[Intensive care nurses' reaction to futile cares:a phenomenological study]

Introduction: Emotional stress due to futile care is very high and decreasing level of futile care can result in decrease of stress and increase nurses' job satisfaction

Objective: This study aimed to determine intensive care nurses' reaction to futile cares

Methods: In this qualitative study, a phenomenological approach was used. This study was conducted to understand ICU nurses' reaction to futile cares. Personal interview and observation was used for data collection.All interviews were recorded and coded and analyzed by Van Manen analytical method

Results: In this study 25 ICU nurses participated in personal interview. In primary coding 82 codes were extracted. In process of analysis and constant comparison of data, codes decreased to 78. Finally six categories, 17 subcategories and 2 themes emerged. These themes included robotic care and ethic-emotional conflict

Conclusion: Futile care causes the emotional exhaustion and moral distress for intensive care unit nurses. Lack of guidelines for nurses' practice futile care situation is among essential nursing care problems. Therefore in order to decrease futile care and its effects in nurses, health palnners should develop appropriate interventions to overcome existant barriers

[Understanding of neonatal intensive care nurse practitioner students of situation of their profession in Iran: a qualitative study]

Introduction: A Nurse Practitioner [NP] is has completed graduate-level education [either a Master of nursing or Doctor of Nursing Practice degree]. The core philosophy of the field is individualized care that focuses on patients' conditions as well as the effects of illness on the lives of the patients and their families. NPs make prevention, wellness, and patient education priorities. In addition to health care services, NPs conduct research and are often active in patient advocacy activities. In Iran, formal and academic education of NP has recently added to nursing education curriculum of some nursing colleges. The aim of this study is exploration about understanding of NICU NP students about situation of this new discipline in Iran in comparison with what they know about their profession in the world

Methods: A qualitative study was conducted using a content analysis approach. Convenience sampling was employed to select 8 nursing master degree students of NICU studying in nursing schools of Tehran public universities, Tehran, Iran. Data were collected through semi-structured interviews, which were tape recorded and transcribed verbatim. Data were analyzed using descriptive content analysis approach according to Graneheim and Lundman method

Results: Eight subthemes and 2 themes emerged from data analyses. Subthemes include "necessity of profession", "positive attitude", "conditional success for future", "professional empowerment", "no proportional current curriculum", "frustration after enterance", "unprepared of clinical fields for profession" and "the power of clinical experience". Two themes were 'role ambiguity' and "conditioned success"

Conclusion: It seems that in the opinion of participants for successful assurance of this newly profession field in Iran there is necessary to structural modifications in education and clinical management fields and without professional empowerment theris no any clear vision for their future professional career. Also the findings of this study can provide a base for further researches on this subject

[Health promotion lifestyle in nursing students: a systematic review]

This review article attempted to synthesize research studies using healthy behaviors in the Pender's Health Promotion Model [HPM] in nursing students. The aim of this systematic review was to determine the health promoting lifestyles of nursing students. The methodology includes a systematic review of 14 studies from across the world, which meets predetermined criteria, to draw implications for health promotion. All studies published in the years 1998 -2012 in Medline, Elsevier, Nursing consult, Proquest and Google databases using computers keywords, were collected, evaluated and compared. All available studies based on the healthy behaviors in the HPM were recruited, coded, and analyzed. The researchers carefully rated the quality of each study and numerous variables were investigated. Health promoting life style and 6 variables in health promoting life style including interpersonal relationship, health responsibility, spiritual growth, stress management, nutrition and physical activity were also assessed. 1130 quantitative studies were found in relation to health promotion and of these, 14 were selected for full-text articles. This systematic review showed that physical activity was at the lowest level among dimensions of health promoting behavior. This article provides evidence for future research direction, which can be focused on developing health promotion programs based on the above-mentioned variables

Comparison of mechanically ventilated patients with three types of Communication

Communication is one of the most essential needs of human beings.Mechanical ventilation compromises patients' ability to communicate their needs. This research was conducted to assess the effect of three methods of communication with patients receiving mechanical on their satisfaction in Arak hospitals 1389[2010]. This randomized clinical trial was conducted in Intensive Care Units of Valey Asr, Amir Al Momenin and Ghods hospitals in Arak, Iran. 60 patients who were admitted in ICU and were receiving mechanical ventilation were included in the study. These patients were randomly allocated in three groups.During a 12 hours period researcher used I method of communication for each group of these patients. These mrthods of communication included :A: Communicational board [words and letters]. B: Communicational board [pictures and letters]. C: The conventional method. Data were collected using a questionnaire. The questionnaire consisted of three', parts: demographic variables, medical history and satisfaction with communication method.Validity of the instrument was assured by content validity index.. Cronbach's alpha was used to determine the reliability of the iinstrument. SPSS, version 16 was used for data analysis. There was not a significant difference among three groups in terms of age, gender, mean length of stay in the ICU before mechanical ventilation treatment. The mean satisfaction scores were 2.58. 3.83 and 4.10 for conventional communication group, communication board A and words and letters] and communication board B[pictures and letters] respectively. There was a significant difference among three groups in terms of their satisfaction with communication method [P0.00l].The one way analysis of variance indicated that using communication boards A and B significantly increased patient satisfaction. Using communication boards facilitates communication with mechanically ventilated patients and increase their satisfaction

[Nurses' views about factors affecting the professional roles]

The mission of professional nursing is that guarantee health promotion and recovery of patients. Several changes have occurred in the health care system and professional standards and nurses, as professionals, should pay attention to the changes and identify factors affecting their professional roles. The aim of this study was to clarify the nurse's viewpoint on factors affecting the professional roles. In this qualitative research, 7 nurses in various hospitals of Tehran were selected by purposeful sampling and sampling continued data saturation. Semistructured interviews were used for data collection. All interviews were recorded and hand written and using the constant comparative method and content analysis were analyzed. Ability to verify data, hand-written overview of the method was used with participants and partners. Data analysis showed that six components; cultural characteristics - beliefs of patients and his family, nurses' job security, management and leadership, gap between the theories -practice, motivational factors of work environment and nurses' personal beliefs were introduced as factors affecting the nurses' professional role. The results of this study showed that some factors affecting the nurses' professional roles that may be facilitated or inhibited the professional roles performance, and this requires a detailed understanding of the factors facilitating and hindering the nurse's professional role and planning to achieve health promotion goal

[ comparison among perspective of doctors, nurses and patients towards nursing advocacy role]

Patient advocacy is one of the most controversial issues in nursing during recent two decades. The purpose of this study was to determine perspective of doctors, nurses and patients towards the advocacy role of nurses about patients in hospitals affiliated to Shahid Beheshti University of Medical Sciences. This descriptive- comparative study was conducted on a sample of 329 doctors and 345 nurses and 225 patients, selected by a multi-stage sampling method. Data were collected using a demographic questionnaire and a Nursing-Advocacy-Perspective-Scale. The content and construct validity as well as internal consistency and test-retest reliability method were assessed and confirmed beforehand. The data was analyzed using SPSS 16 and statistical tests at the significant level of P<0.05. There was a significant difference among the three groups in average scores perspective [p<0/05]. Average scores of patients were higher than nurses and doctors, and nurses average scores were significantly higher than physician [p<0/05]. The nurse managers should promote the role of the facilitator and prevent loss of nursing advocacy and creating opportunities to provide this role in hospitals. In this regard the views of interest groups may help.

[Effect of peer support groups on promotion of physical health status in multiple sclerosis: testing reed's self-transcendence theory]

Introduction: The Theory of Self-Transcendence proposes that individuals who face human vulnerability or mortality obtain an increased capacity for self- transcendence and its positive influence on well-being. The aim of current study was to determine the effect of Peer Support Groups on promotion of Physical Health Status in Multiple Sclerosis by Testing Reed's Self-Transcendence Theory

Methods and Materials: This study is a before and after quasi-experimental method based on self-transcendence theory that was conducted on 33 patients with confirmed MS participated in 3 peer support groups. Eight weekly 2 hours sessions were held. Data collection tools was Physical aspect of 'Multiple Sclerosis Quality of Life Inventory' with 78 item and Cronbach's coefficient was 0.93, 'Self-Transcendence Scale' [STS] with 15 item and Cronbach's coefficient was 0.68 that after modifying, it increased to 0.81. Revised Illness Perception Questionnaire [IPQ-R] with 75 items and Cronbach's coefficient was 0.80. Patients completed tools pre- and post of sessions. Data analyzed by SPSS [v.18]

Findings: Illness perception can predict self-transcendence and physical health with 0.7207 effects. Also, self-transcendence can predict physical health with 0.43 effects. New finding was a direct relation between illness perception and physical health [p=0.001] that was not mentioned in Reed's Theory

Conclusions: Based on the results, this theory can be used in research and educational management in nursing and nursing management to improve the physical health of MS patients

[Use of logistic regression model in surveying effective causes of readmission in patients with congestive heart failure]

The readmission is admission of a patient in hospital after he/she is discharged in a specific period. The prevalence of readmission in patients with congestive heart failure is more than other chronic diseases, and within 3-6 months after discharge in these patients, it is 10-50%. This study was conducted to determine the socioeconomic factors affecting the readmission of patients with congestive heart failure who were admitted in cardiology wards of Shaheed Beheshti University of Medical Sciences Hospitals in 2008. In this descriptive study, 110 male and female patients with congestive heart failure were selected with quota purposive sampling method, and were divided into two groups based on their admission background in the last 6 months prior to study onset. Data were collected by a questionnaire from the patients and referring to their files, and they were analyzed by deductive statistical tests. 61.8% of patients were readmitted to the hospital during the last 6 months ending to study onset; and economic problems, lifestyle and low income level affected the readmission rate of patients. This study confirms that socioeconomic factors, which some of them are amenable to change, dramatically increase the risk for multiple hospital readmissions among patients with CHF; and it advises that more attention to effective causes of its prevalence are needed

[Correlation between self-concept according to Roy adaptation model with adherence to therapeutic regimen in hypertensive outpatients who attended in one of hospitals affiliated to Urmia university of medical sciences and health services]

Although drug treatment for hypertension is available, but just 30% hypertensive patients have controlled hypertension. Nowadays non adherence to recommended health regimen is accepted as a nursing diagnosis by American Nurses Association. The aim of this study was to determine correlation between self-concept [according to Roy Adaptation Model] and adherence to therapeutic health regimen in hypertensive outpatients who attended to one of hospitals affiliated to Uremia University of Medical Sciences and health Services. In this descriptive-correlational study, 120 hypertensive outpatients, who had inclusion criteria, were selected by quota purposive sampling method. Data were collected by a demographic and disease related questionnaire, "Self-Concept Questionnaire in Heart Disease Patients based on [RAM]" and "Hill-Bone Compliance to High Blood Pressure Therapy Scale". Validity and reliability of questionnaires were assessed with content validity and Cronbach's Alpha coefficient. Cronbach's alpha coefficients of "Hill-Bone Compliance to High Blood Pressure Therapy Scale" and threat and challenge perception "Self-Concept Questionnaire in Heart Disease Patients based on [RAM] were calculated 0.71, 0.87, 0.90 respectively. the questionnaires were completed by interview and data were analyzed by SPSS 16. Findings showed that adherence to recommended health regimen had significant negative relationship to total threat perception with perception of threat of self-concept [P<0.001]. Also, Adherence to recommended health regimen had a positive significant relationship with total challenge perception. Similarly, perception of challenge for body sensation, self consistency, self ideal [P<0.001] with self ethical-spiritual of self concept [P=0.027] had a positive significant correlation. According to the correlation between adherence with threat or challenge perception for dimensions of self concept in this study, nurses need to identify methods that cause patients perceive stimuli as a challenge to self-concept. As it guides person to problem solving ways that should be overcame stressful stimuli and leads to integrated adaptation

[Factors contributing to readmission of congestive heart failure patients admitted in internal ward of hospitals of Shahid Beheshti university of medical sciences in Tehran]

The prevalence of congestive heart failure [CHF] continues to rise and nearly 5 million people in the United States have CHF, with more than one-half million new cases diagnosed each year. The readmission rate within 3-6 months after discharge in these patients is 10-50 percent. The aim of this study was to determine factors contributing to readmission of patients with congestive heart failure [class 2 and 3] who were admitted in internal ward of Hospitals of Shahid Beheshti University of Medical Sciences in Tehran 2009. In this correlation -descriptive study, 110 patients with congestive heart failure based on 2 and 3 New York Heart Association Classification [NYHA] were included. Subjects were selected by quota purposive sampling and were divided into two groups [readmission and no readmission]. Data were collected by a questionnaire. Content validity of the questionnaire was assessed by 10 nursing experts, 5 persons with congestive heart failure and 2 cardiologists. Reliability was measured by ted-retest [0/86]. Data were analyzed by SPSS 15. Results showed that,% 61.8 of samples was readmitted to the hospital during the previous 6 months period. In addition, two individual factors [age and literacy level] and two disease related factors [NYHA class and having other disease] contributed to readmissions. Therefore, age and higher NYHA class and having co morbidities had direct and also literacy level indirect relationship with readmissions. The readmission rate of patients with congestive heart failure in this study was high. Therefore, attention to contributing factors is needed

[Effect of group cognitive-behavioral therapy on depression]

Depression is the most prevalent psychotic disorder. In order to cure and prevent the recurrence of this disease, it is necessary to gain more information about remedial methods like Group Cognitive- Behavior Therapy. The aim of this study was to investigate the effects of group cognitive-behavioral therapy on the amount of depression on the patients. This study was experimental and it included both experimental and control group with a pre test. The subjects were selected from patients with mild depression. Their Beck inventory score ranged between 17-20. Patients were randomly divided in two groups. The subjects of experimental group received eight sessions of group cognitive-behavioral therapy. The Beck depression test was completed by the subjects in three phases; before the intervention, after the intervention and one month after that. The data was transferred to SPSS program and analyzed. The results indicated a significant difference between the experimental and control group after the intervention at Beck tests [P=0.043]. Furthermore, there was a significant difference in the experimental group between the depression score in patients before and after the intervention [p=0.033] and the score of patients before and one month after the intervention [p=0.492]. Group Cognitive-Behavioral therapy decreases depression in patients who suffer from mild depression

[Rate of production of inflammatory cytokines TNF and IL- by peripheral blood mononuclear cells stimulated with mycolactone]

Mycobacterium ulcerans is the etiological agent of Buruli ulcer [BU]; the third most common mycobacterial infection in humans after tuberculosis and leprosy. BU is now considered by the WHO to be an emerging infection of major concern. M. ulcerans produces mycolactone toxin, which is required for the organism's virulence. Mycolactone destroys tissue and suppresses host immune responses. In this descriptive analytical study, peripheral blood mononuclear cells from three volunteers with no history of buruli ulcer were used. IL-6 and TNF produced by these cells at different preincubation times with LPS and mycolactone were measured by using ELISA kits. This study showed hyper inhibition of IL-6 and TNF production by mycolactone. TNF levels in the control tubes [containing LPS] in 4hours reached its maximum value and then decreased. While the production of IL-6 in the tube with fresh cells [zero time] had the highest value, after 16hours, it reached its minimum. Since TNF and IL-6 are important immunity inflammatory cytokines, it can be well imagined that decrease of TNF production by this bacterium plays a role in weakening of inflammatory response. So Mycobacterium ulcerans destroys macrophages and at the same time prevents TNF production by important cells in innate immune mechanism

Barriers to and facilitators of empowerment in people with diabetes

Empowerment in individuals with people diabetes is well researched. However, few researchers have focused specifically on the barriers to and facilitators of empowerment in Iranians with diabetes. Understanding the barriers and facilitators that affect the empowerment process could help health professionals to more effectively facilitate self-empowerment. A grounded theory research design was used with in-depth interviews to collect the data from a purposive sample of males and females aged 21-73 years. Data were collected between February and July 2007. Themes were identified using the early steps of the grounded theory data analysis. Common barriers to empowerment were similar to other chronic diseases viZ prolonged stress, negative view about diabetes, ineffective healthcare systems, poverty and illiteracy. Diabetes education, fear of diabetes' complications, and hope for a better future also emerged as being crucial to empowerment. Facilitators specific to Iranians were the concept of the doctor as a holy man, accepting diabetes as God's will and the body as God's gift and support from peers and especially from daughters. Iranians with diabetes describe similar facilitators and barriers to empowerment quite similar to those as people from other countries as well as some specific to Iran. Empowerment is strongly affected by cultural and religious beliefs in Iran. Health professionals with deeper understanding of information about diabetics' lives and sources of strength could facilitate the process

Performance evaluation of nursing faculty members: a qualitative study

Performance evaluation [PE] of nurse faculty members is complicated and difficult but seems necessary. Deans of the faculties, their educational assistants, and faculty member nurses are responsible for planning, performing, and revising evaluation. Finding their common views in developing PE is of special importance. The aim of this study was to elucidate and describe PE of nurse faculty members. In this qualitative study, the required data was gathered through two methods of semi-structured interview with experts and examining the existing policies, procedures, and evaluation documents. Totally, the contents of 22 individual interviews and 26 series of subject materials went under qualitative content analysis using arbitrary approach. Purposive sampling and census methods were used for selecting the interviewees and evaluation documents, respectively. Participants had a wide-ranging perspective toward the PE of faculty member nurses. Having the analysis done, these perspectives and the content of the existing documents were placed in three major themes: individual qualifications of faculty member, performance process, and practice outcome. The items which were not in the concept of PE but had an effect on it were categorized as organizational factors. Findings of the current study confirms the suggestions of the experts, who agree a combination of individual attributes, behavior, and result-based systems for PE. But, it considers the qualifications of faculty members which are improvable and modifiable instead of individual attributes. Besides, paying attention to some organizational factors which affect PE is a matter of importance

[Effect of positioning on low back pain in patients undergone coronary angiography]

Coronary heart disease is an increasing illness and one of the gold standards for their diagnosis is catheterization [CA]. Post-CA bed rest may cause back pain. In Iran, there has been no study about the effects of changing the position on their back pain after coronary angiography. This study was designed to explore these effects amongst the patients admitted to Taleghani hospital, 2006-2007. This clinical trial was carried out on 130 patients hospitalized for coronary angiography. Each Patient was assigned randomly to either the control group [which remained in supine position for 6 hours after coronary angiography], or experimental group. The position of experimental group were changed hourly, from supine to 30 degree elevation and semi position [elevated to 45 degrees] during the first 6 hours after coronary angiography. Check list and numeric pain intensity scale were used for data collection. None of patients developed bleeding, haematoma and arterial thrombosis. There were no significant difference between two groups. There was a significantly lesser pain intensity in experimental group [P<0.001]. The extention of back pain was lesser in experimental group but it was not significantly different [P<0.07]. Changing the bed position of patients would reduce the back pain without increasing the risk of vascular complications. It also promotes physical comfort among patients undergone coronary angiography

[Effects of change positioning on vascular complications and comfort in patients undergoing heart catheterization]

Coronary heart diseases are increasing and one of the gold standards for diagnosis is coronary angiography [CA]. Bed rest after CA may cause back pain. Since, there are a few studies about change position effects on reducing back pain and patients comfort during bed rest after CA in Iran, the study was designed to explore these effects in Taleghani hospital patients [2006-2007]. This clinical trial was conducted on 130 patients hospitalized for coronary angiography. Each Patient was assigned randomly to either the control group, which remained is supine position 6 hours of bed rest after CA, or experimental group. The experimental group changed position hourly, varying between supine, elevated to 3o degrees and semi position [elevated to 45 degrees] during the first 6 hours after coronary angiography. Checklist and numeric pain intensity scale were used for data collection. None of patients developed bleeding, haematoma and arterial thrombosis, so there was no significant difference between two groups. There was significantly less pain intensity of back pain [P<0.001] and nausea [P<0.01] in experimental group. Urinary difficulty, Groin and leg pain were lower in the experimental group but they were not significantly different between the two groups. Changing positions in bed without increased vascular complications may cause reduced back pain; and promote physical comfort among patients who had undergone coronary angiography

[Effects of skin disinfection by alcohol and chlorhexidine on catheter-related phlebitis: a clinical trial study]

Intravenous catheterization is one of the most common invasive procedures at hospitals. This practice is not devoid of complications. Phlebitis is a common complication. This clinical trial was conducted to compare between the efficacy of ethanol 70% and chlorhexidine 0.5% in ethanol 70% as disinfection solutions of the skin on the rate of catheter-related phlebitis. 80 hospitalized patients at emergency ward, CCU and post CCU were enrolled in the study and randomly assigned to one of two equal groups, i.e., for each group, a solution was used. All catheters were inserted and secured by the researcher in the same way. Insertion sites were observed every 12 hours for evidence of phlebitis according to Infusion Nursing Society Phlebitis Scale. Catheters were removed aseptically in the event of phlebitis or after 72 hours. The Study groups were matched in terms of age, sex, level of education, underlying disease and insertion site. Phlebitis occurred in 6 patients [15%] of the chlorhexidine group, and 15 patients [37.5%] of the ethanol group [P=0.022]. It can be concluded that disinfection by chlorhexidine may reduce the incidence of catheter-related phlebitis and can be routinely used in clinical practice