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.

[ effect of orientation tour with angiography procedure on anxiety and satisfaction of patients undergoing coronary angiography]

Recently, coronary angiography has become the largest interventional diagnostic test in cardiac patients worldwide having large effects on anxiety and satisfaction of patients in treatment and care. This study aimed to study the effect of orientation tour on anxiety and satisfaction of patient candidates for coronary angiography procedures. In this randomized control trial study, 148 patients were recruited by random allocation. Patients were divided into two groups with block randomization. Patients in Intervention group, in addition to routine training, orientation tour in the angiography unit was taken too. Anxiety was measured in all patients during admission, before surgery and discharge time; the satisfaction was measured in discharge time too. Collection instruments were according to demographic data, Spielberger state trait anxiety inventory and the Visual Analogue Scale. The Information was obtained by t-test, chi-square and repeated measured were analyzed by SPSS. After the orientation tour, anxiety scores significantly in the intervention group [39.5] compared with the control group [48.26] which decreased [P<0.001]. Anxiety scores at discharge decreased in the intervention group [33.24] compared with the control group [41.22] which was significant [P<0.001]. The mean patient satisfaction score at discharge in the intervention group [9.77] compared to control group [6.11] was statistically significance [P<0.001]. Orientation tour in patient candidates to angiography, reduces anxiety and increases satisfaction, therefore, use of this educational approach in patients undergoing coronary angiography is recommended

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

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

[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

Avicenna the first to describe diseases which may be prevented by exercise

In the modern medical era it has been known as well that physical activity and exercise are important factors to prevent from different chronic diseases. Scientifically, there are numerous evidence based studies about protective role of exercise against chronic diseases such as cardio- respiratory diseases, diabetes, and hyperlipidemia etc, which have been completely explained. Historically, ancient physicians such as Avicenna had described this topic several hundred years ago. However, ancient principles of medicine are too different in comparison with modern medicine and description of diseases which Avicenna has talked about them and their managements are too much different, yet reviewing the protective role of sports and physical activity in his masterpiece, "The Canon of Medicine", reveals that Avicenna has made a significant contribution to the evolution of following knowledge. The present review discusses Avicenna's opinion about protective role of exercise against some diseases through a comparison with modern medical views and also emphasizes aspects that need further investigation for these opinions to be useful in clinic in the future

[Quality of life in burn disfigurement individuals as life in suffocation - a qualitative study]

Nowadays with improving the taking care of the burnt patients, mortality rate decreased. With the increased survival of these patients, the number of the survivors with complications increased. Among these consequences, disfigurement is the most important ones. So recently, psychosocial problems of burnt patients and their rehabilitation have been deeply paid attention to. Therefore, a qualitative study was conducted so as to obtain information concerning quality of life with burn disfigurement after being discharged from the hospital, in order to devise psycho-social support programs based on this evidence. This article reports part of a greater qualitative study. Purposive sampling and theoretical sampling was used to selecting the participants. The main data collecting tool was in-depth interviews. Thirty-four individual in-depth interviews were performed with 22 participants. The interviews were analyzed by the content analysis method and constant comparative method. After analyzing, for quality of life with burn disfigurement theme's "life in suffocation" with three core category "ruin lives", "to get tired" and "slavery disfigurement" appeared. Despite the severity of suffocation for different people was different, but it was for all participants. The evidences indicate quality of life with disfigurement even in people who few years living with problem, in a way that is inappropriate and uncomfortable as life is suffocating. Hence there exists a need to devise a proper supportive plan to enhance quality of life for these people

[The study of nursing student's gratification and hilarity as a mental health index]

Introduction: Psychologists and Sociologists believe that happiness affects the psychological, social, educational and cultural dimensions of all individuals. So to pay attention to this issue as an indicator of students' mental health is very important. Therefore, assessment of nursing students' happiness is very important because they are encountered to multiple stresses and tensions. The aim of this study was to investigate the happiness status of Abhar's nursing students and also its correlation with sex, age, marriage, educational course, and the number of family members

Methods: This descriptive-analytical study was conducted between 2007-2008 in Abhar School of nursing. In this study the Iranian version of Oxford Happiness Inventory was used to measure the students' happiness status. After providing written informed consent questionnaires were distributed among 75 samples and finally 64 students [17=male, 47=female] were measured. Then, the collected data were analyzed using descriptive statistics and appropriate tests like independent-t and one-way ANOVA, by SPSS software version 11.5

Results: Data analysis showed that 17.5% of students had low level of happiness, 69.8% reasonable level and 12.7% were very happy. There was no significant association between the level of happiness and gender [P=0.7], marital status [P=0.4] and age [P=0.2]. But, there was significant relationship between happiness and educational terms [P=0.01]

Conclusion: Based on this study only 12.7% of students were very happy and two groups of junior and senior students were less cheerful. So, it is necessary to consider appropriate plans and interventions to improve and retain the happiness of nursing students in the acceptable levels and thus improve their mental health

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.

[Comparison of the effect of clinical evaluation by two methods: Portfolio and popular, on satisfaction of nurse students]

Introduction: Clinical evaluation is one of the important factors in nursing education, and there are some difficulties in evaluation of clinical skills, representing more practical and effective ways in this field is the topic of many researches. So, in this research we designed a lesson plan based on portfolio evaluation method and used it in nurse student's clinical courses. Then we compared their satisfaction from clinical evaluation with popular method

Methods: In this experimental research, students in fifth semester of nursing at Tehran University of Nursing and Midwifery are participated. These students were divided into subgroups of 7 and 8. Each of these subgroups passed the clinical probationary in cardiac unit. After explaining the research goals, these subgroups were put in two research groups randomly. In portfolio group [n=21] students evaluated by using portfolio method and portfolio evaluation tool. And in other group [n=20], popular form of clinical evaluation in university was used. Both groups answered the satisfaction questionnaire in last day. Content validity and reliability of questionnaire was tested. Data analyzed by SPSS software and with Chi square, Fisher Exact, Mann Whitney, Wilcoxon and spearman's rho tests

Results: Findings showed that students had 21.5 +/- 1.36 years of old and most of them was female and married. Satisfaction in portfolio group was meaningfully greater than popular group in three aspects: alignment of subjects in evaluation method and form with clinical course objects [P=0.04], creating interest and motivation for participation of students in learning [P=0.005], motivating students to use books and other scientific references [P=0.01]. Satisfaction of popular group from fairness of evaluation method was greater than portfolio group [P=0.017]. There were no meaningful results in other aspects

Conclusion: More satisfaction in some aspects from portfolio method represents acceptance of new active methods of learning and evaluation by students. so, using portfolio as one of the best method of clinical evaluation in nursing and doing more researches advised

[Nurses perceived worries from error disclosure: a qualitative study]

Declaration of error is an important aspect of ethic and a necessity for care. It has some benefits for client, care givers and health institution. But always, many concerns prevent health care provider to perform this important and necessary intervention. This study was conducted to clarify these concerns from the perspective of the nurses. This was a qualitative study. The study question was what is the experiences and perceptions of nurses about their worries regard to error declaration or what factors affect this concerns? Purposeful sampling was used. The data was gathered by semi-structured focus groups with 115 nurses of two major university of Iran. The data was explored and analyzed according to inductive content analysis. The data was classified in four groups, patient reaction related concerns, immediate manager reaction related concerns, job position related concerns and negative experiences from past error declaration incidences. According to the undeniable effects of [declaration of error to the patient and/or the family] on increase of safe care and reduction of error incidents, health providing system must reduce the concerns of health care providers in this area and provide appropriate context [situation] for this important caring intervention. Along with that, the reasons and benefits of error declaration should be increase by purposeful education of care givers especially health care managers and it is necessary that rules and regulations [Terms] of error declaration impose [pass] and all health care agencies should be informed to run them. [They should be communicate to run]

[Spirituality in HIV-infected individuals: a phenomenological study]

HIV/AIDS is a well-recognized global problem in the world, including Iran. It is necessary to comprehend and understand lived experience of HIV positive patients. The present study was designed and conducted to better understand the perspectives and experiences of HIV positive patients about the role of the spirituality and religious beliefs in their lives with HIV/AIDS. This qualitative study was conducted using an interpretative phenomenological approach. In-depth, audio-taped and semistructured interviews with 19 participants were conducted to collect data. Data were transcript. Observations were also recorded in comprehensive field notes. A hermeneutic approach was used to analyze the data, according to the method developed by Diekelmann. According to the findings, participants aged between 21 and 56 years of old at the time of contamination to the HIV. Almost half [47.4%] of the participants had CD4 counts under 200 cells/mm3. Analyzes of the data revealed three main themes: [a] Redefining religious values and communicating with God; [b] Compensation; and [c] Individual development. The themes included some sub-themes. Experiencing difficult conditions in HIV positive individuals provide them with an opportunity to return to religious values, redefine themselves and give meaning to their lives, rather than fear or disappointment. Communicating with other HIV positive patients and religious experts are suggested as additional appropriate strategies

Fear of being at risk of acquiring HIV, willingness to care, and discrimination in care and treatment of AIDS patients among nurses

Exposure to infectious blood and body fluids increase risk of occupationally acquired HIV among nurses. Discrimination in care and treatment of AIDS patient is one of the challenging ethical issues in nursing. The aim of this study was to determine fear of being at risk of acquiring HIV, willingness to care, and discrimination in care and treatment of AIDS patients among nurses. In this descriptive -cross sectional study, 165 nurses of internal and infectious wards from four selected hospitals of Tehran and Shahid Beheshti University of Medical Sciences participated. Data were collected by self-administered questionnaires. The instruments used included [demographic data form], [risk perception scale], [willingness to care for people living with HIV/AIDS]questionnaire, and [discrimination against AIDS] questionnaire. Data were analyzed by using SPSS 14, t-test, and pearson correlation. Out of 165 nurses, 36.4% had sever fear of being at risk of acquiring HIV, 81.8% were evaluated to be neutral in willingness to care of AIDS patients, and 54.5% agreed with moderately discrimination practice against AIDS patients. There was a significant correlation between fear of being at risk of acquiring HIV with discrimination in care and treatment of AIDS patients [p=0. 003] and willingness to care [p= 0.007]. It seems that education efforts about universal precautions, ethical issues, and patient rights should be made in order to reduce fear of being at risk of acquiring HIV, decrease discrimination in care and treatment of AIDS patients and increase willingness to care