Informed Consent: A Complex Process in Iran's Nursing Practice / 간호행정학회지

Informed consent should not be regarded as a rigid process. Instead, it should be regarded as a flexible process that provides patient with the right amount of information required to facilitate meaningful decision-making. Informed consent is an important ethical and practical part of patient care. Understanding the moral foundation of informed consent can help to guide therapists in their communication with all patients. Nurses, as members of the multidisciplinary team, are currently key contributors in providing information to patients regarding the treatment process. But in this process, there are some challenges that make it difficult. This paper describes the underlying ethical and regulatory requirements as well as related challenges regarding informed consent in the context of a nursing practice in Iran.

Women empowerment through health information seeking: a qualitative study

Today, women empowering is an important issue. Several methods have been introduced to empower women. Health information seeking is one of the most important activities in this regard. A wide range of capabilities have been reported as outcomes of health information seeking in several studies. As health information seeking is developed within personal-social interactions and also the health system context, it seems that the qualitative paradigm is appropriate to use in studies in this regard. This study aimed to explore how women's empowerment through health information seeking is done. In this qualitative content analysis study, data collection was done with regard to inclusion criteria, through purposive sampling by semi-structured interviews with 17 women and using documentation and field notes until data saturation. Qualitative data analysis was done constantly and simultaneous with data collection. Four central themes were emerged to explain women's empowerment through health information seeking that included: a] Health concerns management with three subcategories of Better coping, Stress management, Control of situation, b] Collaborative care with two subcategories of Effective interaction with health professions and Participation in health decision making c] Individual development d] Self-protection with four sub- categories of Life style modification, Preventive behaviors promoting, Self-care promoting, and medication adherence. The results of this study indicate the importance of women empowerment through foraging their health information seeking rights and comprehensive health information management

Passion for life: lived experiences of patients after coronary artery bypass graft

Coronary artery bypass graft surgery [CABG] improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG. Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. Passion for life was the main theme extracted from the participants' interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery

Psychometric evaluation of the Persian version of the [aging male scales] questionnaire

Men, much like women, are faced with age-related menopause-like symptoms as they age. In recent years, increasing attention has been drawn to clinical research into elderly men and their health-related quality of life. The Aging Male Scales [AMS] questionnaire is an international tool for assessing the health-related quality of life in elderly men. Hence far this questionnaire has not been subjected to psychometric assessment in Iran. This study aims to evaluate the validity and reliability of the Persian version of the AMS questionnaire specific to the health of elderly men in Iran. To validate this instrument, a cross-sectional study was conducted on 521 healthy Iranian men aged 40-65 years old, who attended the blood transfusion center clinic between February 2011 and June 2012. The English version of the AMS questionnaire was translated to Persian and then back-translated. To determine the reliability of the AMS questionnaire, internal consistency was evaluated and test-retest was done. The questionnaire was validated using convergent and structural validity methods. To assess the factor structure of the questionnaire, a correlation matrix of questions and domains was used. Cronbach's alpha was higher than 0.7 [0.73-0.88] in all domains. A Pearson's correlation coefficient of 0.87 between pretest and posttest indicated a high correlation and an acceptable reliability. The convergent validity of the questionnaire was found acceptable by calculating the correlation between the domains and items-total correlation ranging 0.40-0.85, except for question 14 that had a 0.28 correlation with the whole test. The criterion-related validity of the questionnaire in the psychological domain was confirmed with the [two-item Patient Health Questionnaire] [r= 0.63, P < 0.001]. According to the results, the Persian version of the AMS questionnaire has high validity and reliability and may be used to assess the health-related quality of life of men between 40 and 65 years old

[Experiences of living with coronary artery bypass graft: a qualitative study]

Coronary artery bypass graft is a critical intervention for patients with coronary artery disease. This surgery is associated with significant changes and unique experiences in lives of patients. This study was conducted to understand the experiences of patients with coronary artery bypass graft. This qualitative study was conducted using an interpretive phenomenological approach. Eleven patients were selected from outpatient cardiology clinics of Tehran Heart Center using purposive sampling method. Data were gathered through semi-structured in-depth interviews lasting 55-70 minutes. The van Manen six steps analysis was used to analyze the data. During the data analysis, the main themes of experiences of living with coronary artery bypass and rebirth were extracted. These themes contained living with healthy heart, feeling back to the young and attempts for health maintenance. According to the study, participants were inclined to maintain the new lifestyle, dietary changes and also adhere to medications prescription. Nurses can help patients with properly designed educational program based on experiences of the patients

[Ginger effects on control of chemotherapy induced nausea and vomiting]

Chemotherapy-induced nausea [CIN] in the anticipatory and acute phase is the most common side effect in cancer therapy. The purpose of this study was to investigate the effect of ginger capsules on the alleviation of this problem. This randomized, double-blind, placebo-controlled clinical trial was performed on 80 women with breast cancer between August till December 2009 in Imam Khomeini Hospital, Tehran, Iran. These patients underwent one-day chemotherapy regime and suffering from chemotherapy-induced nausea. After obtaining written consent, samples were randomly assigned into intervention and control groups. Two groups were matched based on the age and emetic effects of chemotherapy drugs used. The intervention group received ginger capsules [250 mg, orally] four times a day [1 gr/d] and the same samples from the placebo group received starch capsules [250 mg, orally] for three days before to three days after chemotherapy. To measure the effect of capsules a three-part questionnaire was used, so the samples filled every night out these tools. After collecting the information, the gathered data were analyzed by statistical tests like Fisher's exact, Kruskal-Wallis and Chi-square using version 8 of STATA software. The mean +/- SD of age in the intervention and placebo groups were 41.8 +/- 8.4 and 45.1 +/- 10 years, respectively. Results indicated that the severity and number of nausea in the anticipatory phase were significantly lower in the ginger group compared with placebo group [P=0.0008, P=0.0007, respectively]. Also, the intensity [P=0.0001] and number [P=0.0001] of nausea in the acute phase were significantly lower in the ginger group. On the other hand, taking ginger capsules compared with placebo did not result in any major complications. Consuming ginger root powder capsules [1 gr/d] from three days before chemotherapy till three days after it in combination with the standard anti-emetic regimen can help to reduce the anticipatory and acute nausea.

Ginger as a miracle against chemotherapy-induced vomiting

Vomiting is one of the most prevalent side effects of chemotherapy in cancer patients. The aim of this study was to evaluate the effect of ginger plant on chemotherapy-induced vomiting, since the previous studies were somehow imperfect and have provided controversial results. This randomized double-blind placebo-controlled clinical trial was conducted on 80 women with breast cancer undergoing chemotherapy and suffering from vomiting in Imam Khomeini Hospital, Tehran, Iran, between July and December 2009. During a convenience sampling the participants were randomly allocated into treatment and placebo groups after taking a written informed consent. Two groups were matched based on the age and emetic risk of chemotherapy drugs. The treatment group received 250 mg ginger powder capsules [Zintoma] and placebo group 250 mg starch capsules 4 times a day [1 g/day] for 6 days since 3 days before chemotherapy session. A two-part self-made questionnaire was used to assess the effect of ginger. Patients completed the instrument every day. Then by STATA software version 8, the gathered data were analyzed using Fisher's exact, Kruskal-Wallis, and Chi-square tests. The 2 groups had no significant age differences and were matched [ginger: 41.8 +/- 8.4 vs placebo: 45.1 +/- 10, P = 0.1]. Vomiting cases were significantly lower in ginger group at anticipatory [P = 0.04], acute [P = 0.04], and delayed [P = 0.003] phases. Also, heartburn was the only and venial reported side effect [P > 0.05]. Taking ginger capsules [for 6 days since 3 days before chemotherapy] accompanied by the routine antiemetic treatment could relieve chemotherapy-induced vomiting in all phases.

Recommended foods for male infertility in Iranian traditional medicine

Male infertility accounts for 30-50% of all infertilities among couples. Iranian traditional medicine [ITM] stressed the importance of nutrition in the prevention and treatment of male infertility. Many Iranian traditional physicians have described the traits of specific foods for prevention and treatment of male infertility. To explore the principles and roles of foods recommended by ITM scientists in prevention and treatment of male infertility as well as enlisting all the recommended foods for treating this problem addressed through the ITM original resources written between 815 and 1901. In this review study specific data related to the subject among all referral ITM texts was extracted firstly, and then the collected data were analyzed using inductive content analysis. The analysis of data revealed that foods that enhance sexual performance must have 3 properties; they should be warm in nature, very nutritious, and flatulent. Foods that are warm in nature and nutritious affect the quality and quantity of semen. A food having the third trait of being flatulent is required to complete sexual performance by creating an erection. Foods with only one of these traits must be consumed with another food that has the other trait. This study also provided a list of foods that can enhance the quality and increase the quantity of semen. Foods that can enhance sexual performance and the quality and quantity of semen can be recommended to male patients who suffer from infertility in medical centers

Effect of acupressure on nausea in patients undergoing strabismus surgery

Postoperative nausea is a common problem after general anesthesia, especially in ambulatory surgery. In ocular surgeries including strabismus surgery, intraocular pressure increase may lead to eye damage. Drug therapy has various side effects. The purpose of this study was to evaluate acupressure on nausea in patients undergoing strabismus surgery. In this double-blinded clinical trial, 60 patients undergoing strabismus surgery were allocated into intervention and control groups. In the intervention group, a sea-band was placed on the P6 point of patients' wrists 30 minutes before induction of anesthesia. In the control group, the sea-band was placed in the opposite position of the patients' wrists. Data were collected during six hours after surgery in the recovery room. Data were analyzed using Chi square, t-test, and Mann-Whitney tests. There were no differences in demographic and surgical characteristics between the two groups at baseline. The intensity of nausea in the recovery room [P=0.002] and six hours after surgery [P<0.001] were significantly less in the intervention group than the control group. Based on the findings of this study, acupressure decreases post operative nausea. Acupressure is a simple, noninvasive and cost-effective intervention which can be applied by nurses to prevent post operative nausea

[Appeal of herbal plants as a mechanism for the relief of acute vomiting induced by chemotherapy]

Acute vomiting is one of the most common side effects of chemotherapy during the first 24h in patients with cancer. This study investigated the palliative effect of ginger extract on the rate of this complication. This study was a randomized, double-blind, placebo-controlled clinical trial that was conducted from August to December 2009 in Imam Khomeini Hospital on 80 women with breast cancer undergoing 1-day chemotherapy periods and suffering from vomiting. After obtaining written consent, the samples were randomly assigned into intervention and control groups. Two groups were matched with each other based on the age and emetic risk of chemotherapy drugs used. Participants of the ginger group received ginger capsules[250mg, orally], four times a day [1gr/d] and the samples from the control group received placebo capsules containing starch from three days before to three days after chemotherapy. During this period, to measure the effect of capsules, a two-part questionnaire was used. So, the patients filled these tools out every night. Then, gathered data were analyzed using statistical tests like Fisher's exact, Kruskal-Wallis and Chi-square by the STATA software version 8. The two groups were matched with each other according to the emetic risk of chemotherapy drugs and disease duration [p=0.1, p=0.06, respectively]. Results indicated that the cases of vomiting in the acute phase were significantly lower in the ginger group compared with placebo group [p=0.04]. Also taking ginger capsules compared with placebo did not wake certain complications [p=0.06]. Taking ginger powder capsules [1gr/d] starting three days before chemotherapy for six days and beyond the routine anti-emetic regimen could reduce the acute phase vomiting

Periodontal health status and treatment needs in Iranian adolescent population

Use of the community periodontal index of treatment needs [CPITN] provides a picture of the public health requirements in the periodontal field, which is essential for national oral health policy-making and specific interventions. To determine periodontal status and treatment needs by CPITN index in the Iranian adolescents. The study population consisted of 1,319 subjects aged 15 - 19 years, selected through a multistage cluster stratified random sampling from 13 different provinces of Iran. Six calibrated qualified examiners, using flat dental mirrors and CPITN probes conducted clinical examinations according to the World Health Organization [WHO] standards. The severity and prevalence of the periodontal diseases, as well as its frequency distribution were evaluated and reported according to gender; residency place; frequency of dental brushing; plaque index; number of family members; mean of decayed, missed, and filled teeth index [DMF]; and CPITN. This study was performed during 1999 and 2000. In this study, only 14.5% of subjects demonstrated a healthy periodontal status, with a mean healthy sextant of 2.6. Bleeding was noted in 33.7% of subjects and calculus had the highest score [48.7%]. Shallow and deep pockets were found in 3.9% and 0.5% of the population studied, respectively. Periodontal status in men was worse than women [P < 0.005]. In urban areas it was better than the rural areas [P < 0.0001]. The highest rate of calculus and bleeding were observed in subjects with high plaque index and low frequency of dental brushing [P < 0.005]. A statistically significant [P < 0.005] relationship was also observed between CPITN scores and the number of family members. A positive correlation was found between the periodontal status and treatment needs with the DMF index [P < 0.02]. We found that a high percentage of adolescents need treatment [TN1, TN2, TN3, 4]. If the current trend is not reversed, with increasing the age, periodontal diseases could be escalated