Clinical nursing competency during epidemics: a qualitative content analysis.

BACKGROUND: Nurses are on the frontline for managing epidemic diseases. Different aspects of clinical nursing competencies during epidemics are important issues that need investigation. OBJECTIVES: The aim of this study was to determine the required clinical competencies for nurses during epidemics. Understanding these competencies could provide valuable information for health care services and nursing education organizations to prepare nurses for future epidemics. METHODS: The qualitative conventional content analysis study was conducted using semi-structured interviews with 12 nurses that were actively engaged in providing patient care during COVID-19 pandemic in Shahid Beheshti hospital in Kashan/Iran, from October 2022 to March 2023. The data analysis process was conducted according to 5 steps suggested by Graneheim and Lundman. RESULTS: After analysis, the 159 competencies were derived from interviews that were categorized to 11 subcategories, and three categories of clinical nursing skills in epidemics, knowledge of epidemics, and soft skills for nurses in epidemics. CONCLUSION: Nurses need wide range of competencies to address the professional expectations regarding providing acceptable care during epidemics. Knowing these competencies can help nursing managers to prepare nurses for crisis such as what world experienced during COVID-19 pandemic.

Delegating care as a double-edged sword for quality of nursing care: a qualitative study.

BACKGROUND: Considering the significance of care delegation in enhancing the quality of nursing care and ensuring patient safety, it is imperative to explore nurses' experiences in this domain. As such, this study aimed to explore the experiences of Iranian nurses regarding the delegation of care. METHODS: This qualitative study was conducted between 2022 and 2023, employing the content analysis method with a conventional approach. The study utilized purposeful sampling method to select qualified participants. Data collection was carried out through in-depth and semi-structured interviews utilizing open-ended questions. The data analysis process followed the steps proposed by Graneheim and Lundman (2004) and involved the use of MAXQDA version 12 software. To ensure the trustworthiness of the data, the study employed the four rigor indices outlined by Lincoln and Guba (1985). RESULTS: In the present study, a total of 15 interviews were conducted with 12 participants, the majority of whom were women. The age range of the participants fell between 25 and 40 years. Through qualitative data analysis, eight subcategories and three main categories of "insourcing of care", "outsourcing of care" and "delegating of care to non-professionals" were identified. Additionally, the overarching theme that emerged from the analysis was "delegation of care, a double-edged sword". CONCLUSIONS: The results of the study revealed that the delegation of care occurred through three distinct avenues: to colleagues within the same unit, to colleagues in other units, and to non-professionals. Delegating care was found to have potential benefits, such as reducing the nursing workload and fostering teamwork. However, it was also observed that in certain instances, delegation was not only unhelpful but also led to missed nursing care. Therefore, it is crucial to adhere to standardized principles when delegating care to ensure the maintenance of high-quality nursing care.

Prevalence and characters of post-acute COVID-19 syndrome in healthcare workers in Kashan/Iran 2023: a cross-sectional study.

BACKGROUND: Post-acute COVID-19 syndrome that is called long COVID-19 consists of the symptoms that last more than 12 weeks with no other explanation. The present study aimed to determine the prevalence, frequency of symptoms, and risk factors of long COVID-19 in the healthcare workers (HCWs) of a selected hospital in Kashan/Iran in 2023. METHODS: A total of 350 HCWs with a history of COVID-19 infection were randomly recruited to the study from February to May 2023. Participants completed a questionnaire including demographic characteristics, information related to COVID-19 infection, underlying diseases, and a checklist of long COVID-19 symptoms. Mann‒Whitney U test, chi-square test, T‒tests, and binary logistic regression were used for data analysis by SPSS 16. RESULTS: The results showed that 75.7% of HCWs experienced symptoms of long COVID-19. The most common symptoms were fatigue (53.1%), cough (43.1%) and muscle weakness (37.1%). In bivariate analysis job title, body mass index (BMI), frequency and number of symptoms of COVID-19 infection, preexisting disease, tobacco use, age, and years of experience showed a significant statistical association with long COVID-19. In binary logistic regression the number of symptoms during COVID-19 infection, nursing occupation, use of corticosteroids, and symptoms of dyspnea and loss of taste could explain the occurrence of long COVID-19. CONCLUSION: The long COVID-19 is a prevalent condition among HCWs especially nurses. Symptoms of long COVID-19 such as fatigue and cough can persists over time. This chronic condition has significant associations with different clinical risk factors.

The barriers and facilitators of developing clinical competence among master's graduates of gerontological nursing: a qualitative descriptive study.

BACKGROUND: Clinical competence development is a main goal of specialized nursing courses. Nonetheless, some master's graduates of gerontological nursing programs have inadequate Clinical competence. The aim of this study was to explore the barriers and the facilitators to clinical competence development among the master's graduates of gerontological nursing. METHOD: This qualitative descriptive study was conducted in 2020. Participants were twenty nursing master's students, master's graduates, and instructors of gerontological nursing. They were purposively selected from several faculties of nursing and midwifery in Tehran, Isfahan, and Kashan, Iran. Semi-structured interviews were held for data collection and the conventional content analysis proposed by Graneheim and Lundman was used for data analysis. Data were managed using the MAXQDA 10 software. RESULTS: The main barriers to clinical competence development were students' neglectfulness towards learning, inefficiency of educational system, and ineffective management. The main facilitators to clinical competence development were effective educational planning and management improvement. CONCLUSION: There are different personal, educational, and managerial barriers and facilitators to clinical competence development among master's graduates of gerontological nursing. Effective educational planning and management improvement are needed for clinical competence development among master's students and graduates of gerontological nursing.

Motivation for Healing in Cancer Patients: A Qualitative Study.

BACKGROUND: Studies have revealed that motivation plays a vital role in a person's ability to heal. The nature of motivation for healing in cancer patients is unknown. The aim of this study was to explore the meaning of motivation for healing in cancer patients. MATERIALS AND METHODS: A qualitative research approach was used as the study design. Data were collected using individual semi-structured interviews and the themes were derived from the data using the inductive content analysis method. The patients consisted of 34 cancer patients, 4 family members, 1 psychologist, 1 oncologist, and 3 nurses. The participants were interviewed in the cancer clinics or chemotherapy wards. RESULTS: Based on the results of the interviews, three main themes and seven categories were determined. The themes were identified as (i) the desire to survive, (ii) a spirit of optimism, and (iii) belongingness and responsibility. CONCLUSIONS: The results of this study could be used by researchers to develop tools to measure motivation in cancer patients, and to design intervention mechanisms to enhance the patients' motivation in cancer care. Moreover, a better understanding of motivation can improve psychosocial support in oncology nursing.

Severity of illness affecting the length of stay and outcomes in patients admitted to intensive care units, Iran, 2019.

BACKGROUND: Length of stay (LOS) and patients' outcome are two important indicators in intensive care units (ICUs). The severity of illness influences these variables and could have a predictive value in clinical settings. The impact of severity of illness on the LOS and outcomes in patients admitted to ICUs was investigated in a selected hospital in Iran in 2019. MATERIALS AND METHODS: This research was a descriptive longitudinal study. Data were prospectively collected on 150 patients. The sequential organ failure assessment (SOFA) score, LOS, and demographic variables of the patients were recorded. Abbreviated mental test and Barthel index measuring activities of daily living questionnaires were completed at the time of the discharge from ICU and 1 month later to show the patient outcomes. Data analysis was performed using Chi-square test, t-test, analysis of variance, Pearson's correlation, and linear and ordinal logistic regression with SPSS software version 16. RESULTS: The mean of LOS was 11.21 ± 10.54 days. 24.7% of the patients were discharged from ICUs with optimal recovery, 49.3% with poor recovery, and 26% died in ICUs. One month after discharge, 67.6% of patients had optimal recovery, 24.3% had poor recovery, and 8.1% died. The SOFA score had a significant relation with LOS and patient outcomes in discharge and 1 month later. All the patients with SOFA score <5 survived, and all the patients with SOFA score more than 12 died. CONCLUSIONS: The severity of illness had a significant relation with LOS and patient outcomes in the time of the discharge from ICU and 1 month later. It seems that the initial SOFA score of 12 and higher can be suggested as a cutoff point for poor prognosis in ICU patients.

Clinical competence in nursing: A hybrid concept analysis.

BACKGROUND: Clinical competence (CC) is central issue in nursing. There are some controversies about this concept that needs further investigation. The present study was conducted to analyze the concept of clinical competence in nursing. METHODS: This concept analysis was conducted using the three-phase hybrid model. In the theoretical phase, the Science Direct, PubMed, CINAHL, ProQuest, Scopus, Web of Science, SID, Iranmedex, and Magiran databases were searched to retrieve articles published from 2000 to 2020. Forty two eligible articles were included and analyzed. In the fieldwork phase, semi-structured interviews were held with eighteen university lecturers, clinical instructors, students, and hospital nurses and the data were analyzed through conventional content analysis. In the final analytic phase, the findings of the first and the second phases were combined. RESULTS: The majority of literature defined CC in nursing as a combination of knowledge, and skills, and attitudes that is consistent with those of the fieldwork phase. Most participants in fieldwork stated that gaining CC is a process that is achieved over time through practice and repetition and increasing experience. A nurse needs to acquire personal, social and professional competencies during the study and work period. The CC has antecedents of efficient education, and organizational support. It also has consequences for patients and nurses such as satisfaction, and quality care. CONCLUSION: CC is a continuous process of obtaining knowledge, values, and attitudes, and skills such as critical thinking skills that brings creativity and innovation in nursing practice.

Educating the Existential View to Nurses in Cancer Care: A Review.

BACKGROUND: The aim of this study was to review the interventional studies about educating existential concepts to the nurses working in cancer care. MATERIALS AND METHODS: In this systematic narrative review, the papers published in English and Farsi databases of PubMed, Elsevier, web of since, Scopus, ProQuest, ERIC, Google Scholar and Ovid, MagIran and SID, from 1990 to 2018 were reviewed. Methodological quality of the studies was independently assessed by, using checklists developed by Greenhalgh, and Cochrane Center. No statistical pooling of the outcomes was performed, due to heterogeneity of the outcomes. RESULTS: After wide search, the 17 studies entered to this narrative study. The results showed that educating the existential concept to the nurses dealing with cancer patients can improve their self-competency in providing efficient care to these patients and their ability in decision making. It also enhances their quality of life and decreases the death anxiety and emotional exhaustion. CONCLUSIONS: There were limited and low quality interventional studies about the effects of educating existential concepts to the nurses dealing with cancer patients. These studies showed that knowing this philosophy can help nurses to address caring needs of cancer patients more efficiently. The specific method or content of education cannot be recommended because of the large differences in the methodologies between the studies.

Psychometric Testing of the Persian Version of the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II-PV).

BACKGROUND: Structural empowerment (SE) is an effective method of advancing work environments and has previously been widely discussed in Western countries. Due to the lack of culturally and academically accepted scales in Iran for measuring SE, localization of a foreign scale in this field is necessary. OBJECTIVES: This study aimed at investigating the validity and reliability of the Persian Version of the Conditions of Work Effectiveness Questionnaire-II (CWEQ-II-PV) among Iranian nurses. METHODS: The present cross-sectional methodological research was conducted during 2017-2018. Participants were 230 nurses working in four teaching hospitals affiliated to Kashan University of Medical Sciences in Kashan, Iran, who were selected using quota sampling. A standard forward-backward translation procedure according to Wild et al. (2005) was used to translate the English Version of the CWEQ-II to Persian. The psychometric evaluation processes were achieved by face, content, and construct validity (confirmatory factor analysis [CFA]). Reliability was examined using test-retest and Cronbach's alpha for internal consistency reliability. RESULTS: The CWEQ-II-PV showed good content validity (the mean content validity scores for relevancy, clarity, and simplicity were 94%, 96%, and 94%, respectively). In the CFA, the original six-factor version with 19 items was confirmed. The original model was presented and incorporated in the CFA, indicating an acceptable fit for the model (root mean square error of approximation = 0.06, comparative fit index = 0.92, goodness of fit index (GFI) = 0.94, and adjusted GFI = 0.91). Cronbach's alpha coefficient for the total scale was 0.84 and for each component ranged from 0.71 to 0.87, indicating good internal consistency, and the test-retest Spearman and intraclass correlation coefficients were 0.93 and 0.87, respectively, showing good test-retest reliability. CONCLUSIONS: Evidence was found to support the reliability and validity of the CWEQ-II-PV scale that measures the quality of the work environment for nurses from a SE perspective.

Developing a Tool for Evaluating Ageism in Nursing Care of Older People in Kashan/Iran.

Ageism implies negative views and attitudes towards older people. These unconscious behaviors could make the elderly feel as if they were no longer useful for the family and community. Ageism is common in healthcare services. The objective of this study was to develop a tool to assess ageism in nursing care in Kashan/Iran 2015. This psychometric study was carried out in four stages: literature review for item generation; content validity testing; exploratory factor analysis (EFA) for evaluation of construct validity; and reliability assessment. The data analyzed with SPSS version 16. The final questionnaire had 24 items. The total CVI and CVR were 0.88 and 0.57. Explanatory factor analysis identified 3 factors of respecting older adult in nursing care (14 items); age discrimination and negative views towards older adults (5 items); attention to older adult and their basic caring needs (5 items). The three factors could explain 49.54% of variance. The test-re-test correlation stood at 0.9. The internal consistency of the questionnaire was Cronbach's alpha =0.85. A valid and reliable instrument for the evaluation of ageism in nursing care was developed in this study.

Effect of vitamin D supplementation on depression in elderly patients: A randomized clinical trial.

BACKGROUND & AIMS: Treatment of depression in elderly population is a crucial issue. The effect of vitamin D supplementation on treatment of depression in older adults was investigated in this clinical trial. METHODS: It was an 8-week, randomized clinical trial of vitamin D supplementation and placebo in the treatment of depression in 3 psychiatric clinics. The study sample included 78 older adults aged over 60 years with moderate to severe depression. Subjects were randomly allocated to receive 50,000 U vitamin D3 pearl weekly for 8 weeks or placebo (39 subjects in each group). Main outcome measures comprised Geriatric Depression Scale-15 (GDS-15) questionnaire and 25-hydroxyvitamin D3 [25(OH)D3]. The analysis utilized Mann Whitney U test, Wilcoxon signed ranks test, chi-square and multiple regression analysis. RESULTS: The mean baseline 25(OH)D3 concentration was 22.57 ± 6.2 ng/ml in vitamin D group and 21.2 ± 5.8 ng/ml in placebo group (p = 0.16). The Vitamin D increased to 43.48 ± 9.5 ng/ml in vitamin D and 25.9 ± 15.3 ng/ml in placebo group. The depression score decreased from 9.25 to 7.48 in vitamin D group (p = 0.0001), while there was a non-significant increase in depression score in placebo group. The multiple regression analysis showed that the vitamin D group and the score of depression before study were the variables that could explain 81.8% of depression score after intervention. CONCLUSION: The findings indicated that vitamin D supplementation can improve the depression score in persons aged 60 and over.

Surveying the quality of prehospital emergency services for the elderly falls 2017.

INTRODUCTION: Falls are the most common cause of injuries in elderly population. This study aimed to determine the quality of prehospital emergency services (EMS) for the elderly falls in 2017. MATERIALS AND METHODS: This cross-sectional study was carried out at the Pre-hospital Emergency Center of Kashan in 2017. The sample consisted of elderly people who had reported fall incidents in EMS. The questionnaire consisted of 7 areas with 54 items. Data collected by descriptive and inferential statistics of Friedman and Mann-Whitney were analyzed by SPSS v. 16 software. RESULTS: The number of elderly people was 150 (58% female) and the average age was 68.22 ± 6.75 years. Most falls (88.65%) occurred at home. The average performance scores (between 0 and 2) were as follows: assessment of the scene of the incident (1.51), primary assessment of the elderly (1.46), airway management (1.64), circulation management (1.78), fixation (1.82), secondary and continuous assessment (1.59), and patient transfer (1.68). It was found that secondary assessment and transfer of the male patients were significantly higher in quality than female patients (P < 0.05). CONCLUSIONS: In this research, the quality of care in all areas was reported to be desirable. It is recommended that the weaknesses of each area are investigated and the necessary strategies are taken into account such as staff training, changes in data collection forms, and training for the elderly.

Emotional Intelligence and the Occurrence of Accidents in Motorcycle Drivers in Kashan, Iran.

There is an inherent risk of death and injury for motorcyclists. Some factors such as personality and psychological characteristics may be contributors of motor vehicle accidents/crashes. This study aimed to determine the relationship between emotional intelligence and its related components and the occurrence of accidents/crashes in motorcycle drivers. In this case-control study, 280 motorcycle drivers with and without a history of motorcycle-related accidents or crashes in Kashan, Iran, were selected for convenience sampling. The tool used was the Bar-On Emotional Intelligence Questionnaire and included 90 items. Logistic regression revealed that components of emotional intelligence identified as happiness, optimism, flexibility, self-actualization, autonomy, and interpersonal relationships were different between motorcycle drivers with and without an accident/crash. Our findings emphasized the important role of developing and enhancing the skills of emotional intelligence as related to the prevention of accidents/crashes.

Designing and validity evaluation of Quality of Nursing Care Scale in Intensive Care Units.

BACKGROUND AND PURPOSE: Quality of nursing care measurement is essential in critical care units. The aim of this study was to develop a scale to measure the quality of nursing care in intensive care units (ICUs). METHODS: The 68 items of nursing care standards in critical care settings were explored in a literature review. Then, 30 experts evaluated the items' content validity index (CVI) and content validity ratio (CVR). Items with a low CVI score (< 0.78) and low CVR score (< 0.33) were removed from the scale. RESULTS: The 50 items remained in the scale. The Scale level-CVI and Scale level-CVR were 0.898 and 0.725, respectively. CONCLUSION: The nursing care scale in ICU (Quality of Nursing Care Scale- ICU) that was developed in this research had acceptable CVI and CVR.

Factor analysis of self-treatment in diabetes mellitus: a cross-sectional study.

BACKGROUND: Self-treatment is a treatment of oneself without professional help, which may cause health-related consequences. This investigation examined the self-treatment behaviors in patients with diabetes mellitus in Iran/kashan. METHODS: The patients who referred to the clinic of diabetes and those who were admitted to the General hospital in the city of Kashan due to diabetes mellitus were asked to participate in this cross-sectional study. For data collection, The 25 item questionnaire of Likert scale type with four scales was used. Factor analysis was performed to define the patterns of self-treatment. RESULTS: 398 patients participated in the study. The mean age of the study population was 54.9 ± 12.9 years. The majority (97%) had type 2 diabetes. 50% of patients reported self- treatment. The self-treatment score was 45.8 ± 8.8 (25-100). Female gender, lower education and co-morbid illnesses of hypertension, hyperlipidemia and cardiac disease had significant relationship with self-treatment. The factor analysis procedure revealed seven factors that explained the 43% of variation in the self-treatment. These seven factors were categorized as knowledge, deficiencies of formal treatments, available self-treatment methods, physician related factors, the tendency to use herbal remedies, underlying factors such as gender and factors related to diabetes. CONCLUSIONS: There is a medium tendency for self-treatment in diabetic patients. The assessment of self-treatment practices must be an essential part of patients' management in diabetes care.

The pre-hospital delay in seeking treatment in patients with acute myocardial infarction referring to a central hospital in Kashan, Iran.

INTRODUCTION: A cardiovascular disease, especially the acute myocardial infarction (AMI), is the most important health problem worldwide. Pre-hospital delay in seeking medical treatment is an effective factor on patients' outcomes. The aim of this study was to identify the patients' reactions to the signs and symptoms of AMI and identifying the factors contributing to the pre-hospital delay in a central hospital in Kashan, Iran. MATERIALS AND METHODS: In this cross-sectional study, a random sample of 248 patients suffering from AMI was recruited. A questionnaire used, which contained demographic data, the time, and place of experiencing the symptoms, and the manner of responding to the initial symptoms. The SPSS software (version, 19 was used for data analysis. RESULT: 248 patients participated in the study, 183 (73.8%) were males and 65 (26.2%) were females. The mean delay time was 127 ± 174 min. Moreover, 162 patients had arrived at the hospital during the first 60 min after the onset of the symptoms. The variables of being female (P = 0.024), low level of education (P = 0.014), living in urban area (P = 0.01) and referring to the hospital by one's own car instead of using ambulance were accompanied by more pre-hospital delay. 63 patients (25.4%) referred to the hospital by ambulance. CONCLUSION: Despite having only 25% of the patients referring to this center by ambulance, most patients arrived on time to the hospital.