Development and psychometric properties evaluation of nurses' innovative behaviours inventory in Iran: protocol for a sequential exploratory mixed-method study.

INTRODUCTION: Nurses' innovative behaviours play a crucial role in addressing the challenges including adapting to emerging technologies, resource limitations and social realities such as population ageing that are intricately tied to today's healthcare landscape. Innovative behaviours improve healthcare quality, patient safety and satisfaction. Organisational factors and individual attributes influence nurses' inclination to innovate. With the rise of artificial intelligence and novel technology, healthcare institutions are actively engaged in the pursuit of identifying nurses who demonstrate innovative qualities. Developing a comprehensive protocol to elucidate the various dimensions of nurses' innovative behaviours and constructing a valid measuring instrument, rooted in this protocol represents a significant step in operationalising this concept. METHODS AND ANALYSIS: The study encompasses two phases: a qualitative study combined with a literature review, followed by the design and psychometric evaluation of the instrument. To ensure diversity, a maximum variation purposive sampling method will be used during the qualitative phase to select clinical nurses. In-depth semistructured interviews will be conducted and analysed using conventional content analysis. Additionally, a comprehensive literature review will supplement any missing features not captured in the qualitative phase, ensuring their inclusion in the primary tool. The subsequent quantitative phase will focus on evaluating the questionnaire's psychometric properties, including face, content and construct validity through exploratory factor analyses (including at least 300 samples) and confirmatory factor analyses (including at least 200 samples). Internal consistency (Cronbach's alpha), reliability (test-retest), responsiveness, interpretability and scoring will also be assessed. ETHICS AND DISSEMINATION: This study originates from a doctoral dissertation in nursing. Permission and ethical approval from Semnan University of Medical Sciences has been obtained with reference code IR.SEMUMS.1401.226. The study's findings will ultimately be submitted as a research paper to a peer-reviewed journal.

Unheard voices: The sexual challenges of families of patients with bipolar disorder: A qualitative content analysis.

OBJECTIVES: The aim of this study was to explore the voices of the family members of Bipolar Disorder (BD) patients about the challenges ahead of them. METHODS: In this qualitative study, 22 participants shared their experiences of sexual challenges of patients with BD through in-depth, face-to-face, semi-structured interviews. Qualitative content analysis was used for data analysis. RESULTS: An overarching theme entitled "Unheard voices" reflected this experience. It comprised four main categories include sexual promiscuity, a change in sexual patterns, sexual support, and sexual indifference. The results revealed that the families of patients with BD have to deal with sexual promiscuity and change in sexual patterns in their family, and the family system attempts to respond to these changes by sexual support mechanisms and sexual indifference. CONCLUSIONS: Given the significant impact of healthy sexual behaviors on the quality of life of both the individual and the family, therapists and family support systems are advised to strengthen and educate families to support their patients' sexual health and needs and protect their sexual existence; they should also address the sexual challenges faced by these families as a diagnostic and therapeutic priority, and early sexual health interventions should be provided to these families.

Academic burnout in nursing students: An explanatory sequential design.

AIM: Despite the harmful effects of burnout among many nursing students, academic burnout is poorly understood. This study was conducted to better explain the concept of burnout in nursing students. DESIGN: An explanatory sequential mixed-method design was used. METHODS: In the quantitative phase, the Maslach Burnout Inventory-Student Survey was completed by 91 nursing students in eastern Iran. In the qualitative phase, individual interviews were conducted with 13 undergraduate nursing students, one nurse and one instructor. Data were analysed using the directed content analysis method. RESULTS: Results from an ANOVA test showed differences in burnout scores in different semesters (p = .02) that were confirmed by the qualitative data. In addition to the three dimensions of the Maslach burnout model (exhaustion, cynicism and inadequacy feeling), qualitative data from the present study indicated the presence of a fourth dimension (incompatible learning style).

Effects of rose and lavender scents on nurses' job stress: A randomized controlled trial.

INTRODUCTION: A high percentage of nurses working in hospitals suffer from job stress and related psychological problems. This study aimed to examine and compare the effects of aromatherapy using lavender and rose essential oils on nurses' job stress. MATERIALS AND METHODS: This randomized placebo controlled trial was conducted on 118 eligible nurses who were randomly assigned into three groups of lavender (n = 39), rose (n = 40), and sesame seed as placebo (n = 39). The nurses received lavender and rose scents for two hours a day during four weeks. The Gray-Toft and Anderson's Nursing Stress Scale (NSS) was used to measure job stress before the interventions on the first day, and at the end of the second and fourth weeks. Descriptive and inferential statistics tests were used for data analysis. The statistical significance level was set at p < 0.05. RESULTS: No statistically significant differences between the groups in job stress before the interventions and at the end of the second week were observed. There were statistically significant differences between the groups at the end of the fourth week (p <0.003). Aromatherapy using rose scent had a positive effect on the nurses' job stress at the end of the fourth week compared to the placebo (p = 0.002). CONCLUSION: Aromatherapy using rose scent is a safe and non-pharmacologic method that can be used by nurses for improving their own comfort at the workplace. It can reduce nurses' overreliance on medications for relieving the symptoms of job stress.

Effect of Citrus aurantium Aroma on the Happiness of Pre-Hospital Emergency Staff: A Randomized Controlled Trial.

Happiness is a positive internal experience and an indicator of mental health. Having happy and efficient employees is one of the ideals of healthcare organizations, given its impact on the quality of healthcare services. Emergency healthcare staff members face various unpleasant and stressful events. It has been suggested that fragrant herbs such as Citrus aurantium can have cheerfulness effects on individuals. Therefore, this study was conducted to investigate the effect of Citrus aurantium aroma on the happiness of pre-hospital emergency staff. A randomized placebo controlled clinical trial was carried out on 167 prehospital emergency medical staff who were randomly assigned into two groups of aromatherapy and placebo. The participants received Citrus aurantium aromatherapy and placebo for five work shifts and for two consecutive weeks. Aromatherapy was performed using 10% Citrus aurantium scent applied via a pendant containing 1.5 cc of Citrus aurantium scent. The distance from the nose to the container was about 20 cm with the neck straight and the head in a balanced position. Data regarding staff happiness were collected using the Oxford Happiness Questionnaire, which were analyzed using descriptive and inferential statistics. The mean level of happiness did not differ between the intervention and control groups (p = 0.99). Work experience had a statistically significant inverse association with happiness (coefficient = -0.76, 95% CI: -1.49, -0.03). The findings of this randomized controlled trial indicate that Citrus aurantium aroma has no effect on the happiness of prehospital emergency medical services workers. There is a need to study the effect of a combination of complementary and alternative methods on the creation of positive psychological feelings among pre-hospital emergency staff.

Effects of Valsalva Maneuver on Pain and Vasovagal Reaction During the Removing of Femoral Arterial Sheath After Percutaneous Coronary Intervention: A Randomized Controlled Trial.

PURPOSE: The objective of this study was to investigate the effects of the Valsalva maneuver on pain and vasovagal reactions during femoral arterial sheath removal in patients undergoing percutaneous coronary intervention. DESIGN: This study was a randomized controlled trial. METHODS: In this study, 60 patients undergoing elective coronary angioplasty were randomly assigned to the intervention and control groups. After angioplasty, the patients in the intervention group performed the Valsalva maneuver (20-30 mm Hg) for 10 seconds during the sheath removal. Conversely, in the control group, no inspiratory pressure was applied. Before and immediately after the sheath removal, the patients' pain, vital signs, and vasovagal reactions were measured. FINDINGS: The primary characteristics of the patients were similar in the two groups. The patients in the intervention group had significantly lower pain scores during femoral sheath removal compared to the control group (2.33 ± 1.56 vs 5.56 ± 3.08, P < .001). The Valsalva maneuver during femoral sheath removal decreased the patients' heart rate in the intervention group compared to the control group (78.26 ± 12.37 vs 85.46 ± 11.79, P < .001); however, blood pressure and vasovagal reactions were not significantly different. CONCLUSIONS: This study showed that the Valsalva maneuver during femoral arterial sheath removal can reduce the pain severity score, without increasing the incidence of vasovagal reactions.

The effect of aromatherapy with peppermint essential oil on anxiety of cardiac patients in emergency department: A placebo-controlled study.

INTRODUCTION: Anxiety is an unpleasant feeling that increases the myocardial oxygen demand in acute coronary syndrome. This study aimed to evaluate the effect of peppermint aromatherapy on anxiety in patients with acute coronary syndrome in the emergency department. MATERIALS AND METHODS: In this clinical trial study, 64 patients with acute coronary syndrome were randomly divided into intervention and control groups. In the intervention group, a cotton ball was soaked in 100% peppermint essential oil and placed about 20 cm from the patient's nose for 1 h while in the control group, the cotton ball was soaked in water. Anxiety was measured before and after the intervention with The Spielberger state-trait anxiety inventory. The data were analyzed in SPSS ver.23 software. RESULTS: No significant difference was observed between the two groups in terms of patients' demographic data. The mean score of trait and state anxiety before the intervention was not significantly different between the two groups. After the intervention, anxiety was significantly lower in the intervention group (37.72 ± 10.41) compared to the control group (42.62 ± 5.99) (P = 0.021). Results indicated a significant decrease in anxiety after the intervention (P < 0.001) in the intervention group. Such a difference was not significant in the control group. CONCLUSION: Peppermint essential oil inhalation significantly reduces anxiety of patients with acute coronary syndrome in emergency department.

Development and psychometric properties of the Nursing Student Academic Resilience Inventory (NSARI): A mixed-method study.

INTRODUCTION: Resilience has been proposed as a suitable solution to better deal with nursing students in cases of challenges but the complex and multidimensional nature of resilience has made its measurement challenging. This study aimed to develop and validate a new inventory theory-driven labeled Nursing Student Academic Resilience Inventory. METHODS: This study was performed with an exploratory sequential mixed-method design. In the qualitative phase of the study, individual interviews were conducted by including 15 participants to elicit the concept of resilience through purposive sampling. In the quantitative phase, psychometric analysis of the extracted items was performed using face, content, and construct validities (exploratory and confirmatory factor analyses) on a sample size of 405 nursing students. Besides, reliability has been tested using internal consistency and test-retest methods. According to the COSMIN standards, beside two important indicators of validity and reliability, responsiveness and interpretability were also considered. RESULTS: A 6-factor structure (optimism, communication, self-esteem/evaluation, self-awareness, trustworthiness, and self-regulation) with 24 items were extracted in terms of the derived categories from the qualitative phase. In confirmatory factor analysis, the χ2/df ratio was calculated as 2.11 for the NSARI six-factor structure. Suitable values were obtained for the goodness of fit indices (CFI = 0.904, AGFI = 0.885, IFI = 0.906, PCFI = 0.767, and RMSEA = 0.053). In the second-order factor analysis, AVE = 0.70 indicated the existence of both convergent and divergent validities. The Cronbach's alpha and omega coefficients were investigated as (0.66-0.78) and (0.66-0.80), respectively. The AIC was between 0.33 and 0.45 for all factors, which is an acceptable rate. Additionally, an intraclass correlation coefficient (ICC) was obtained as .903 for the whole instrument (CI .846- .946, P <0.0001). CONCLUSION: Multidimensional nature of resilience was supported through exploring its 6-factor structures in the nursing students' field. This tool also showed an acceptable validity and reliability for measuring resilience in the population of nursing students.

Incidence and severity of nausea and vomiting in a group of maintenance hemodialysis patients.

Introduction: Chronic kidney disease (CKD) is a rising problem across the world, including Iran. Most of the patients will require hemodialysis for survival. Despite the great progress has been made in the hemodialysis equipment, but it is still associated with complications. Nausea and vomiting are common complication of during hemodialysis, which leads to unpleasant feeling in patients. Objectives: This study aimed to determine incidence and severity of nausea and vomiting in a group of maintenance hemodialysis patients. Patients and Methods: This is a descriptive and analytical study on 60 hemodialysis patients of dialysis wards in Semnan University of Medical Sciences. Verbal Numeric Rating Scale (VNRS) and Korttila vomiting severity scale were used to measure the severity of nausea and vomiting during hemodialysis respectively. Results: In this study, the incidence of nausea and vomiting during hemodialysis were 28.3% and 11.7%, respectively. Meanwhile, the mean severity of nausea was 1.15 and the mean rank of vomiting was 2.08. Conclusion: The results of the study showed a relatively high incidence of nausea and vomiting in patients undergoing hemodialysis, hence nurses must consider these problems by suitable measures to prevent the occurrence of the these unpleasant feelings in the patients during hemodialysis.

The effect of topical application of lavender essential oil on the intensity of pain caused by the insertion of dialysis needles in hemodialysis patients: A randomized clinical trial.

BACKGROUND: Patients undergoing hemodialysis experience constant fear and anxiety due to the pain of the insertion of dialysis needles, which might lead to certain physiological and psychological complications for them in the long term. It is therefore essential to control their pain through a simple, safe method. OBJECTIVE: The present study was conducted to determine the effect of the topical application of lavender essential oil on the intensity of pain during the insertion of dialysis needles in hemodialysis patients. DESIGN: This open crossover study was conducted on 34 hemodialysis patients with arteriovenous fistula (AVF) admitted to the dialysis unit of one of the hospitals of Semnan University of Medical Sciences in 2013. The intensity of pain was measured in all the patients in three different states during the insertion of arterial needles for hemodialysis: (1) The topical application of 100% lavender essential oil, (2) no intervention, (3) placebo (with water). MAIN OUTCOME MEASURES: Pain intensity was measured in this study through the numeric rating scale (NRS) of pain. RESULTS: The findings showed that the mean±SD of pain intensity was 2.91±1.69 with the topical application of lavender, 4.59±2.02 in the no intervention state and 4.18±1.66 with the placebo state. Statistical tests showed a significant difference between the patients' intensity of pain in the three different states (p=0.001). CONCLUSION: Based on the findings of the study, the topical application of lavender decreases moderate intensities of pain during the insertion of dialysis needles. Accordingly, lavender oil may be an option to reduce pain by insertion of hemodialysis needles.

Predictors of inappropriate hospital stay: experience from Iran.

OBJECTIVE: Hospital services are the most expensive component of modern health care systems and inappropriate hospital stay is one of the most important challenges facing hospitals in many countries. The purpose of this study was to determine the extent of inappropriate hospital stay and investigate the related factors in Semnan city (Iran). METHODS: In this study, the Iranian version of Appropriateness Evaluation Protocol (AEP) was used in a representative sample of 300 hospital admissions and 905 hospital days. Data collection was performed during six weeks in January and February 2014 in four wards (two internal medicine and two surgical wards) of two hospitals in Semnan city (Iran). RESULTS: The results showed that 7.4% of admissions and 22.1% of stays have been inappropriate. Inappropriate stays were mainly concerned to the factors, including length of stay, inappropriate admissions, as well as factors related to hospitals. The most frequent causes of unjustifiable days were due to waiting for diagnostic or therapeutic procedures (35.1%), and 20.6% delay in discharge of patients by physicians due to conservative medical policy. CONCLUSION: In conclusion, this study confirms the existence of inappropriate hospital stays which may be due to patient characteristics and hospital factors. The most unjustifiable reasons for inappropriate hospital stay were related to internal processes of hospital, which mostly could be prevented through appropriate management Therefore, some steps must be taken to decrease inappropriate hospital stay and preserve hospital resources for patients who need them.

Effect of postoperative supplemental oxygen on nausea and vomiting after cesarean birth.

Postoperative nausea and vomiting (PONV) has a significant impact on patients and health care providers. Some nonpharmacologic methods may have an effect on PONV. Administration of supplemental oxygen (80%) during and for 2 hours after surgery has been shown to reduce the incidence of PONV from 44% to 22%. However, the effect of limiting supplemental oxygen to the immediate postoperative period on PONV is unknown. The purpose of this study was to test the efficacy of postoperative supplemental oxygen in reducing the incidence of PONV. Patients (n = 106) undergoing cesarean birth were given general anesthesia with 50% oxygen balanced nitrous oxide and in the postoperative period were randomly assigned to 2 groups. Patients in the experimental group received 8 L/min oxygen by a simple face mask for 6 hours. The control group received routine care of oxygen 5 L/min in the PACU and no supplemental oxygen on the ward. Trained nurses evaluated pulse oximetry and PONV after surgery. The incidence of PONV during the first 6 postoperative hours was 28.3% in the experimental group and 24.5% in the control group ( P = .659). There was no statistically significant difference between the 2 groups. In this study, postoperative supplemental oxygen 8 L/min did not prevent PONV in patients undergoing cesarean birth.