Challenges and advantages of electronic prescribing system: a survey study and thematic analysis.

INTRODUCTION: Electronic prescribing (e-prescribing) systems can bring many advantages and challenges. This system has been launched in Iran for more than two years. This study aimed to investigate the challenges and advantages of the e-prescribing system from the point of view of physicians. METHODS: In this survey study and thematic analysis, which was conducted in 2023, a researcher-made questionnaire was created based on the literature review and opinions of the research team members and provided to the physician. Quantitative data were analyzed using SPSS software, and qualitative data were analyzed using ATLAS.ti software. Rank and point biserial, Kendall's tau b, and Phi were used to investigate the correlation between variables. RESULTS: Eighty-four physicians participated in this study, and 71.4% preferred to use paper-based prescribing. According to the results, 53.6%, 38.1%, and 8.3% of physicians had low, medium, and high overall satisfaction with this system, respectively. There was a statistically significant correlation between the sex and overall satisfaction with the e-prescribing system (p-value = 0.009) and the computer skill level and the prescribing methods (P-value = 0.042). Physicians face many challenges with this system, which can be divided into five main categories: technical, patient-related, healthcare providers-related, human resources, and architectural and design issues. Also, the main advantages of the e-prescribing system were process improvement, economic efficiency, and enhanced prescribing accuracy. CONCLUSION: The custodian and service provider organizations should upgrade the necessary information technology infrastructures, including hardware, software, and network infrastructures. Furthermore, it would be beneficial to incorporate the perspectives of end users in the system design process.

The lived experiences of operating room nurses from the surgery on COVID-19 patients: a phenomenological study.

BACKGROUND: During the COVID-19 pandemic, some patients who were transported to the operating room for emergency surgery had COVID-19; operating room nurses should be in direct contact with these patients in a small and closed space of the operating room. This can lead to unpleasant experiences for these people. Accordingly, this study was conducted to understand the experience of operating room nurses during the surgery of COVID-19 patients. METHODS: This qualitative study is a descriptive phenomenological study. Sampling was done purposefully and participants were selected based on the inclusion and exclusion criteria. The data of this study was obtained through semi-structured interviews with 12 participants and analyzed using the Colaizzi method. RESULTS: Four main themes and 13 sub-themes were presented in this study: (1) feeling heroic (being a savior, self-sacrificing). (2) Exacerbating burnout (emotional exhaustion, feeling of incompetence, physical overtiredness). (3) Psychiatric crisis (destructive anxiety, horror of death, worrying about being a carrier, drastic feeling of pity). (4) Feeling the need for support (need for professional support, need for emotional support, need for social support). CONCLUSION: The results of this study show that operating room nurses experienced conflicting feelings during surgery on patients with COVID-19. So the feeling of being a hero was a heartwarming experience, but the aggravation of job burnout and mental crisis was unpleasant for them. Also, these people have experienced the need to be supported in various aspects.

Evaluation of risk management status in selected departments of educational hospitals of Hamadan University of Medical Sciences.

BACKGROUND: Healthcare organizations are among high-risk organizations due to the nature of their work as well as structural, physical and technological complexities. Accordingly, it is important to use risk management and control programs in all departments of these organizations. OBJECTIVE: The present study was conducted for the first time to evaluate the risk management status of the operating room and laboratory departments of Hamadan hospitals in 2022. METHODS: In this descriptive-observational cross-sectional study, laboratory and operating room departments were selected as the research environment. To conduct this research, a valid and reliable questionnaire was used to collect data, and the data were analyzed using SPSS 22 statistical software. RESULTS: The findings of the present study showed that the overall mean score of risk management status for the laboratory and operating room departments was 2.66 ± 0.15 and 2.89 ± 0.13, respectively. Furthermore, there was no statistically significant difference in the mean scores of the research components based on work experience, education level, and gender. CONCLUSION: It is suggested that the laboratory and operating room departments should focus more on adopting policies and solutions to improve the position of risk management, training and budget allocation for risk management.

Comparing the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery.

Background: Due to the sensitivity of the surgical site and a higher probability of injury, the use of a scalpel and electrocautery to create an incision in the spine is discussed. In this study, we will compare the intraoperative and postoperative complications of the scalpel and electrocautery techniques for severing the inner layers of the lumbar disc during discectomy surgery. Materials and methods: This study was conducted in Iran as a randomized controlled trial with double-blinding (1,401). Sixty candidates for spine surgery were randomly divided into two groups of 30 using electrocautery (A) and a scalpel (B) based on available sampling. The VAS scale was used to assess postoperative pain. The duration of the incision and intraoperative blood loss were recorded. The infection and fluid secretions were determined using the Southampton scoring scale. Utilizing the Manchester scar scale, the wound healing status was evaluated. The SPSS version 16 software was used for data analysis (t-test, Mann-Whitney U, ANOVA). Results: The electrocautery group had substantially lower bleeding, pain, and wound healing rates than the scalpel group (P > 0.05). However, the electrocautery group had significantly longer surgical times, more secretions, and a higher infection rate than the scalpel group (P > 0.05). In terms of demographic and clinical characteristics, there was no significant difference between the two groups (P < 0.05). Conclusion: Electrocautery reduces postoperative hemorrhage and, potentially, postoperative pain in patients. However, as the duration of surgery increases, so does the duration of anesthesia, and patient safety decreases. Additionally, the risk of infection increases in the electrocautery group compared to the scalpel group, and the rate of wound healing decreases. Clinical Trial Registration: https://www.irct.ir/, identifier (IRCT20230222057496N1).

Prevalence and Clinical Characteristics of Low Back Pain among Operating Room Personnel: A Cross-Sectional Study in South of Iran.

Background: Low back pain is one of the most common musculoskeletal disorders and the most common cause of activity restriction in people younger than 45 years. Nurses have a high incidence and prevalence of low back pain in terms of physical and emotional factors among healthcare workers. This study aimed to evaluate the prevalence and clinical characteristics of low back pain. Methods: This cross-sectional study was performed on 385 operating room personnel of the hospitals affiliated with Shiraz (the largest city in southern Iran) University of Medical Sciences. The data were collected via a research-made developed questionnaire. The questionnaire consisted of two parts, including the demographic information and prevalence and dimensions of low back pain. Results: The results showed that the prevalence of low back pain was 74% among operating room personnel. There was a significant relationship among low back pain, education level, and marital status (p < 0.05). Conclusion: Hospital managers should reduce the prevalence of this disorder among operating room staff by teaching preventative patient handling techniques via training courses.

Operating room nurses' experience about patient cares for laparotomy surgeries: A phenomenological study.

Introduction: The primary purpose of the present study was to explain the lived experiences of operating room nurses in the field of patient care undergoing laparotomy surgeries. Methods: The analytical phenomenological method was used. Ten operating room nurses employed in the operating rooms were selected using purposeful sampling. In-depth and semi-structured interviews were used for data collection. Data analysis was also applied using van Manen's six-step test. Results: In this study, 749 initial codes were extracted, classified into three main themes and six sub-themes following the elimination of similar codes. The main themes included a positive view of patient care, preservation of the physical safety of patients, and consideration of patient vulnerability in the operating room. Moreover, responsibility, holistic care, readiness standards of the surgical environment, physical care provision, medical team malpractice, and lack of care context were considered as sub-themes. Conclusion: The operating room nurses' experiences of patient care in operating rooms included a positive view of patient care, preservation of the patient's physical safety, and consideration of patient vulnerability in the operating room.

Effects of Inhalation Aromatherapy With Rosa damascena (Damask Rose) on the State Anxiety and Sleep Quality of Operating Room Personnel During the COVID-19 Pandemic: A Randomized Controlled Trial.

PURPOSE: Although aromatherapy with damask rose can reduce anxiety and improve sleep quality in different conditions, no study has yet addressed its effects among operating room (OR) personnel. Considering the high level of workload among Iranian OR personnel during the COVID-19 pandemic which can affect their anxiety and sleep quality, this study evaluated the effects of damask rose aromatherapy on state anxiety and sleep quality among a population of Iranian OR personnel during the COVID-19 pandemic. DESIGN: A randomized, nonblinded, parallel-group controlled trial. METHODS: Eighty OR personnel were divided into the two groups of damask rose and placebo (paraffin oil) using the stratified randomization method. In the first aromatherapy session, the participants inhaled two drops of either damask rose oil or paraffin oil for 10 minutes at the beginning of their morning shift. Then, they attached an absorbent cloth napkin impregnated with 5 drops of products to the side of their pillow for 30 consecutive nights. The Spielberger state anxiety inventory (SAI) and the Pittsburgh sleep quality index (PSQI) were completed before random allocation (T1) and on the 31st day of the study (T3). Also, the SAI was completed 90 minutes after the end of the first aromatherapy session (T2). FINDINGS: The mean changes in the SAI score were significant compared to T1 both at T2 and T3 in favor of the damask rose group (P < .001 in two cases). Similarly, the mean change in PSQI score was significant compared to T1 at T3 in favor of the damask rose group (P < .001). CONCLUSIONS: Damask rose can be effective in reducing state anxiety and improving sleep quality of OR personnel. Further studies are needed to determine the generalizability of the findings.

Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses and Its Reduction Strategies: A Systematic Review.

BACKGROUND: Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke, on members of the surgical team. METHODS: A systematic review was conducted focusing on the complexity of surgical smoke. PubMed, Scopus and web of science databases were searched until May 2020 without any time or language limitation. All documents were reviewed by title or abstract according to the search strategy. The screening process of articles was performed by two independent authors. The articles were selected according to the inclusion and exclusion criteria. RESULTS: Overall, 37 studies in this systematic study were investigated. The effects of many surgical smokes were found in a nutshell including complications such as carcinogenic, toxicity, mutation, irritant, transmission of tumor cells, virus transmission, headaches, dizziness, sleepiness, headache, the bad odor in head hair, the tearing of the eye on the surgical team and staff. CONCLUSION: Surgical smoke, produced during surgical operations, is one of the risks and threats to which the surgical team and operating room staff are at risk then can affect the organs of different bodies from the body of all operating room staff and surgical team.

The lived experience of HIV-infected patients in the face of a positive diagnosis of the disease: a phenomenological study.

BACKGROUND: AIDS as a human crisis may lead to devastating psychological trauma and stress for patients. Therefore, it is necessary to study different aspects of their lives for better support and care. Accordingly, this study aimed to explain the lived experience of HIV-infected patients in the face of a positive diagnosis of the disease. METHODS: This qualitative study is a descriptive phenomenological study. Sampling was done purposefully and participants were selected based on the inclusion and exclusion criteria. Data collection was conducted, using semi-structured interviews. Data analysis was performed using Colaizzi's method. RESULTS: 12 AIDS patients participated in this study. As a result of data analysis, 5 main themes and 12 sub-themes were identified, which include: emotional shock (loathing, motivation of social isolation), the fear of the consequences (fear of the death, fear of loneliness, fear of disgrace), the feeling of the guilt (feeling of regret, feeling guilty, feeling of conscience-stricken), the discouragement (suicidal ideation, disappointment), and the escape from reality (denial, trying to hide). CONCLUSION: The results of this study showed that patients will experience unpleasant phenomenon in the face of the positive diagnosis of the disease and will be subjected to severe psychological pressures that require attention and support of medical and laboratory centers.

Correlation between Spiritual Intelligence and Clinical Competency in Students Who Are Children of War Victims.

Objective: Providing effective and correct care to patients requires clinical competence. One of the important components in clinical competence is spiritual intelligence the purpose of the study was to consider the correlation between clinical competence and spiritual intelligence in students who are children of victims of war of Hamadan University of Medical Sciences in 2019. Method : The cross-sectional study was carried out on 145 Martyrs' and War Veterans' Students of medical, nursing, midwifery, and paramedical schools. Sampling was done through census of students of operating room, anesthesia, medicine, nursing, midwifery, laboratory science, and radiology. The data collection tools were Kazdin et al's (1986) Spiritual Intelligence questionnaire and Liu et al's (2009) Clinical Competency Assessment questionnaire. Data were analyzed by SPSS 23 software. Results: The results of data analysis showed a direct, positive, and significant linear relationship between spiritual intelligence and clinical competence of all students (P < 0.05). According to the students' self-report, the highest mean score of clinical competency of the students was related to medical students with a mean score of 37 and the lowest to the laboratory students with a mean score of 30 (P =0.012). In addition, the results showed that the highest mean score of spiritual intelligence belonged to nursing students with a score of 48 (good spiritual intelligence) and the lowest to radiology students with a score of 39 (moderate spiritual intelligence) (P =0.019). Conclusion: We found that there is a direct and positive correlation between spiritual intelligence and clinical competence, so it seems that promoting spiritual intelligence may be associated with an increase in clinical competence.

Self-management of patients with heart valve replacement and its clinical outcomes: a systematic review.

INTRODUCTION: For patients with heart valve replacement, self-management can play an essential role in the management of their condition. AIM: This review aimed to identify the aspects of self-management and its clinical outcomes in patients with heart valve replacement. MATERIAL AND METHODS: In this systematic review, the peer-reviewed research literature on self-management of patients with heart valve replacement was assessed. Since May 2020, the PubMed, Scopus, and web of science databases were searched regardless of time and language limitations. The eligibility of the articles was assessed by title or abstract according to the search strategy. Article selection was applied regarding to inclusion and exclusion criteria. Also, article screening was conducted by 2 independent authors. RESULTS: Twenty-five studies were considered in this systematic review. For inclusion, the self-management of patients had to have prerequisites, appropriate training, and be applicable in the aspects of anticoagulation therapy self-management, international normalized ratio (INR) self-testing, low-dose INR self-management, and heart valve function self-monitoring. In this method, through proper management of INR levels and anticoagulation therapy, the complications rate could be reduced and the patients would be able to diagnose functional disorders in the early stages by monitoring the valve function. This procedure was able to prevent the progression of complications. CONCLUSIONS: Self-management is an applicable protocol in the field of anticoagulation therapy, INR control, low-dose INR management, and the monitoring of cardiac valve function. This protocol could improve the quality of treatment for these patients through upgrading the care standards.

Self-care training and informational support of patients with a mechanical heart valve on the international normalized ratio and bleeding complications.

AIM: The aim of the study was to determine the effect of self-care training and informational support of patients with a mechanical heart valve on the international normalized ratio (INR) and bleeding complications. MATERIAL AND METHODS: Design: A quasi-experimental study. Participants were recruited via convenience sampling and were randomly divided into two groups: control (n = 80) and intervention (n = 80). Participants in the control group received only routine training; in addition, the intervention group received 6 sessions of self-care training and 6 months of informational support. Monthly the level of INR and incidence of bleeding were determined. Data were analyzed using the independent t-test and χ2 in SPSS16 software at a significance level of 0.05. RESULTS: During 6 months of follow-up, except for the third month, the frequency of INR levels in the therapeutic target range (2.5-3.5) in the intervention group was significantly higher than that in the control group (p < 0.05). Also in the intervention group, the incidence of bleeding complications was lower than that in the control group, but this difference was not statistically significant (p > 0.05). CONCLUSIONS: Proper self-care training and informational support in patients with mechanical heart valve replacement have positive results. By maintaining self-care, the level of a therapeutic target range of INR can be maintained and the incidence of bleeding complications can be reduced.

The effect of familiarization with preoperative care on anxiety and vital signs in the patient's cesarean section: A randomized controlled trial.

INTRODUCTION: Cesarean section (C-section) is one of the most prevalent surgeries among women. The preoperative stages in the surgery day and lack of control over being in an unfamiliar situation and feeling danger cause anxiety, and consequently, instability in patients. This study aimed to determine the effect of familiarization with preoperative nursing care on anxiety and vital signs of patients in cesarean section. METHODS: This randomized controlled trial study was performed on 80 pregnant candidates for C-section in Hamadan Fatemieh Hospital, Iran, in 2020. Patients were randomly divided into control (n=40) and intervention (n=40) groups. The control group just received the routine intervention of the hospital, but the intervention group, in addition, received the two familiarizing sessions with preoperative nursing care. Data were collected via vital signs sheet and Spielberger situational anxiety questionnaire and were analyzed using SPSS16 software at a significance level of p=0.05. RESULTS: Before the intervention, there was no significant difference between the mean anxiety scores of the control and intervention groups, and the two groups were homogeneous (p=0.396). However, after the intervention, the mean anxiety of the intervention group decreased significantly (p=0.001) and increased in the control group (p=0.600); and the mean post-test of the two groups showed a significant difference (p=0.001). After the intervention, the mean heart rate, respiration rate, systolic and diastolic blood pressure in the intervention group decreased significantly (p<0.05). However, there was no significant difference in heart rate and systolic blood pressure of the control group (p>0.05). CONCLUSIONS: Based on the results of this study we conclude that familiarity with preoperative care reduces the level of anxiety and stabilized the level of vital signs parameters.

Operating room nurses' lived experiences of ethical codes: A phenomenological study in Iran.

OBJECTIVE: Operating room nurses, as essential members of health care teams, often face ethical challenges in the operating room. By using the ethical experiences of operating room nurses, a better understanding of ethics in the operating room can be achieved, which can lead to better nursing decisions in the face of these challenges. Therefore, this study was conducted to investigate operating room nurses' lived experiences of ethical codes. METHODS: A hermeneutic phenomenological study was performed in Hamadan (Iran) from February 2019 to November 2020. Ten operating room nurses were selected as participants by purposive sampling. Data were collected through in-depth and semi-structured interviews. Data analysis was performed based on Van Manen methodology. RESULTS: Data analysis revealed three main themes and 11 sub-themes representing the operating room nurses experience of the ethical code. The main themes were; adherence to professional commitments, preserving patient dignity, and respect to colleagues. CONCLUSION: The results underlined ethics and ethical values in the operating room. Due to the intense interactions between operating room nurses with the patient and surgical team, commitment to ethics by nurses can lead to improving quality of care and interactions among members of the surgical team. It is suggested that using these codes as a guideline and a framework could be developed to improve the ethical and professional performance of operating room nurses.

Clinical Education Stressors in Operating Room Students: A Qualitative Study.

OBJECTIVES: The aim of this study is to explain the stressors of the clinical environment from the perspective of operating room undergraduate students. METHODS: The present study is a qualitative study of contractual content analysis type that was conducted in 2019 at Hamadan University of Medical Sciences. In this study, 10 undergraduate operating room students were selected by purposive sampling. Semi-structured interviews were used to collect data. RESULTS: From the analysis of interviews, 4 main categories were extracted as the stressors of operating room students of Hamadan Paramedical School in clinical learning environment: the need to receive support from the clinical environment (Insufficient students' skills in communicating with staff, Discrimination between paramedical students and residents, and Facilities available for training), lack of practical prerequisite skills (Contradiction between training and performance, and Lack of prerequisite knowledge for clinical practice), poor supportive and communication performance related to the instructor (Insufficient support of the instructor to the students against the medical staff, Evaluation criteria for instructors, and Treatment of instructor with students in presence of others), and psychological needs (Concerns about career prospects, Lack of motivational factors, and Lack of supportive counseling). CONCLUSIONS: The results of this study showed that Operating room students are faced with many stressors in the clinical learning environment. All stressors identified in this study affected the students' learning in the clinical setting. Lack of support for students in the clinical environment, poor practical skills training, poor support and communication performance related to the instructor, and poor psychological support of students are the factors that cause operating room student stress in the clinical environment.

Self-Efficacy, Self-Regulated Learning, and Motivation as Factors Influencing Academic Achievement Among Paramedical Students: A Correlation Study.

INTRODUCTION: Academic achievement is the most important indicator of the success of students in educational activities, but its nature is complex and multifactorial. The purpose of the present study was to determine self-efficacy, self-regulated learning, and motivation as potential factors influencing academic achievement among paramedical students. METHODS: In this correlation study, 400 undergraduate students were selected through a stratified random sampling method. The criterion for academic achievement was the student's grade point average. The data were analyzed using multiple linear regression equation, ANOVA, and independent t-tests. RESULTS: The mean score of the self-efficacy, self-regulated learning, and motivation was 62.18±9.3, 76.31±11.3, and 81.83±8.58, respectively. Self-regulated learning, self-efficacy, and motivation together accounted for 19.6% of the variance in academic achievement (p<0.001). Self-regulated learning had a direct relationship with academic achievement (p<0.001) and was the better predictor of academic achievement (b=0.337). A significant relationship between self-regulated learning and academic achievement was seen in operating room nursing, radiology sciences, anesthesiology (p<0.001), and laboratory sciences (p<0.01) students. CONCLUSIONS: Self-regulated learning was the better predictor of academic achievement. Self-regulated learning seems to encourage students to believe in their abilities and to be more motivated and self-learning in both classroom and practical settings.

Iranian Hospital Nurses' Lived Experiences of Emotional Intelligence: A Phenomenological Study.

Emotional intelligence can help nurses improve their clients' satisfaction and health. The aim of this hermeneutic phenomenological study was to explore Iranian hospital nurses' lived experiences of emotional intelligence. Data collection was done through holding ten in-depth semi-structured interviews with ten hospital nurses. Participants were recruited from hospitals affiliated with Hamedan University of Medical Sciences, Hamedan, Iran. Data analysis was done using Van Manen's ( 1997 ) six-step approach and resulted in the development of the main theme of normative interactive management and the following three subthemes of resorting to spiritualities, self-protection, and intelligent resilience.

Hospital nurses' lived experiences of intelligent resilience: A phenomenological study.

AIM AND OBJECTIVES: To explore Iranian hospital nurses' lived experiences of intelligent resilience. BACKGROUND: Nurses do high levels of emotional work when fulfilling patients' and their family members' complex needs. Intelligent resilience can alleviate nurses' stress and enhance their endurance. DESIGN: This study was based on the Husserlian descriptive phenomenology. METHODS: A purposive sample of ten hospital nurses was drawn from hospitals affiliated with Hamadan University of Medical Sciences, Hamadan, Iran. In-depth semi-structured interviews were held to collect data. The seven-step data analysis approach proposed by Colaizzi was used for the data analysis. In this study, the adherence to consolidated criteria for reporting qualitative guidelines has been followed. RESULTS: The participating hospital nurses' lived experiences of intelligent resilience came into four main themes of patience and wisdom, reverence, situational self-control and appealing to religiosity. Each of the four main themes included two subthemes which were having peace and wise quietness, reverence for the patients, physicians and nurses, distancing themselves from stressful situations and displacing staff who cause stress, and the nurse's trust in God as well as the patient and his family`s trust in God, respectively. CONCLUSION: Nurses with intelligent resilience are able to bring peace, reverence for others and situational self-control to stressors thereby providing higher quality of care to their patients. RELEVANCE TO CLINICAL PRACTICE: Nurses work in unstable and stressful conditions. The findings of this study provide better understanding about the concept of nurses' intelligent resilience and its indicators and attributes.