The effect of an educational program based on Roy's adaptation model on the quality of life of patients suffering from heart failure: A clinical trial study.

AIM: Heart failure is a progressive, debilitating disease with exacerbated physical and psychological symptoms that reduces the quality of life of patients. Nursing intervention based on nursing theories could help in the adaptation of patients to the disease and improving quality of life. The aim of this study was to determine the effect of an educational program based on Roy's adaptation model on the quality of life of patients with heart failure. METHODS AND MATERIAL: In this randomized controlled trial, 76 patients with heart failure were allocated to either the intervention or control group through a blocked randomization method. The data were collected between May and October 2017. The intervention group received oral and written educational programs for 4 weeks. Minnesota quality-of-life questionnaire and Roy's adaptation model-based evaluation form was completed at the beginning of the trial, and 1 month after the completion of the study. RESULTS: Intervention patients showed statistically significantly improved scores on the physiologic, role function, independence-interdependence dimensions and the total score of Roy's adaptation model over time compared with control patients (p < .05). The mean score of all of the three quality-of-life dimensions and total score of quality of life increased significantly (p < .05). CONCLUSION: The study results help nursing staff detect the stimuli and the behaviors of patients with heart failure. Roy's adaptation model can be used as a standard practice to increase adaptation to the disease and improving quality of life.

Effect of the Walking Exercise Program on Cancer-Related Fatigue in Patients with Acute Myeloid Leukemia Undergoing Chemotherapy.

Background: Cancer-related Fatigue (CRF) is one of the most common complications of acute myeloid leukemia (AML) and its related therapies. It can influence all physical and psychological aspects of the patient's life. Also, it is believed that exercise can improve CRF in patients with cancer. Objective: This study aimed to investigate the effect of the walking exercise program on CRF in patients with AML undergoing chemotherapy. Methods: In this quasi-experimental study with a pre- and post-test design, 50 patients with AML undergoing chemotherapy were selected using a convenience sampling method at a teaching hospital in an urban area of Iran. The intervention included daily 30 minutes of planned walking for ten days. Data was collected using a demographic data form and the Brief Fatigue Inventory, which were filled out before the intervention, and on the fifth and tenth days of the intervention. Findings: Statistically significant differences were reported in the reduction of CRF on the fifth day and tenth day of the intervention (p <0.001). Conclusions: The planned walking intervention can be used as an easy and low-cost method for reducing CRF in patients with leukemia.

Investigation of Nursing Student Satisfaction with the First Clinical Education Experience in Universities of Medical Sciences in Iran.

Satisfaction with the experience gained in clinical settings is of great significance to nursing students and novice first-year students in particular and contributes significantly to developing basic clinical skills and competence. Accordingly, the present study aimed to examine nursing student satisfaction with the first clinical education experience. A total of 390 second- and third-semester nursing students gaining clinical experience in general surgery, internal medicine, gynecological surgery, orthopedics, emergency, obstetrics and gynecology, ophthalmology, andrological surgery, post-CCU, and otorhinolaryngology departments participated in this analytical cross-sectional study from March to June 2017. The research instrument included the "Assessment of nursing student's Satisfaction with First Clinical Practical Education Questionnaire: Modified Version", consisting of three parts: demographic characteristics, 37 items, and a 10-degree visual analog scale to assess student satisfaction. Descriptive statistics were used to hypothesis test in SPSS 22. The highest rate of student satisfaction was related to the third domain labeled "Instructor's behavior", and the lowest rate of student satisfaction was related to the fifth and seventh domains labeled "Emotional atmosphere and learning in the clinical setting" and "Creating appropriate learning opportunities", respectively. The results of statistical tests suggested a statistically significant relationship between the mean satisfaction score (based on the 10-degree scale) and gender (p=0.01). However, no statistically significant relationship was observed between the mean satisfaction score and other demographic characteristics such as age, grade point average (GPA), and university type. Student satisfaction rate varies in different domains of the questionnaire. Accordingly, it is recommended that schools of nursing and midwifery incorporate the findings of this study into their first clinical, educational experience planning and take into account the educational needs of students to bring greater satisfaction.

A Comparison of Symptom Management for Children with Cancer in Iran and in the Selected Countries: A Comparative Study.

AIM: The aim of this study is to describe the experiences of other countries regarding the status of pediatric palliative care in the field of symptom management and to compare it with the current status in Iran to achieve an appropriate level of symptom management for children with cancer. MATERIALS AND METHODS: This is a comparative study. The research population includes the palliative care systems of Jordan, England, Australia, and Canada, which were ultimately compared with Iran's palliative care system. RESULTS: The results showed that in the leading countries in the field of palliative care, such as Australia and Canada, much effort has been made to improve palliative care and to expand its service coverage. In the UK, as a pioneer in the introduction of palliative care, a significant portion of clinical performance, education and research, is dedicated to childhood palliative care. Experts in this field and policymakers are also well aware of this fact. In developing countries, including Jordan, palliative care is considered a nascent specialty, facing many challenges. In Iran, there is still no plan for providing these services coherently even for adults. CONCLUSION: Children with cancer experience irritating symptoms during their lives and while they are hospitalized. Regarding the fact that symptom management in developed countries is carried out based on specific and documented guidelines, using the experiences of these successful countries and applying them as an operational model can be useful for developing countries such as Iran.

The relationship between pain, fatigue, sleep disorders and quality of life in adult patients with acute leukaemia: During the first year after diagnosis.

The aim of this study was to investigate the relationship between pain, fatigue, sleep disorders and quality of life and assess the most powerful predictor of quality of life in patients with acute leukaemia. In this cross-sectional multicentre study, 406 patients were recruited. Data were collected using the Iranian Short-Form 36-item Health Survey, the Pittsburgh Sleep Quality Index, and the Numeric Rating Scale for Pain and Fatigue Intensity. It was found that pain and fatigue had direct relationship with sleep disorders. Statistically significant relationships were reported between pain, fatigue, sleep disorders and QoL. Also, a statistically significant relationship was found between pain and QoL (p < .001). Pain, fatigue and sleep disorders in total had the predictive power for quality of life (R2  = 36%). The most powerful predictor of quality of life was pain. It is suggested that healthcare professionals note the importance of patients' symptoms in clinical investigations and take appropriate measures for their management. The assessment of pain as the most powerful predictor of quality of life can be considered a basis for the improvement of quality of life, fatigue and sleep quality in patients with acute leukaemia.

Challenges Encountered by Nurses Working in Acute Psychiatric Wards: A Qualitative Study in Iran.

BACKGROUND: The provision of care to patients with psychiatric disorders and working in a challenging environment lead to many problems among psychiatric nurses. The aim of this study was to explore the challenges nurses faced while working in acute psychiatric wards. DESIGN: A qualitative design using content analysis was used. Fifteen nurses working in psychiatric wards in hospitals affiliated to a university hospital in an urban area of Iran were chosen using a purposive sampling approach. Semi-structured interviews were used for data collection. An inductive content analysis method was used to analyse the collected data. RESULTS: Four themes were developed based on the analysed data: "experiencing psycho-social challenges," "experiencing psychological challenges," "encountering catalysts causing challenges," and "employing various strategies for coping with challenges." CONCLUSIONS: Given the importance of physical and mental well-being of nurses and the moral and professional responsibility of an organization to protect staff health, it is of prime importance to examine the inpatient psychiatric nurses' experiences to better understand them and hopefully use such knowledge so as to improve their work life.

Impact of the self-care education program on quality of life in patients with type II diabetes.

INTRODUCTION: Diabetes is an irreversible disease requiring lifetime self-care and rehabilitation. Patient education to improve their ability in administering self-care is also effective, lowering the risks of developing complications and promoting the quality of life. This study was conducted to assess the effect of self-care educational programs in promoting the quality of life of diabetic patients. METHODS: In this pre-test/post-test intervention study design, 30 diabetes patients were included on the basis of a non-randomized sampling, using each subject as her/his own control. The self-care educational program was introduced to participants by researcher through two 55-min sessions. Quality of life by using Iranian Short Form Health Survey was assessed before and after the educational sessions. The paired t-test was used to compare the total and subscale mean scores of the Quality of life before and after the training. RESULTS: Finding showed that there was a significant increase in General health (P=0.027), Physical role (P<0.001), Physical functioning (P=0.027), Social functioning (P=0.029) and Body pain (P=0.020). CONCLUSION: The results from the present study demonstrate that structured patient education improves patients 'well-being' after the teaching program. Diabetes educational program should be a basis for the management of diabetes.

Effect of Face-to-face Education, Problem-based Learning, and Goldstein Systematic Training Model on Quality of Life and Fatigue among Caregivers of Patients with Diabetes.

BACKGROUND: Education is a fundamental component for patients with diabetes to achieve good glycemic control. In addition, selecting the appropriate method of education is one of the most effective factors in the quality of life. The present study aimed to evaluate the effect of face-to-face education, problem-based learning, and Goldstein systematic training model on the quality of life (QOL) and fatigue among caregivers of patients with diabetes. MATERIALS AND METHODS: This randomized clinical trial was conducted in Hajar Hospital (Shahrekord, Iran) in 2012. The study subjects consisted of 105 family caregivers of patients with diabetes. The participants were randomly assigned to three intervention groups (35 caregivers in each group). For each group, 5-h training sessions were held separately. QOL and fatigue were evaluated immediately before and after the intervention, and after 1, 2, 3, and 4 months of intervention. RESULTS: There was a significant increase in QOL for all the three groups. Both the problem-based learning and the Goldstein method showed desirable QOL improvement over time. The desired educational intervention for fatigue reduction during the 4-month post-intervention period was the Goldstein method. A significant reduction was observed in fatigue in all three groups after the intervention (P < 0.001). CONCLUSIONS: The results of the present study illustrated that the problem-based learning and Goldstein systematic training model improve the QOL of caregivers of patients with diabetes. In addition, the Goldstein systematic training model had the greatest effect on the reduction of fatigue within 4 months of the intervention.

Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia: Supportive Care in Cancer Nursing.

BACKGROUND: Patients with acute leukemia usually experience pain, fatigue, and sleep disorders, which affect their quality of life. Massage therapy, as a nondrug approach, can be useful in controlling such problems. However, very few studies have been conducted on the effects of massage therapy on the complications of leukemia. OBJECTIVE: The aim of this study was to examine the effects of slow-stroke back massage (SSBM) on the symptom cluster in acute leukemia adult patients undergoing chemotherapy. METHODS: In this randomized controlled trial, 60 patients with acute leukemia were allocated randomly to either the intervention or control group. The intervention group received SSBM 3 times a week (every other day for 10 minutes) for 4 weeks. The pain, fatigue, and sleep disorder intensities were measured using the numeric rating scale. The sleep quality was measured using the Pittsburgh Sleep Quality Index. Statistical tests of χ, t test, and the repeated-measure analysis of variance were used for data analysis. RESULTS: Results showed that the SSBM intervention significantly reduced the progressive sleep disorder, pain, fatigue, and improved sleep quality over time. CONCLUSIONS: Slow-stroke back massage, as a simple, noninvasive, and cost-effective approach, along with routine nursing care, can be used to improve the symptom cluster of pain, fatigue, and sleep disorders in leukemia patients. IMPLICATIONS FOR PRACTICE: Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.

Learning challenges of nursing students in clinical environments: A qualitative study in Iran.

BACKGROUND: Clinical learning environment is a complex social entity. This environment is effective on the learning process of nursing students in the clinical area. However, learning in clinical environment has several benefits, but it can be challenging, unpredictable, stressful, and constantly changing. In attention to clinical experiences and factors contributing to the learning of these experiences can waste a great deal of time and energy, impose heavy financial burden on educational systems, cause mental, familial and educational problems for students, and compromise the quality of patient care. Therefore, this study was carried out with the goal of determining the learning challenges of nursing students in clinical environments in Iran. MATERIALS AND METHODS: In this qualitative study carried out in 2012-2013, 18 undergraduate nursing students were selected by using purposive sampling method from the Faculty of Nursing and Midwifery of Tehran and Shahid Beheshti Universities. Semi-structured interviews were used to collect data. The content analysis method was used to determine relevant themes. RESULTS: Two themes were derived from the data analysis, which represented the students' clinical learning challenges. These two themes included insufficient qualification of nursing instructors and unsupportive learning environment. CONCLUSIONS: Identification of the students' clinical learning challenges and actions to remove or modify them will create more learning opportunities for the students, improve the achievement of educational goals, provide training to nursing students with the needed competencies to meet the complex demands of caring and for application of theories in practice, and improve the quality of healthcare services.

Comparing the effect of two educational programs on the quality of life of hemodialysis patients in iran.

BACKGROUND: Various researchers have shown that the health level, performance status, and quality of life (QOL) are often less than expected especially in hemodialysis (HD) patients. OBJECTIVES: This study aimed to determine the effect of the two methods of educational programs on health- related QOL (HRQOL) in Iranian HD patients. PATIENTS AND METHODS: In this quasi-experimental, pretest-posttest interventional study, we employed each subject as his/her own control. The study was conducted at the dialysis units in three major general hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. A total of 90 HD patients were randomly allocated to two 45-patient groups of oral and video education programs, respectively. The educational programs included dietary and fluid regimens, the care of fistula and skin, and stress management. HRQOL was assessed in both groups using a Farsi version of the Short Form Health Survey (SF-36) before and after the educational programs. Repeated measures analysis of variance and ANOVA were used for data analysis through SPSS. RESULTS: SF-36 domains of physical functioning (P < 0.021), role physical (P < 0.031), social functioning (P < 0.001) and mental health (P < 0.001) were significantly increased in both oral and vide education groups after the interventions. There was no difference in the effectiveness of the two educational programs. CONCLUSIONS: Appropriate interventions may potentially lead to improvement in the HRQOL of these patients. Therefore, video education as an effective, inexpensive, simple, and attractive method is recommended for HD patients.

The diversity of Iranian nursing students' clinical learning styles: a qualitative study.

BACKGROUND: Numerous factors, including learning styles, affect the learning process of nursing students. Having insights about students' learning styles helps promoting the quality of education. The aim of this study was to explore the Iranian baccalaureate nursing students' learning styles in clinical settings. METHODS: A qualitative design using a content analysis approach was used to collect and analyze data. Semi-structured interviews were conducted with fifteen Iranian baccalaureate nursing students selected using a purposive sample method. FINDINGS: During data analysis, it was found that nursing students employed different clinical learning styles such as 'thoughtful observation,' 'learning by thinking,' and 'learning by doing'. CONCLUSION: Students adopt different learning strategies in clinical practice. Designing teaching strategies based on students' learning styles can promote students' learning and maximize their academic and clinical practice success. Nursing educators, curriculum designers, and students can use the findings of this study to improve the quality of nursing education in both the classroom and clinical settings.

Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening.

BACKGROUND: Diabetic Peripheral Neuropathy is one of the most prevalent complications of diabetes mellitus. The development and progression of such complications are responsible for much of the morbidity and mortality. The purpose of this study was to evaluate the effectiveness of Semmes-Weinstein monofilament ten gram in 3, 4, eight and ten points in the screening of diabetic peripheral neuropathy in patients with diabetes mellitus. METHODS: In a descriptive correlational design, 150 patients with diabetes mellitus were selected using convenience sampling. All patients were evaluated for sensory neuropathy using ten gram Semmes-Weinstein Monofilaments and questionnaire on neuropathy symptoms. In the next phase, nerve conduction velocity was examined. The most common subjective symptoms were paresthesia of both feet, pain in feet, burning sensation in the extremities and numbness in the extremities. RESULTS: The results showed that the sensitivity of Monofilament in three and four points were 35.9 to 53.8 present and 38.5 to 51.3 percent respectively. Specificity of Monofilament the same points, were 73.9 to 84.7 and 73 to 87.4 percent respectively. Monofilament sensitivity at eight and ten points were 38.5 to 61.5 and 64.1 to 30.8 percent respectively. Also, specificity of the same points were 77.5 to 95.5 and 64 to 89.2 percent respectively. It was revealed that the difference sensitivity and specificity of Monofilament in three and four points with sensitivity and specificity in eight and ten point is not statistically significant. CONCLUSIONS: This study showed that Semmes-Weinstein monofilament can easily use as a simple and inexpensive device for screening. Since increasing the number of points it was not significantly difference. Therefore, we suggest that screening for diabetic peripheral neuropathy, especially in large populations to avoid wasting time on Monofilament application, areas like three or four points eight and ten points could be used.

Development and Evaluation of a Questionnaire for Assessment of Determinants of Weight Disorders among Children and Adolescents: The Caspian-IV Study.

BACKGROUND: Little experience exists on valid and reliable tools for assessment of the determinants of underweight and overweight in children and adolescents living in the Middle-East and North Africa (MENA). This study aimed to develop a valid and wideranging questionnaire for assessment of these parameters in a nationwide sample of Iranian children and adolescents. METHODS: This national study was conducted in 31 provinces in Iran. The first phase consisted of focus group discussion with 275 children and adolescents and their parents. After a qualitative content analysis, the initial items were extracted. In the next step, the face validity was assessed by expert panelists using the quantitative method of the Impact Score. To assess the content validity, the content validity rate (CVR) and the content validity index (CVI) were determined. The internal consistency was examined by Cronbach alpha, and its test-retest reliability was determined. The socio-demographic variables, perinatal factors, lifestyle factors, family history, knowledge and attitude were assessed. Dietary intakes were assessed by a validated 168-item semi-quantitative food frequency questionnaire. A validated questionnaire for quality of life was filled in anonymously. RESULTS: A team of expert researchers conducted the data analysis of 576 interviews by using qualitative content analysis method. The analysis process began by determining the semantic units about the concepts studied. The initial questionnaire was developed in four domains by including Likert scale questions. In the face validity step, all questions of the primary questionnaire obtained a score of more than 1.5. In the phase of CVR assessment, 6 questions obtained a score of less than 0.62, and were omitted. The rest of questions were assessed for CVI, and got a score of more than 0.75. Cronbach's alpha coefficient of the whole questionnaire was 0.97, and the Pearson correlation coefficient of the test-retest phase was 0.94. CONCLUSION: The developed questionnaire is a valid and reliable tool for assessment of the determinants of weight disorders in a nationally representative sample of children and adolescents in the MENA.

Dietary and fluid compliance: an educational intervention for patients having haemodialysis.

AIM: This paper is a report of a study conducted to determine the effect of an educational intervention on dietary and fluid compliance in patients having haemodialysis. BACKGROUND: Many of the clinical problems experienced by patients having haemodialysis are related to their failure to eat appropriate foods and restrict their fluid intake. Educational intervention in patients having haemodialysis to improve their compliance with dietary and fluid restrictions appears to be effective. METHODS: Sixty-three patients having haemodialysis in three general hospitals in Tehran, Iran, were allocated into two groups at random for oral and/or video education. They were asked to give demographic and medical data. Bimonthly average values of serum potassium, sodium, calcium, phosphate, albumin, creatinine, uric acid, and blood urea nitrogen and interdialytic weight gain were measured before and after the teaching programmes. The data were collected in 2007. FINDINGS: Compliance in terms of biochemical parameters and interdialytic weight gain was observed in 63.5% and 76.2% of patients in the oral and video teaching groups respectively. Statistically significant correlations were observed between demographic variables (age, educational level and occupation) and dietary and fluid compliances (P < 0.001). There was no difference between the effectiveness of two educational interventions. CONCLUSION: Nurses should emphasize sodium compliance in patients having haemodialysis and explain its adverse effects, such as excessive weight gain, hypertension, and peripheral oedema.