The relationship between moral sensitivity and caring behavior among nurses in iran during COVID-19 pandemic.

BACKGROUND: Caring for patients during a pandemic can be difficult for healthcare workers, the patients themselves, and healthcare systems. Nurses are expected to recognize ethical dilemmas and make sound judgments when confronted with them. Sensitizing nurses to ethical issues strengthen their ability to identify ethical dilemmas and make ethical choices. As a result, this study aimed to determine a relationship between moral sensitivity and caring behavior among nurses during the coronavirus (COVID-19) pandemic. METHOD: The current study is a cross-sectional study of 406 nurses who worked in a single hospital during the COVID-19 epidemic. We used a demographic questionnaire and the caring behavior inventory (CBI) tool to collect data online. The data were analyzed using descriptive and correlational statistics. FINDINGS: Eighty-three point seven percent of participants in this study were female, and 71.9% were married. 47.5% reported caring for a COVID-19 patient for longer than a month; their average work experience was 13.1 years. Additionally, Moral Sensitivity correlated positively with caring behavior and its dimensions (r = 0.164, P = 0.001). However, a significant and inverse link existed between the dimension "following the rules" and the nurse's caring conduct (r = -0.117, P = 0.019). CONCLUSION: During the pandemic, nurses' moral sensitivity was moderate and significantly connected with their caring behavior. Because nurses encounter numerous obstacles while caring for patients in critical conditions, they require ethical empowerment to perform correctly, as caring behavior improves with increased moral sensitivity.

Predictors of Persistence of Anxiety, Hyperarousal Stress, and Resilience During the COVID-19 Epidemic: A National Study in Iran.

Background: The coronavirus pandemic can cause unprecedented global anxiety, and, in contrast, resilience can help the mental health of people in stressful situations. This study aimed to assess anxiety, hyperarousal stress, the resilience of the Iranian population, and their related factors during the coronavirus disease 2019 (COVID-19) epidemic. Methods: A cross-sectional study was conducted in 31 provinces in Iran between March 18 and 25, 2020. A four-part questionnaire, including the demographic information, the State-Trait Anxiety Inventory (STAI-y1-a 20-item standard questionnaire for obvious anxiety), the Connor-Davidson Resilience Scale (CD-RISC-a 25 item standard questionnaire), and the stress hyperarousal subscale from the Impact of Event Scale-Revised (IES-R), was used to collect data. The ordinal multivariable generalized estimating equation (GEE) model was used to identify correlates of the psychological factors mentioned above. The Fisher exact test was used to investigate the relationship between anxiety, stress, resilience, and the COVID-19 outbreak. All analyses were conducted with SPSS 26 and GIS 10.71. Results: The findings show that most people had moderate-to-severe anxiety (80.17%) and a high level of resilience (96.4%) during the COVID-19 epidemic. The majority of participants had a moderate level of stress (58.9%). The lowest and highest prevalences of psychiatric disorders were in Sistan and Baluchestan (3.14 cases per 100,000 people) and Semnan (75.9 cases per 100,000 people) provinces, respectively. Men and unmarried people were the only variables significantly associated with anxiety and resilience. Age, gender, and education were significantly associated with hyperarousal stress. Conclusion: The high and moderate levels of anxiety and stress in Iranians can have negative effects on the well-being and performance of the people and can lead to serious problems. Also, high resilience during negative life events (such as the COVID-19 pandemic) is associated with the well-being in the lives of people. The results of this study can be used in interventions and other psychological studies.

The Effect of the Neuman Systems Model on Anxiety in Patients Undergoing Coronary Artery Bypass Graft: A Randomized Controlled Trial.

BACKGROUND: Coronary artery bypass graft (CABG) surgery is the most commonly used surgical procedure for patients with coronary artery disease. Anxiety is a significant psychological problem associated with CABG surgery that may reduce related treatment outcomes. PURPOSE: This study was designed to investigate the effect on anxiety of applying the Neuman Systems Model in patients awaiting and undergoing CABG surgery. METHODS: A single-blind, parallel-group randomized controlled trial was conducted on patients scheduled to receive coronary artery bypass surgery in an urban area of Iran. Seventy participants were enrolled using a convenience sampling method and randomly assigned to either the intervention group (n = 35) or the control group (n = 35). Participants in the intervention group received intervention in accordance with the Neuman Systems Model format, including meetings held at three levels of prevention. Patients' anxiety was measured using the State Anxiety Inventory before the intervention, immediately after the intervention, and at discharge time. The chi-square test, Fisher's exact test, independent sample t test, one-way repeated measures analysis of variance test, and Fisher's least significant difference were used to analyze the data. RESULTS: No significant difference was found between the mean anxiety scores of the two groups before the intervention (p = .48, t = 0.71). However, the mean anxiety score of the intervention group was significantly lower than that of the control group immediately after the intervention (p = .008, t = 2.73) and at discharge time (p = .007, t = 2.77). CONCLUSIONS: The Neuman-based program is an effective and low-cost intervention that may be applied to reduce anxiety in patients awaiting and undergoing CABG surgery. This program may be a good guide in providing healthcare services.

Molecular, Morphological, and Spatial Study of Galba schirazensis (Pulmonata, Lymnaeidae) from Southeastern Iran.

BACKGROUND: Snails of the genus Galba are the intermediate hosts of Fasciola species, the etiological agents of liver fluke disease, fascioliasis. A genetically different but morphologically very similar species in the genus, G. schirazensis, is sympatrically distributed with G. truncatula in some regions of the world. We aimed to investigate the occurrence of G. schirazensis in Kerman province, Iran and to characterize genetically G. schirazensis specimens from southeast Iran. METHODS: Field-collected snails from four localities in Jiroft, Bam and Faryab, Kerman province, southeastern Iran were studied. Hydrological variables including temperature and pH were recorded for each habitat. Each specimen was identified using morphological as well as conchological characteristics. Genetic characterization was performed using PCR-sequencing followed by phylogenetic analyses on nuclear ITS2 as well as mitochondrial cox1 gene fragments. MaxEnt software was used to predict the most appropriate ecological niches for the targeted species. RESULTS: G. schirazensis was found in 4 out of 28 locations. One ITS2 and two cox1 haplotypes were detected among G. schirazensis populations from the four localities. Habitat study showed that G. schirazensis thrives in habitats with alkaline pH. G.schirazensis from South America were clustered with specimens from Bam, Kerman, Iran; however, north Iranian isolates of G. schirazensis were strongly correlated with specimens from Jiroft and Faryab. MaxEnt model for the most appropriate ecological niches of the targeted species predicted environmental suitability for this species in western Africa as well as coastal areas in north and southwestern Africa. CONCLUSION: G. schirazensis is frequently present in southern areas of Kerman Province. At least two genetically different haplotypes are present in southeastern Iran.

Nursing workload in intensive care units and the influence of patient and nurse characteristics.

BACKGROUND: Understanding factors that can potentially influence patient care and nursing workload in intensive care units is important. Previous studies have shown contradictory outcomes about the relationships between nursing workload and patient and nurse characteristics. AIMS AND OBJECTIVES: This study aimed to investigate nursing workload in intensive care units and examine the association between this in relation to patient and nurse characteristics. DESIGN: A cross-sectional design was conducted. METHODS: All nurses who were working in the intensive care units of five hospitals and met the study criteria were enrolled in the study. Two demographic questionnaires collected nurse and patient demographic information. The Nursing Activities Score was applied to determine nursing workload in three shifts (morning, evening, night) for each nurse. Data were analysed using the independent sample t-test, one-way analysis of variance, and multivariable linear regression analysis. RESULTS: The Nursing Activities Score was calculated for 509 patients who were under the care of 105 intensive care unit nurses. The mean (SD) Nursing Activities Score was 72.84% (22.07%). Morning shifts, male patients, medical treatments, and referred patients from the emergency ward and other intensive care units imposed a higher workload for nurses. Specifically, female nurses, increased number of patients receiving care, and increased patient length of intensive care unit stay were directly associated with increased Nursing Activities Scores. Work in surgical and burn intensive care units were inversely associated with the Nursing Activities Score. CONCLUSION: This study suggests that the workload of nurses in intensive care units can be affected by both nurse and patient characteristics. RELEVANCE TO CLINICAL PRACTICE: The findings can be used to ensure appropriate staffing of intensive care units by nurses. However, nurse and patient characteristics should not be considered the only factors that influence nursing workload in intensive care units.

Resilience in Iranian adolescents during the COVID-19 pandemic: Psychometric Evaluation of the Connor-Davidson Resilience Scale.

Background: Resilience is a measure of the ability to cope with stress and the accurate measurement of it is critical. This study aimed to translate and evaluate the psychometric properties of the Connor-Davidson Resilience Scale in Iranian adolescents during the Coronavirus Disease (COVID-19) pandemic.Methods: In this cross-sectional study, after the scale translation, the content and construct validity were assessed using exploratory and confirmatory factor analysis. Moreover, internal consistency, composite reliability, and invariance measurement were evaluated.Results: The content validity ratio was greater than 0.49, and the modified kappa coefficient for all items was higher than 0.6. With exploratory factor analysis, two factors were extracted consisting of 16 items and explaining 43% of the total variance. The results of confirmatory factor analysis indicated a good fit for the model. Cronbach's alpha and composite reliability for both factors were greater than 0.7. Although there is no significant difference (p = 0.09) in the average resilience of adolescents in different provinces, boys (42.64 ± 10.90) had a significantly (p < 0.001) higher resilience score than girls (40.10 ± 11.92).Conclusion: The study results showed that the Persian 16-item version of the Connor-Davidson Resilience Scale has acceptable reliability and validity in the Iranian adolescent population.

Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review.

BACKGROUND: When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. MATERIALS AND METHODS: Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. FINDINGS: 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. CONCLUSION: Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries.

Modifying Stressors Using Betty Neuman System Modeling in Coronary Artery Bypass Graft: a Randomized Clinical Trial.

Introduction: Coronary artery disease (CAD) is one of the major causes of mortality all over the world. In this relation, coronary artery bypass grafting (CABG) is one of the most important treatments for CAD patients. However, it leads to a lot of stress in the patient. The aim of this study was to use the Neuman model to moderate the stressors in patients undergoing coronary artery bypass graft. Methods: This study was a randomized clinical trial of two groups performed on patients admitted to the coronary artery bypass graft; and the study completed with 64 patients. The intervention was performed by the researcher according to the format of the Neuman Model, which included the investigation of the stressors, and the determination of the goals and strategies for the actions. Intrapersonal, interpersonal, and extra personal factors were evaluated using a Revised Cardiac Surgery Stressor Scale (RCSSS). The intervention program was designed by the researcher based on prevention levels using scientific resources. The collected data were analyzed in SPSS ver. 13 using descriptive and inferential statistics. Results: Before the intervention, the mean score of the stressors was not significantly different between the two groups. But immediately after the intervention and before discharging the intervention group, it was significantly less than the control group. Conclusion: Using a Neuman-based program as an effective and low-cost intervention can moderate the stressors and reduce the stress of patients awaiting coronary artery bypass graft. This theory can be a good guide to offering the roles needed to provide health services in the community.

The Relation between Toxocariasis and Toxoplasmosis co-infection and the presence of Rheumatoid Factor (RF) in people with hydatidosis in Southwestern Iran, from 2013 to 2018.

Toxoplasmosis, toxocariasis, and hydatidosis are parasite diseases with a very human-like pathway of infection. worldwide including Iran, there are infected people with these infections. Between 2013 and 2018, serum samples were collected from 124 patients with hydatidosis and 124 serums from hydatidiosis free. Samples were examined for the presence of toxocariasis by detecting IgG antibodies, using the ELISA (Enzyme-Linked Immunosorbent Assay) IBL kit and for the presence of IgG antibodies for toxoplasmosis, using the ELISA test. Risk factors such as contact with animal pets; cats and dogs, rural or urban living, age, sex, and Presence of rheumatoid factor (RF) in serum were investigated during the study. The presence of RF was examined using an agglutination test in all confirmed cases of hydatidosis, toxocariasis, and toxoplasmosis. Of the 124 positive cases of hydatidosis, 30 (24.2%), 51 (41.1%) and 15 (12.09%) had toxoplasmosis, toxocariasis and simultaneous infection (toxoplasmosis and toxocariasis), respectively. In people with toxocariasis, rheumatoid factor was reported more frequently than in other cases. The relationship between the prevalence of rheumatoid factor in serum in people with toxocariasis was significant (41.18%). Interaction with dogs and cats and area of residence were identified as risk factors for toxocariasis (P value > 0.005). Although hydatidosis and toxocariasis are Less common infections compare with toxoplasmosis, they are considered a threat to public health in some parts of the world, including Iran. Some factors, such as habitat and interaction with animal pets (dogs and cats), play a more significant role in toxocariasis compared to toxoplasmosis in people with hydatidosis.

Morphometric and Molecular Study of Fasciola Isolates from Ruminants in Iran.

OBJECTIVE: The purpose of the present study was morphometric and molecular characterization of Fasciola isolates from ruminants in Iran. METHODS: Flukes were collected from the livers of 54 naturally infected sheep and cattle. The proportion of body length to width (L/W) of each fresh fluke was measured using a digital caliper. We employed receiver operating characteristic (ROC) curve analysis to explore the reliability of L/W for differentiating the two species. Polymerase chain reaction (PCR)-sequencing was performed on ribosomal Internal Transcribed Spacers (ITS) and mitochondrial cytochrome c oxidase subunit 1 (cox1) genes. The sequences were then analyzed and phylogenetic relationships were investigated. RESULT: Forty-eight out of 54 isolates (88.9%) were identified as F. hepatica and four isolates (7.4%) as F. gigantica. All the sheep isolates were F. hepatica, while 4 out of 10 cattle were infected with F. gigantica. The morphometric study revealed an L/W ratio of 1.2 to 6.5 in Fasciola isolates with significantly higher L/W ratio in F. gigantica (p<0.00). According to the ROC curve analysis, the L/W value of 3.55 was regarded as the critical value to discriminate between the two species. CONCLUSIONS: Findings of the present study indicate the presence of both Fasciola species in southeastern Iran. The phylogenetic analysis revealed two different clades representing F. hepatica and F. gigantica. The two isolates in this study were described as Fasciola sp. The mitochondrial DNA of these isolates were similar to F. hepatica, while their ITS fragments were identical to F. gigantica.