The impact of telenursing on level of depression, stress and anxiety in discharged patients after coronary artery bypass graft surgery: A randomized clinical trial.

BACKGROUND: After coronary artery bypass graft surgery patients are susceptible to mental disorders such as stress, anxiety, and depression following discharge from the hospital and often require post-discharge support and follow-up. Telenursing is an accessible method that may reduce stress, anxiety, and depression experienced by patients. This study aimed to investigate the impact of telenursing on depression, stress, and anxiety in discharged patients after CABG surgery. MATERIALS AND METHODS: A randomized clinical trial was carried out. Eligible patients were divided randomly into intervention (n=40) and control (n=40) groups. Depression Anxiety Stress Scale-21 (DASS21) questionnaire was filled out by both groups one day before discharge from the hospital. The intervention group received SMS reminders of their treatment plan, referrals to the cardiac rehabilitation clinic, and routine care three times a week for six weeks, while the control group received routine care provided by the hospital only. In the week following the completion of the intervention period, both groups returned to fill out the questionnaire, and the data were analyzed using SPSS version 16.0, descriptive and inferential statistics, and independent and paired T-tests. RESULT: The mean scores of depression, stress, and anxiety before intervention in the intervention group were 11.95, 18.75, and 18.17, and in the control group were 11.55, 18.37, and 17.4 respectively. The mean scores of depression, stress, and anxiety after intervention in the intervention group were 7.85, 10.5, and 10.45, and in the control group were 10.56, 17.9, and 16.5 respectively. No significant differences were seen between the two groups before the intervention (P>0.05), but the results showed significant differences between the two groups' mean scores of depression, stress, and anxiety after intervention (P<0.001). CONCLUSION: Telenursing can reduce stress, anxiety, and depression in discharged patients after coronary artery bypass graft surgery by providing proper and cost-effective follow-up.

Impact of inhalation aromatherapy with Damask Rose (Rosa damascena) on stress, anxiety and hemodynamic parameters of patients undergoing coronary angiography: a single blind randomized clinical trial.

OBJECTIVES: Coronary arteries angiography is used commonly for diagnosing cardiovascular diseases. In spite of the low risk of coronary artery angiography method, it could lead to stress, anxiety and consequently hemodynamic changes in patients. This study aimed to assess the effects of inhalation aromatherapy with Rosa damascena on stress, anxiety, and hemodynamic parameters of patients undergoing coronary angiography. METHODS: A single-blind randomized clinical trial was conducted on 98 patients in Besat Educational Hospital, Hamadan, Iran. Before coronary angiography, patients at aromatherapy group inhaled five drops of 40% Rosa damascena for 20 min and in the control group, patients inhaled distilled water. Stress, anxiety, and hemodynamic parameters were measured before and after the intervention using DASS-21 questionnaire and checklist. RESULTS: Data were analysed by SPSS 16 software using descriptive and inferential statistics such as paired t-test and non-parametric tests. There were significant differences in terms of stress and anxiety severity in patients at aromatherapy group (p=0.005) and control group (p=0.001). There were significant differences in terms of hemodynamic parameters such as heart rate (p=0.001), mean arterial pressure (p=0.001), systolic (p=0.003) and diastolic blood pressure (p=0.001) and SpO2 (p=0.02). CONCLUSIONS: Inhalation aromatherapy with Rosa damascena can significantly decrease stress and anxiety severity and improve hemodynamic parameters of patients undergoing coronary angiography. REGISTRY NUMBER: This study has registered with the number IRCT201702019759N8 at Iranian Registry Clinical Trial.

Effects of a multi-component educational intervention on nurses' knowledge and adherence to standard precautions in intensive care units.

BACKGROUND: The standard precautions (SPs) should be disseminated and implemented by healthcare providers. This study aimed to examine the effects of a multi-component educational intervention on nurses' knowledge and adherence to the SP guidelines in intensive care units (ICUs). METHODS: This small-scale study consisted of a cluster randomised trial. Two ICUs, located in different hospitals, participated in the study. Nurses (n = 15) in one ICU received the multi-component educational intervention. The intervention involved an educational (with multiple instructional media) and a behavioural (with hands-on practice) component. Nurses' knowledge and adherence were assessed at pre-test and two and six weeks after the intervention. RESULTS: Results showed significant group by time interaction effects for both outcomes: a large improvement was found in the experimental group over time, but not in the control group. The experimental nurses' knowledge improved from 15 ± 2.47 at pre-test to 19 ± 2.65 and 19.53 ± 0.92 at follow-ups. Similarly, their adherence increased from 19.87 ± 4.44 at pre-test to 29.20 ± 5.00 and 28.40 ± 4.37 at two and six weeks post-test, respectively. CONCLUSIONS: The multi-component educational interventions had demonstrated initial effectiveness in enhancing ICU nurses' knowledge and adherence to the SPs guidelines. The intervention is a promising approach for designing effective continuing education initiatives aimed to improve nurses' practice.

Effect of inhalation aromatherapy with lavender essence on pain associated with intravenous catheter insertion in preschool children: A quasi-experimental study.

OBJECTIVE: The aim of this study was to assess the effect of inhalation aromatherapy with lavender essence on the pain severity of intravenous catheter insertion in hospitalized preschool children. METHOD: A quasi-experimental study involving 60 participants using convenience sampling were assigned to control (n = 30) and aromatherapy (n = 30) groups. Children in the aromatherapy group inhaled 5 drops of the essence, while children in the control group inhaled 5 drops of distilled water, 20 min before venipuncture. Pain severity was measured using OUCHER scale 10 min after catheterization. RESULTS: Mean of pain severity between the aromatherapy and control groups demonstrated a significant difference immediately (P = 0.002) and 5 (P = 0.001) and 10 min (P = 0.01) after intravenous catheter insertion. Mean of pain severity in the three assessed time points had significant differences in aromatherapy and control groups (P = 0.001). CONCLUSION: Aromatherapy with Lavender essence helped to reduce pain severity of intravenous catheter insertion in children.

Impact of telephone counseling on the quality of life of patients discharged after coronary artery bypass grafts.

BACKGROUND: This study aimed to assess the impact of telephone counseling on quality of life in patients with coronary artery bypass graft. METHODS: A quasi-experimental study was conducted with 71 discharged patients after coronary artery bypass graft surgery at Ekbatan Edcuational hospital in Hamadan, Iran, in 2014. The patients were randomly allocated into intervention (n=36) and control group (n=35). The intervention group received education and counseling about therapeutic plan via telephone after discharge. Patients in the control group received only routines. All patients completed the quality of life questionnaire before and after the intervention period of five weeks. RESULTS: There was no significant difference between intervention and control group about quality of life before intervention (p=0.696). However, there was significant and positive deference between the two groups in favor of the telephone counseling after the intervention (P=0.01) and control group (P=0.04). Quality of life in the intervention group was significantly better compared to control group (P=0.01). CONCLUSIONS: Telephone counseling could be a cost-effective patient counseling plan for therapeutic adherence after coronary artery bypass surgery in order to improve the patients' quality of life. PRACTICE IMPLICATIONS: Telephone counseling is feasible to implement and well accepted for patient counseling for many diseases.

The effect of inhalation aromatherapy with damask rose (Rosa damascena) essence on the pain intensity after dressing in patients with burns: A clinical randomized trial.

BACKGROUND: Pain is one of the common problems encountered by patients with burns, which increases after each dressing. This study aimed to investigate the effect of inhalation aromatherapy with damask rose essence on the pain of patients with burns that is caused after dressing. MATERIALS AND METHODS: A randomized clinical trial was conducted on 50 patients with second- and third-degree burn wounds. The baseline pain of the patients was assessed 30 min before they entered into the dressing room on the first and second days of intervention. The patients in the experimental group inhaled five drops of damask rose essence 40% in distilled water, while those in the control group inhaled five drops of distilled water as placebo. The pain intensity was assessed using Visual Analogue Scale at 15 and 30 min after the patients exited from the dressing room. Data were analyzed by SPSS (version 18) using descriptive and inferential statistics. RESULTS: There was significant difference between the mean of pain intensity before and after intervention at 15 and 30 min after dressing (P < 0.001). Moreover, there was significant difference in reduction of pain intensity before and after aromatherapy in the experimental group (P < 0.05). Also, there was a significant reduction in severity of pain after dressing in the experimental group compared with the control group (P < 0.05). CONCLUSIONS: Inhalation aromatherapy with damask rose could be effective for relieving the pain caused after dressing in patients with burns. Therefore, it could be suggested as a complementary therapy in burn patients for pain relief.

Impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft surgery: A quasi-experimental study in Iran.

BACKGROUND AND AIMS: Coronary artery bypass graft is a major surgery and has complications that require professional and long term follow-up and nursing care that if do not properly handled, could reduce the quality of life and increase post-operative complications. On the other hand Tele-nursing is a cost-effective way to educate and follow-up of patients. This study aimed to assess the impact of Tele-nursing on adherence to treatment plan in discharged patients after coronary artery bypass graft. MATERIALS AND METHODS: A quasi-experimental study was carried out at Ekbatan Therapeutic and Educational Center of Hamadan University of Medical Sciences at Hamadan, Iran, in 2013. In this study, 71 patients who had undergone coronary artery bypass graft surgery and had inclusion criteria were randomly divided into two experimental group (n=36), and control group (n=35). They completed questionnaire before discharging from Therapeutic and Educational Center. In the experimental group on days 2, 4, 7, second week (day 11), third week (day 18) and fourth week (day 25) after discharge, follow-up interventions and nursing education with Tele-nursing was done, but in the in the control groups, patients received only routine interventions. After completion of the intervention period, both groups completed the questionnaire and the results were compared. RESULTS: Adherence of treatment plan in both groups did not have significant difference before intervention (P=0.696), but had a significant difference with regard to baseline after intervention in aromatherapy group (P< 0.01) and with control group after intervention (P<0.01). Adherence to treatment plan in the aromatherapy group was better in compared to control group (P<0.01). CONCLUSION: Tele-nursing is a convenient way, cost effective training and follow-up care for patients after coronary artery bypass surgery, which can improve patients' adherence to treatment plan in developing countries such as Iran.

Effect of inhalation aromatherapy with lavender essential oil on stress and vital signs in patients undergoing coronary artery bypass surgery: A single-blinded randomized clinical trial.

OBJECTIVES: At present, aromatherapy is used widely in medical research. This study aimed to investigate the effects of inhalation aromatherapy using lavender essential oil to reduce mental stress and improve the vital signs of patients after coronary artery bypass surgery (CABG). DESIGN: A single-blinded randomized controlled trial was conducted with 60 patients who had undergone CABG in a 2-day intervention that targeted stress reduction. PARTICIPANTS: Sixty subjects following coronary artery bypass surgery in two aromatherapy and control groups. SETTING: The study was conducted in Ekbatan Therapeutic and Educational Center, Hamadan, Iran, in 2013. INTERVENTIONS: On the second and third days after surgery, the aromatherapy group patients received two drops of 2% lavender essential oil for 20min and the control group received two drops of distilled water as a placebo. MAIN OUTCOME MEASURES: The primary outcome was mental stress, which was measured before and after the intervention using the DASS-21 questionnaire. The secondary outcomes were vital signs, including the heart rate, respiratory rate, and systolic and diastolic blood pressure, which were measured before and after the intervention. RESULTS: The individual characteristics of the aromatherapy and control groups were the same. There were no significant difference in the mean mental stress scores and vital signs of the aromatherapy and control groups on the second or third days after surgery. CONCLUSION: Inhalation aromatherapy with lavender essential oil had no significant effects on mental stress and vital signs in patients following CABG, except the systolic blood pressure.

Occupational Burnout and Its Determinants among Personnel of Emergency Medical Services in Iran.

Several observations have addressed high rates of occupational burnout among personnel of emergency medical services (EMSs) centers. Occupational burnout influences EMS personnel's well-being and quality of life. The main objective of this study was to assess burnout and its determinants among Iranian EMS personnel. This study was carried out at all EMS centers in two provinces of Kermanshah and Hamadan located at the west of Iran. The sample consists of 260 personnel (110 in Hamadan and 150 in Kermanshah) that were consecutively entered. The information was collected by researcher attendance at their workplaces using a self-administered questionnaire. Occupational-burnout was measured using the Maslach Burnout Inventory. An average of 46.54% of personnel displayed high frequency in the subscale emotional exhaustion, 38.85% displayed high frequency in the subscale depersonalization, and only 2.69% of them displayed high frequency in the subscale incompetence/lack of personal accomplishment. Regarding the severity of burnout, severe emotional exhaustion and depersonalization were detected in an average of 25.39% and 37.69 of the personnel, respectively; while, an average of 97.31% expressed a low level of the lack of personal accomplishment. Frequency and severity of burnout were adversely affected by younger age, single status, history of smoking, lower income, higher work experience, longer shifts, and even work status of the spouse. Iranian EMSs personnel considerably suffered from emotional exhaustion and depersonalization. This should be effectively managed and improved by organizational supports, psychological consultations, and effective management aimed to improve determinants of appearing occupation-related burnout.

Identifying challenges for effective evaluation in nursing education: A qualitative study.

BACKGROUND: Although nursing education in Iran has a positive trend in growth; it is still facing with multifaceted challenges. This study aims to explore the challenges for effective evaluation of nursing education perceived by academic managers. MATERIALS AND METHODS: A qualitative study was performed by using 21 face-to-face, in-depth interviews with academic managers in medical universities and at the Ministry of Health and Medical Education in Iran. All interviews were recorded digitally, transcribed verbatim, and analyzed by qualitative content analysis. RESULTS: The main challenges could be categorized under 3 themes, each included 3 subthemes: managerial issues (inefficacy of management, inadequacy of policies and strategies, ineffective evaluation planning); administrative issues (inefficient and affected evaluators, inappropriate implementation, and inefficacy of approaches and tools); and structural issues (inappropriate culture, clinical education complexity, lack of alumni follow-up system). CONCLUSIONS: The results emphasize the need for educational evaluation development in nursing, including systematic and regular educational evaluation planning focusing on efficient feedback system and regard to excellence models. The comprehensive educational evaluation requires participation, involvement, and collaboration among the Nursing Board, Nursing ministerial office, faculties of nursing, and Nursing Organization. Thus, it is necessary to better designate current educational evaluation systems, policies, approaches, methods, and procedures.

Identifying challenges for academic leadership in medical universities in Iran.

CONTEXT The crucial role of academic leadership in the success of higher education institutions is well documented. Medical education in Iran has been integrated into the health care system through a complex organisational change. This has called into question the current academic leadership, making Iranian medical universities and schools a good case for exploring the challenges of academic leadership. OBJECTIVES This study explores the leadership challenges perceived by academic managers in medical schools and universities in Iran. METHODS A qualitative study using 18 face-to-face, in-depth interviews with academic managers in medical universities and at the Ministry of Health and Medical Education in Iran was performed. All interviews were recorded digitally, transcribed verbatim and analysed by qualitative content analysis. RESULTS The main challenges to academic leadership could be categorised under three themes, each of which included three sub-themes: organisational issues (inefficacy of academic governance; an overly extensive set of missions and responsibilities; concerns about the selection of managers); managerial issues (management styles; mismatch between authority and responsibilities; leadership capabilities), and organisational culture (tendency towards governmental management; a boss-centred culture; low motivation). CONCLUSIONS This study emphasises the need for academic leadership development in Iranian medical schools and universities. The ability of Iranian universities to grow and thrive will depend ultimately upon the application of leadership skills. Thus, it is necessary to better designate authorities, roles of academic staff and leaders at governance.

The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study.

BACKGROUND: Road traffic injuries (RTIs) are a major public health problem, especially in low- and middle-income countries. Among middle-income countries, Iran has one of the highest mortality rates from RTIs. Action is critical to combat this major public health problem. Stakeholders involved in RTI control are of key importance and their perceptions of barriers and facilitators are a vital source of knowledge. The aim of this study was to explore barriers to the prevention of RTIs and provide appropriate suggestions for prevention, based on the perceptions of stakeholders, victims and road-users as regards RTIs. METHODS: Thirty-eight semi-structured interviews were conducted with informants in the field of RTI prevention including: police officers; public health professionals; experts from the road administrators; representatives from the General Governor, the car industry, firefighters; experts from Emergency Medical Service and the Red Crescent; and some motorcyclists and car drivers as well as victims of RTIs. A qualitative approach using grounded theory method was employed to analyze the material gathered. RESULTS: The core variable was identified as "The lack of a system approach to road-user safety". The following barriers in relation to RTI prevention were identified as: human factors; transportation system; and organizational coordination. Suggestions for improvement included education (for the general public and targeted group training), more effective legislation, more rigorous law enforcement, improved engineering in road infrastructure, and an integrated organization to supervise and coordinate preventive activities. CONCLUSION: The major barriers identified in this study were human factors and efforts to change human behaviour were suggested by means of public education campaigns and stricter law enforcement. However, the lack of a system approach to RTI prevention was also an important concern. There is an urgent need for both an integrated system to coordinate RTI activities and prevention and a major change in stakeholders' attitudes towards RTI prevention. The focus of all activities should take place on road users' safety.

Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators.

BACKGROUND: Road traffic injuries are a major public health problem, especially in low- and middle-income countries. Post-crash management can play a significant role in minimizing crash consequences and saving lives. Iran has one of the highest mortality rates from road traffic injuries in the world. The present study attempts to fill the knowledge gap and explores stakeholders' perceptions of barriers to - and facilitators of - effective post-crash management in Iranian regions. METHODS: Thirty-six semi-structured interviews were conducted with medical services personnel, police officers, members of Red Crescent, firefighters, public-health professionals, road administrators; some road users and traffic injury victims. A qualitative approach using grounded theory method was employed to analyze the material gathered. RESULTS: The core variable was identified as "poor quality of post crash management". Barriers to effective post-crash management were identified as: involvement of laypeople; lack of coordination; inadequate pre-hospital services; shortcomings in infrastructure. Suggestions for laypeople included: 1) a public education campaign in first aid, the role of the emergency services, cooperation of the public at the crash site, and 2) target-group training for professional drivers, police officers and volunteers involved at the crash scene. An integrated trauma system and infrastructure improvement also is crucial to be considered for effective post-crash management. CONCLUSION: To sum up, it seems that the involvement of laypeople could be a key factor in making post-crash management more effective. But system improvements are also crucial, including the integration of the trauma system and its development in terms of human resources (staffing and training) and physical resources as well as the infrastructure development.

Requirements for effective academic leadership in Iran: a nominal group technique exercise.

BACKGROUND: During the last two decades, medical education in Iran has shifted from elite to mass education, with a considerable increase in number of schools, faculties, and programs. Because of this transformation, it is a good case now to explore academic leadership in a non-western country. The objective of this study was to explore the views on effective academic leadership requirements held by key informants in Iran's medical education system. METHODS: A nominal group study was conducted by strategic sampling in which participants were requested to discuss and report on requirements for academic leadership, suggestions and barriers. Written notes from the discussions were transcribed and subjected to content analysis. RESULTS: Six themes of effective academic leadership emerged: 1)shared vision, goal, and strategy, 2) teaching and research leadership, 3) fair and efficient management, 4) mutual trust and respect, 5) development and recognition, and 6) transformational leadership. Current Iranian academic leadership suffers from lack of meritocracy, conservative leaders, politicization, bureaucracy, and belief in misconceptions. CONCLUSION: The structure of the Iranian medical university system is not supportive of effective academic leadership. However, participants' views on effective academic leadership are in line with what is also found in the western literature, that is, if the managers could create the premises for a supportive and transformational leadership, they could generate mutual trust and respect in academia and increase scientific production.