Nurses' use of non-pharmacological pain management methods in intensive care units: A descriptive cross-sectional study.

BACKGROUND: Pain is a common and unpleasant feeling among patients in intensive care units. Therefore, the use of proper pain management methods, such as non-pharmacological interventions, is a priority in intensive care units. OBJECTIVE: This study aimed to ascertain the extent of the use of non-pharmacological pain management methods by intensive care unit nurses in Iran and to identify the obstacles that hindered the use of these methods. MATERIAL AND METHODS: This study used a descriptive cross-sectional design which involved a convenience sample of 224 nurses who worked in 16 intensive care units across northern Iran. Data were collected using the non-pharmacological pain management questionnaire and a researcher-developed checklist of the obstacles that hindered the use of non-pharmacological pain management methods. RESULTS: A moderate number of ICU nurses used non-pharmacological pain management methods (55.8 %). The most common method used by nurses was repositioning (M = 2.72), while methods such as acupuncture and reflexology were used less frequently. Furthermore, the most common obstacles to the use of non-pharmacological pain management methods were nurses' fatigue (M = 2.92) and multiple responsibilities (M = 2.91). Demographic variables such as age, gender, educational level, and work experience were not significantly associated with the use of non-pharmacological pain management methods. CONCLUSIONS: Due to factors such as fatigue, multiple responsibilities, a heavy workload, and an insufficient number of nurses per shift, the rate of utilization of non-pharmacological pain management methods among intensive care unit nurses in Iran was low. Furthermore, most of the participants in this study had not attended courses on non-pharmacological pain management.

The effects of foot reflexology on agitation and extubation time in male patients following coronary artery bypass surgery: A randomized controlled clinical trial.

BACKGROUND AND PURPOSE: This study examined the effects of foot reflexology on agitation and extubation time of male patients following coronary artery bypass graft surgery. MATERIALS AND METHODS: In this randomized three-arm controlled clinical trial, participants (n = 120) were randomly assigned to the intervention, placebo, or control groups. The intervention group received foot reflexology massage for 15 min. Agitation was assessed using the Richmond Agitation- Sedation Scale before the intervention (Time 1) and immediately (Time 2) and 10 min after the intervention (Time 3). Extubation time was measured as the time from gaining full consciousness to endotracheal extubation. RESULTS: Agitation reduced in all groups from Time 1 to Time 3 (p < 0.05); however, the intervention group showed a significantly higher reduction at Time 2 (p < 0.001) and Time 3 (p < 0.001). Also, extubation time was significantly shorter in the intervention group (p < 0.01). CONCLUSION: Foot reflexology may be introduced as a nursing intervention to facilitate the weaning process in the cardiac ICUs.

Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study.

BACKGROUND: The acute nature of the intensive care unit (ICU) environment necessitates that urgent clinical decisions are frequently made by the health care team. Therefore, it is important that critical care nurses have the authority to make decisions about their patient care. PURPOSE: The purpose of this study was to explore perceived barriers to the practice of professional autonomy from the perspectives of ICU nurses in Iran. METHODS: In this qualitative study, 28 critical care nurses were interviewed using a semistructured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. DISCUSSION: Data analysis led to identification of two main themes and five subthemes: (a) the profession-related barriers with two associated subthemes of "lack of capacity to exercise autonomy" and "lack of strong professional bodies"; (b) organizational barriers with the associated subthemes of "role ambiguity," "a directive rather than supportive workplace," and "lack of motivation." CONCLUSION: ICU nurses in Iran may face many challenges in gaining professional autonomy. The identified inter- and intraprofessional barriers to the exercise of autonomy need to be addressed to promote critical thinking, job satisfaction, and motivation of ICU nurses, which can in turn lead to improved patient outcomes.

Dying with dignity: a concept analysis.

AIMS AND OBJECTIVES: This article is a report of an analysis of the concept of dying with dignity. BACKGROUND: Dignity is an important component of providing care for dying patients and their families. Nevertheless, given that this concept is poorly defined, concept analysis is one of the best ways to define and clarify the concept of death with dignity with the aim to enhance its application in clinical practice, research and education. DESIGN: A search of multiple nursing and social sciences databases was undertaken, including Academic Search Complete, Science Direct, ProQuest, Scopus, Medline, PubMed, EBSCO, Ovid, Noormage, Cinahl, Magiran, PsycINFO and SID. METHODS: After an extensive review of the literature from 1998-2014, about 14 related articles were included in the study. Based on these articles, the applications, attributes and experimental results of and references to death with dignity were recorded. RESULTS: Based on this analysis, the most important attributes of this concept included respect for privacy, respect, spiritual peace and hope. The antecedents of this concept included consideration of moral values during caregiving, preservation of human dignity as a patient right and professional ethics, and belief in the dignity of self and others, consideration of culture in providing end-of-life care. The consequences of this concept included a sense of peace in the patient and their family, peaceful death and provision of patient privacy and comfort. CONCLUSION: The concept of patient dignity has been referred to in many contexts. However, considering the dignity of dying patients commensurate with their culture is the most important component of care provided by nurses to facilitate a peaceful death. RELEVANCE TO CLINICAL PRACTICE: Respecting the dignity of the patient results in the reduction of her/his suffering and prepares her/him for a comfortable death.

The lived experiences of patients post coronary angioplasty: a qualitative study.

Few qualitative studies have focused on the experiences of patients post angioplasty. A deep understanding of patient experiences of care and the way a treatment can affect their everyday life is particularly important in chronic disease management. The aim of this study was to explore experiences that patients undergo after angioplasty. Using a phenomenological study design, 15 patients participated in individual, face-to-face, semistructured interviews. Data were analyzed using qualitative content analysis. The following core themes emerged from the analysis, which reflect the experiences of patients post angioplasty: (a) Angioplasty is a milestone in the patient's life, (b) living with a mended heart, and (c) psychological distress as an integral part of the patient's life. Participants after angioplasty went through both positive and negative changes in their life. Understanding these experiences is essential to modifying high-risk behaviors while supporting patients through their rehabilitation.

Spiritual well-being of patients with multiple sclerosis.

BACKGROUND: Spiritual well-being is one of the fundamental concepts in chronic diseases which create meaning and purpose in life and is an important approach in promoting general health and quality of life. This study performed to determine the level of spiritual health and its dimensions in patients with multiple sclerosis (MS). METHODS: 236 members of Iranian MS Society were volunteered to participate in a descriptive co-relational study. Spiritual well-being was evaluated by The Spiritual Well-Being Scale (SWBS) questionnaires in two religious and Existential dimensions. Descriptive statistics, ANOVA, t-test and Pearson correlation coefficient were used to analyse the data. RESULTS: The majority of patients (% 97.9) showed moderate spiritual well-being (mean score = 74.3, SD= 8.90). Although Existential well-being (mean score = 40.3, SD= 5.51) was higher than religious well- being (mean score = 33.9, SD= 4.88). A significant relationship was seen between economic status and the spiritual well-being. CONCLUSIONS: The results emphasize on the necessity of spiritual well-being as an effective factor on different aspects of these patients' life. This key point is useful and even necessary to be considered to design programs of care and cure for these patients in a country (like Iran) with cultural and religious beliefs. On the other hand, patients' economic status should be considered.