Explaining the challenges of Iranian caregivers in provision of home health care to spinal cord injury patients: a qualitative study.

BACKGROUND: The incidence of spinal cord injury (SCI) is increasing across the globe. The caregivers of patients with spinal cord injuries experience many problems during providing care to these patients. Identifying the problems experienced by caregivers can facilitate the process of care provision to these patients. So, the aim of this study was to explore the challenges of caregivers in provision of home health care to SCI patients. METHODS: This study was conducted by qualitative description approach in Iran from Apr 2021 to Dec 2022. The participants included the caregivers of SCI patients recruited by purposive sampling. The data were collected by face-to-face interviews and analyzed using the method proposed by Lundman and Graneheim. RESULTS: Two themes emerged from the data analysis, including burnout (with the categories of physical challenge and psychological challenges) and coping strategies (with the categories of social support and professional support). CONCLUSION: Resolving the obstacles and problems faced by home caregivers can improve the circumstances of care provision so that they can be relieved of their own physical and psychological conundrums and deliver suitable home care to SCI patients. TRIAL REGISTRATION NUMBER: Not applicable.

Evaluation of the clinical educational environment based on the DREEM model from the viewpoint of the OR students.

BACKGROUND: The most important part of learning happens in the clinic. To determine the differences between the real educational environment and the desirable environment, the DREEM1 model is used. The present study was conducted to evaluate the clinical educational environment based on the DREEM model from the viewpoint of the OR2 students of the Lorestan University of Medical Sciences. MATERIALS AND METHODS: The present descriptive-analytical cross-sectional study evaluated the viewpoint of 118 students of operation room (OR) technology using the DREEM (Dundee Ready Educational Environment Measure) questionnaire in the hospitals affiliated with the Lorestan University of Medical Sciences during the second semester of 2020. The DREEM questionnaire has 50 statements and is divided into five sections, which are rated on a five-point Likert scale (0-4). The data were analyzed using frequency distribution tables, mean and standard deviation indices, Mann-Whitney and Kruskal-Wallis tests. Data analysis was conducted using IBM SPSS Statistics 22.0. IBM Corp.; 2013. and the level of significance was set at 0.05. RESULTS: The total perception of the students of the clinical educational environment was good and excellent in 73.8% of the cases and of the subscales was also good (50.8%-63.2%). There was a significant relation between the total score of students' perception of the clinical educational environment and age (Z = 5.618, P < 0.001), semester (χ2= 43.929, df = 3, P < 0.001), internship hospital (χ2= 12.948, df = 6, P = 0.044) and also the mean score of the subscales (P < 0.001). As the GPA3 and interest in the major increased, the mean score of total perception and its subscales also increased except for perception from the educators (P < 0.05). CONCLUSION: According to the results, the studied students had a positive perception of the clinical educational environment. It is recommended that the scientific foundation of the educators, the physical facilities of the operating rooms, and social communication should be strengthened to improve the care, treatment, and educational services. It will be useful to use the results to improve the accreditation level of medical centers.

The Effect of Education and Telephone Follow-up on the Burden of Family Caregivers of Patients With Cancer.

Introduction: Family caregivers of patients with cancer face a care burden due to the responsibilities and problems of providing care to the patients. Applying appropriate strategies to reduce the burden is essential. Objective: The study aimed to determine the effect of education and telephone follow-up on family caregivers' burden on patients with cancer. Methods: In this quasi-experimental study, 69 family caregivers of patients with cancer referred to only one chemotherapy center of a hospital in Lorestan province in Iran were recruited by convenience sampling method. They were randomly assigned to intervention (n = 33) and control (n = 36) groups. For the intervention group, two face-to-face training sessions and six telephone counseling sessions were held related to the care of the patients and self-care. The control group received only routine care. The family caregiver burden was measured by Novak and Gast Caregiver Burden Inventory (1989) completed before, immediately, and 6 weeks after the study. Data were analyzed by SPSS21 using independent t-tests, paired t-tests, and repeated measures. Results: Both groups were homogeneous regarding demographic characteristics and the baseline care burden. The caregiver burden decreased significantly in the intervention group, so its score was 77.33 ± 8.49, 58.93 ± 8.03, and 52.78 ± 6.86 before the study, immediately after and 6 weeks later, respectively (p < .001). In the control group, there were no significant changes. Conclusion: Education and telephone counseling reduced the burden on family caregivers. Therefore, this type of support is beneficial for providing holistic care and preserving the health of family caregivers.

Exploring caregivers' perceptions of community-based service requirements of patients with spinal cord injury: a qualitative study.

BACKGROUND: The incidence of spinal cord injury is increasing worldwide. Patients with spinal cord injury and their families face many difficulties during the disease course. Caregivers are more involved with these patients than anyone else, so recognizing patients' care requirements based on caregivers' opinions can facilitate care provision to these people. The purpose of this study was to explore caregivers' perceptions of the community-based services requirements of patients with spinal cord injury. METHODS: This qualitative research was conducted in Iran from Apr 2021 to Dec 2022 using the conventional content analysis method. The participants in the study included family caregivers and providers of home care services to patients with spinal cord injury, who were selected by purposeful sampling. Data were collected by conducting 14 face-to-face interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Data analysis led to the extraction of 815 primary codes, which were organized into two themes: community reintegration (with two categories, including the need to provide a suitable social platform and lifelong care) and palliative care (with two categories, including family conference and survival management). CONCLUSION: Social facilities and infrastructure should be modified in a way that patients with spinal cord injury can appropriately benefit from community-based care services and an independent satisfactory life. Palliative care should be continuously provided from the time of lesion development until the patient's death.

The impact of training chemotherapy safety standards with a smartphone application on the knowledge, attitude, and performance of nurses.

BACKGROUND: Nurses who play the leading role in caring for patients, especially nurses in the chemotherapy department who are constantly exposed to high-risk drugs and their side effects, should pay more attention to occupational safety. This study was performed to determine the effect of training chemotherapy safety standards using a smartphone application on nurses' knowledge, attitude, and performance. METHODS: The whole enumeration of fifty oncology nurses was recruited who they worked in 3 hospitals affiliated with Lorestan University of Medical Sciences (west of Iran). The study was conducted from June to November 2021. The training was done for four weeks with a smartphone application, including six main courses of familiarity with hazardous drugs, Personal Protective Equipment, preparation, storage and transfer, spilling, and wastes disposal of hazardous drudges . The nurses' knowledge, attitude, and performance questionnaire were completed before, immediately after, and one month after the intervention. Data analysis was performed using SPSS version 26, descriptive and inferential statistical tests of independent t-test, one-way analysis of variance, Spearman's rank correlation coefficient, repeated measures analysis of variance, and the Generalized Estimating Equation (GEE) model. RESULTS: Mean knowledge score of participants before, immediately after, and one month after the intervention was (47.18 ± 8.19), (60.08 ± 3.82), and (61.88 ± 3.45), respectively. The mean attitude score of participants before, immediately after, and one month after the intervention was (30.34 ± 3.94), (34.32 ± 3.25), and (34.98 ± 2.88), in order, and the mean performance score of participants before, immediately after, and one month after the intervention was (43.60 ± 5.11), (51.78 ± 3.15) and (52.88 ± 3.06), respectively. The mean nurses' knowledge, attitude, and performance score increased significantly over time (P < 0.001). CONCLUSIONS: Teaching chemotherapy safety standards using the application improved oncology nurses' knowledge, attitude, and performance. Appropriate educational programs, especially by new methods such as E-learning, are recommended for providing safety for nurses.

The effect of self-management support program on patient activation and inner strength in patients with cardiovascular disease.

OBJECTIVE: The aim of the present study was to evaluate the effect of a self-management program on activation and inner strength in patients with cardiovascular diseases (CVDs). METHODS: This study assigned 86 patients with CVDs to an experimental and a comparison group utilizing alternate allocation based on a quasi-experimental design. The experimental group participated in a self-management program based on a theoretical framework in three stages, i.e. orientation-recognition, reinforcing-engaging and monitoring-follow-up; whereas the comparison group received routine care. The supportive program was administered through holding five individual face-to-face sessions, providing educational booklets and performing four phone-call follow-ups during three months after discharge. The outcomes were measured using the patient activation measure (PAM) and the inner strength scale (ISS). RESULTS: The between group analysis indicated a statistically-significant difference in the mean score of patient activation (P < 0.001) in the two groups. Nevertheless, there was not a statistically-insignificant difference in the mean score of inner strength between the two groups (P < 0.104). CONCLUSION: Although a three-month nurse-led self-management support program was found to improve patient activation levels, it was ineffective in promoting inner strength. PRACTICE IMPLICATIONS: Psychosocial dynamics should be integrated in providing self-management program by nurses. To promote patient activation, tailored consultations is recommended.

Exploring nurses' perception of taking care of patients with coronavirus disease (COVID-19): A qualitative study.

Aim: Healthcare staff, especially nurses, who are in the frontline of caring of patients with COVID-19 have valuable experiences about taking care of these patients. Therefore, the aim of this study was exploring nurses' perception of taking care of patients with COVID-19. Design: This qualitative study was performed using the conventional content analysis method. Methods: 13 nurses who were taking care of patients with COVID-19 were selected using purposeful sampling in the Lorestan University of Medical Sciences. The data were collected through telephone interviews and analysed based on the Lundman and Graneheim's approach. Results: Qualitative analysis of the data revealed 3 sub-categories, 8 categories and 3 main categories including care erosion, nursing professional growth and necessities. Relevance to clinical practice: Improve the work situation of the nurses during care of COVID-19 patients, which can directly or indirectly improve the quality of care of these patients.

Exploring nurses' perception about the care needs of patients with COVID-19: a qualitative study.

BACKGROUND: COVID-19 is a new disease affecting and killing a large number of people across the world every day. One way to improve health care for these patients is to recognize their needs. Nurses, as a large population of health care staff, can be rich sources of information and experience on patients' care needs. Therefore, the aim of this study was to explore nurses' perception about the care needs of patients with COVID-19. METHODS: The present qualitative research was performed using the conventional content analysis approach in Iran from March to May 2020. The participants of this study included the nurses caring for patients with COVID-19, recruited by the purpose sampling method. The data was collected through 20 telephone interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Qualitative data analysis revealed six main categories including need for psychological consulting, need for quality improvement of services, need for upgrading of information, need for improving of social support, need for spiritual care and need for social welfare. CONCLUSION: The data showed that patients with COVID-19 were psychologically, physically, socially, economically, and spiritually affected by the disease. Therefore, they should be comprehensively supported by health care staff and other supportive systems.

Evaluation of in-person continuing education programs from the perspective of ward nurses.

BACKGROUND: Assessing how programs are implemented from the perspective of the learners themselves is one of the most effective ways to improve the quality of continuing education. The aim was to evaluate the implementation of in-person continuing education programs from the perspective of nurses. METHODOLOGY: Setting of the study was the selected hospital of Isfahan University of Medical Sciences (Al-zahra hospital). This study is a descriptive cross-sectional one. Using a researcher-made questionnaire, the implementation of continuing education programs in four areas of the aim, educational techniques, educational content, and educational field was evaluated. The sample consisted of 236 nurses working in these hospitals who participated in the study through convenience sampling. Data were analyzed by SPSS software version 19 using descriptive statistics. RESULTS: Based on the results, "the need for new content learning" was mentioned as the first priority in continuing education programs. The majority of participants scored each of the following domains (aim, educational techniques, educational content, and education field) as well as all items related to the continuing education program evaluation as "moderate." CONCLUSION: Most nurses assessed the implementation of in-person continuing education programs implemented in Isfahan University of Medical Sciences in general and in each of the domains as "moderate." Therefore, in order to improve the quality of programs, it is necessary to take steps to match the goals with the needs of learners, improve teaching techniques, improve the quality of program contents, and optimize the scope of the programs.

Exploring nurses' experiences of psychological distress during care of patients with COVID-19: a qualitative study.

BACKGROUND: COVID-19 infection is a new disease that infects a large number of people, killing a ratio of whom every day in the world. Healthcare staff, especially nurses, experience a great deal of psychological distress during care of COVID-19 patients. Detecting factors that disturb nurses' mental health during care of these patients can help to reduce their psychological distress. Therefore, this study aimed to explore nurses' experiences of psychological distress during care of patients with COVID-19. METHODS: The present qualitative research was performed using the conventional content analysis method in Iran from March to May 2020. Participants in this study included the nurses caring for patients with COVID-19, and they were selected based on the purposeful sampling method. The data was collected through 20 phone call interviews and analyzed based on the method proposed by Lundman and Graneheim. RESULTS: Qualitative data analysis revealed 11 categories including death anxiety, anxiety due to the nature of the disease, anxiety caused by corpse burial, fear of infecting the family, distress about time wasting, emotional distress of delivering bad news, fear of being contaminated, the emergence of obsessive thoughts, the bad feeling of wearing personal protective equipment, conflict between fear and conscience, and the public ignorance of preventive measures. CONCLUSION: The data showed that the nurses experienced a variety of psychological distress during care of patients with COVID-19. Through proper planning by authorities, it is possible to manage the risk factors of mental health distress in nurses and improve their mental health status.

Green Synthesis and Characterization of Copper Nanoparticles and Their Effects on Liver Function and Hematological Parameters in Mice.

OBJECTIVES: The present investigation is based on the green synthesis of copper nanoparticles (CuNPs) from aqueous extract of Capparis spinosa L. fruit. Their effects on liver function and hematological parameters in mice were evaluated. MATERIALS AND METHODS: The green synthesis of CuNPs by means of C. spinosa extract was achieved. Ultraviolet-visible spectroscopy, fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy were used to identify the synthesized nanoparticles. BALB/c mice were orally administrated CuNPs at doses of 1000, 2000, and 5000 µg/kg for 2 weeks. Later, the effects of CuNPs on liver function in the treated mice were evaluated by measuring the serum levels of enzymes such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and bilirubin as well as hematological parameters including hemoglobin, hematocrit, white blood cell, red blood cell, and platelet counts. RESULTS: A maximum peak at wavelength 414 nm confirmed the biosynthesis of CuNPs. FTIR spectrum analysis revealed that the factor groups shaped a coating extract on the surface of the nanoparticles. SEM images demonstrated a particle size between 17 and 41 nm. Although some liver enzymes and hematological parameters increased with increasing dose of extract, there was no significant difference (p>0.05) between oral administrations of CuNPs at doses of 1000, 2000, and 5000 µg/kg and the control group. CONCLUSION: The findings revealed that CuNPs biosynthesized from aqueous extract of C. spinosa fruit have no toxic effects on the liver functions and hematological parameters of mice. However, more studies are needed for evaluation of the hepatoprotective effects of CuNPs.

A Review of the Role of Statins in Heart Failure Treatment.

BACKGROUND: Heart failure is a common medical problem in the world, which has a high prevalence in both developed and developing countries. Today, among the medications used for the heart failure treatment, there are many medications with a positive cardiac contraction effect (positive inotropic such as digital glycosides, adrenergic receptor stimulants, and phosphodiesterase inhibitors), a large number of cardiac diluents (such as Angiotensin-Converting Enzyme (ACE) inhibitor group), and a few other types of drugs whose final effects are still under review. Statins are valuable drugs that are broadly prescribed in hyperlipidemia and cardiovascular patients due to their multiple properties, such as cholesterol reduction, endothelial function improvement, antioxidative, anti-inflammatory, neovascularization, and immunomodulatory activities. METHODS: There is evidence that the therapeutic role of statins in HF, due to myocardial hypertrophy, show reduction in cardiomyocyte loss in the apoptosis process, oxidative stress, inflammation, and also the return of neurohormonal imbalance. However, the fact that these drugs have no sideeffects has not been confirmed in all studies, as statins prevent the production of particular beneficial and protective factors, such as coenzyme Q10 (CoQ10), while inhibiting the production of specific proteins involved in pathologic mechanisms. RESULTS: Recently, it has been hypothesized that, despite the positive effects reported, high doses of statins in patients with long-term heart failure lead to progress in heart failure by inhibiting CoQ10 synthesis and intensifying hypertrophy. CONCLUSION: Thus, it can be stated that the advantage of using statins depends on factors, such as stroke fraction, and the existence of other standard indications such as atherosclerotic diseases or high Low-Density Lipoprotein-C (LDL-C).

Reminding the Health Team About What Companions of the Patients Undergoing Gynecological Surgery Should Know: A Qualitative Study.

BACKGROUND: Patients' family members often do not receive sufficient information, especially because the reproductive system of women is considered a taboo, providing information becomes problematic. The aim of the current study was to explore the informational-educational needs of companions of the patients who were undergoing gynecological surgery. MATERIALS AND METHODS: This study was conducted using inductive and conventional content analysis method. For data collection, 34 semi-structured in-depth interviews were performed at a gynecology and obstetrics center with purposeful sampling and maximum variation. The participants included patients' companions, nurses, physicians, patients, and service personnel. RESULTS: Qualitative content analysis extracted 8 categories, 2 main categories of "Informational needs of companions" and "Educational needs of companions" and a final theme of "the need for knowing." CONCLUSIONS: According to the results, "the need for knowing" is one of the most important needs of the patients' companions during hospitalization. Knowing companions' needs in the hospital and understanding its deficiencies would assist health care professionals, especially authorities, in providing high-quality care and developing programs to meet the informational needs of patients' companions.