question prompt list had no significant effect on improving shared decision making through OPTION 12. Conclusion: The findings of this systematic review could not confirm the impact of using question prompt list on shared decision making. more preliminary studies are needed to answer the question expressed by this systematic review study.

Exploring the Reasons for the Inadequate Clinical Competency in the Newly Graduated Nurses: A Qualitative Study

Aim: The most important mission of Healthcare systems is to deliver safe, efficient, and high-quality patient care. Manpower is the key pillar in achieving this goal. Studies show that newly graduated nurses do not have sufficient clinical competence to care for patients. This study aimed to explore the reasons for inadequate competence of newly graduated nurses. Method: The present study is a qualitative study. Participants in this study were 30 individuals, including nursing students, newly graduates nurses, nursing faculties, clinical nurses, nursing managers and deputies for the education of nursing schools who were selected by purposeful sampling method. Data were collected through semi-structured interviews. The data collection continued to data saturation. Data were analyzed using qualitative content analysis in MAXQDA 10 software. Results: Three main categories emerged as reasons for the inadequate clinical competency in the newly graduated nurses i.e. inefficient mechanism of student recruitment, ineffective education, and gloomy outlook for the nursing profession. Conclusion: Training qualified clinical nurses is a dynamic process that requires enrolling the appropriate individuals, preparing a suitable infrastructure to train, training them effectively, providing in-service training, and providing the necessary motivation for professional development in the health care settings.

The Relationship Between Unmet Needs of Parents with Hospitalized Children and the Level of Parental Anxiety in Iran

PURPOSE

This study aimed to investigate the relationship between parents' unmet needs with hospitalized children and the level of parental anxiety.

DESIGN AND METHODS

This correlational study was conducted on 194 parents with hospitalized children. The data were collected using the questionnaires of "revised needs of parents with hospitalized children" and "Zung's anxiety scale". The data were then analyzed through descriptive and inferential statistics using SPSS software version 19.

RESULTS

There was a very weak positive relationship between the number of unmet needs of the sick child and the physical symptoms of anxiety (P = 0.038, r = 0.149) and overall anxiety score (P = 0.018, r = 0.17). However, there was no significant relationship between the number of unmet needs in other groups. Also, there was no significant relationship between the total number of unmet needs and parental anxiety. The most frequent unmet needs of parents, respectively, belonged to 1) support and guidance, 2) needs of other family members, and 3) comfort.

CONCLUSIONS

It might not be possible to obviate all the parental needs during the child's hospitalization. It is noteworthy that failure to meet those parental needs directly related to the child may cause anxiety for the parents.

PRACTICE IMPLICATIONS

Meeting the needs of parents regarding support and guidance, comfort, other family members, and needs directly related to the child is recommended to prioritize in pediatric nursing care.

Families' Experiences of End-of-Life Care at Home for Iranian Older Adults: A Qualitative Study

Aim:

While the care of dying elderly patients at home is very complex and ambiguous, it has not been studied in Iran so far. Hence, this study aimed to explore the experience of a representative sample of the Iranian family caregivers from the end-of-life (EOL) care for their elderly relatives.

Methods:

The present study was conducted using a qualitative content analysis method. Twelve family caregivers caring for the chronically ill dying elderly were selected using purposeful sampling. The purposive sampling method was applied with an extreme variation in sampling, and data gathering was pursued until data saturation was achieved. Semi-structured interviews were utilized for data collection. Interviews were recorded and instantly transcribed verbatim. Inductive content analysis was used to analyze the data.

Results:

Four core themes and 13 subthemes emerged from the experiences of family's caregiver as fallow: (1) Committed to care: This is related to encounter with the end of stage disease of the relative, accepting the care role and priority of care, (2) challenges of Care: Caregivers, despite their efforts, provided ineffective care, so they sought to empower themselves and at the same time provide compassionate care, (3) the crisis of care including the complexity of care, fear, and wandering, helplessness, devastating tension, and vacuum of supporting, and (4) conditions after death that family members involved with a sense of loss and Tension control.

Conclusion:

When families had to take care of their elderly patients at home, although their wish to give the best care, they are completely powerless to provide care, and in an atmosphere of the vacuum of supporting, they encounter severe challenges and crisis. It is vital that palliative care centers in the society are arranged to care for EOL elderly with comprehensive insurance services.