The effect of inspiratory muscle training on fatigue and dyspnea in patients with heart failure: A randomized, controlled trial.

AIM: Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. METHODS: In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II-III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6-week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). RESULTS: The between-group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within-group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. CONCLUSIONS: The 6-week home-based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.

Nurses' perception of empowerment and its relationship with organizational commitment and trust in teaching hospitals in Iran.

AIM: The aim of the present study was to clarify the relationship between perception of job empowerment and organizational commitment and trust among nurses in teaching hospitals of Khorramabad (Iran). BACKGROUND: Lack of power has been widespread among nurses in their workplaces due to uneven distribution of power among hospital staffs. Giving power to only a few individuals at the top of hospital hierarchy may often make nurses feel weak in their workplaces and causes reduction in the patients' quality care. METHODS: This is a descriptive cross-sectional study which included 160 officially employed nurses in four teaching hospitals of Khorramabad (west Iran) selected by stratified random sampling. The instruments used were: The Conditions of Work Effectiveness Questionnaire-II (C.W.E.Q-II), which measures nurses' empowerment, the Pressure Management Indicator, which measures organizational commitment and the Trust in Management Scale, which measures organizational trust. The data were analysed by the SPSS software using the descriptive and analytic statistical tests employing chi-square, Fisher's test and the Spearman-Brown correlation coefficient. RESULTS: The results showed that the nurses had a below moderate score in their perception of job empowerment ( < ! [ C D A T A [ x ¯ ] ] >  = 2.38 ± 0.70), with the highest score in their perception of access to "opportunity" subscale ( < ! [ C D A T A [ x ¯ ] ] >  = 3.11 ± 0.95), and the lowest score in their perception of access to "formal power" ( < ! [ C D A T A [ x ¯ ] ] >  = 2.43 ± 0.95). Additionally, moderate "organizational commitment" and "organizational trust" were reported with < ! [ C D A T A [ x ¯ ] ] >  = 4.5 ± 0.90 and < ! [ C D A T A [ x ¯ ] ] >  = 4.01 ± 1.11, respectively. The highest and the lowest perception scores were found for "continuous commitment" and "affective commitment" with < ! [ C D A T A [ x ¯ ] ] >  = 4.94 ± 0.97 and < ! [ C D A T A [ x ¯ ] ] >  = 4.26 ± 1.21, respectively. There were positive significant relationships between the three major variables of the study (p < 0.001). CONCLUSION: The results showed that there was a positive and significant relationship between nurses' perception of job empowerment, organizational commitment and trust. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers can increase the motivating factors among their nurses through evaluating organizational variables like empowerment and organizational trust. In fact, through recognition of the relationship between empowerment and organizational trust, one can design the interventions of structural empowering for the improvement of professional nursing practice, nurses' workplace well-being and safe quality care.

The effect of progressive muscle relaxation on the management of fatigue and quality of sleep in patients with chronic obstructive pulmonary disease: A randomized controlled clinical trial.

OBJECTIVE: To assess the effect of progressive muscle relaxation (PMR) on fatigue and sleep quality of patients with chronic obstructive pulmonary disease (COPD) stages 3 and 4. MATERIALS AND METHODS: The pretest posttest clinical trial recruited 91 patients COPD grades 3 and 4. Following random assignment of subjects, the treatment group (n = 45) performed PMR for eight weeks and the control group (n = 46) received routine cares. At baseline and after the intervention, fatigue and sleep quality was assessed. Data obtained were analyzed in SPSS. RESULTS: It was determined that PMR decreased patients' fatigue level and improved some sleep quality subscales including subjective sleep quality, sleep latency, sleep duration and habitual sleep efficiency, but no improvement was found in global sleep quality and other sleep subscales. CONCLUSION: An eight-week home-based PMR program can be effective in reducing fatigue and improving certain subscales of sleep quality in patients with COPD stages 3,4. (IRCT2016080124080N3).

Iranian Nursing Students' Experiences of Case-Based Learning: A Qualitative Study.

The purpose of this study was to explore the experiences of undergraduate nursing students of the implementation of case-based learning in an emergency nursing course. The present qualitative study was conducted using the qualitative content analysis method. Participants consisted of 18 third year undergraduate nursing students selected through purposive sampling, which continued until the saturation of the data. Data were collected using semistructured interviews and were analyzed concurrently with their collection through the constant comparison method. The process of data analysis led to the emergence of 4 main themes, including "the continuum of knowledge from production to transfer competence," "a positive atmosphere of interaction," "the process of stress relieving," "the sense of role-playing in professional life," and the emergence of 12 subthemes signifying participants' experiences and perceptions with regard to the implementation of case-based learning (CBL) in teaching the emergency nursing course. The results of the present study showed that CBL is a stressful but pleasant and empowering experience for Iranian nursing students that develops critical thinking and stress management skills, reinforces peers' potentials, improves diagnostic abilities, and helps acquire professional competencies for use in future practices through the creation of a positive environment.