Moral reckoning among nurses: A directed qualitative content analysis.

BACKGROUND: When nurses face ethical challenges, they attempt to accept responsibility for their actions and start moral reckoning. Moral reckoning is the personal evaluation of one's behaviors or others' behaviors during ethically challenging situations. RESEARCH AIM: This study aimed at exploring the concept of moral reckoning and its stages among Iranian nurses using Nathaniel's moral reckoning Theory. RESEARCH DESIGN: This descriptive qualitative study was conducted in 2022 using directed content analysis. PARTICIPANTS AND RESEARCH CONTEXT: Eighteen nurses were purposively recruited from three teaching hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Data were collected via in-depth semi-structured interviews which lasted 50 minutes on average and were concurrently analyzed via the three-step directed content analysis method proposed by Elo and Kyngas. ETHICAL CONSIDERATIONS: This study earned the ethical approval of the Ethics Committee of Golestan University of Medical Sciences, Gorgan, Iran (code: IR.GOUMS.REC.1400.171). FINDINGS: During data analysis, 157 final codes were developed and categorized into 23 subcategories, 10 categories, and four themes. The themes of the study are ease (with the two categories of becoming and interacting), upset (with the two categories of mental upset and behavioral upset), resolution (with the two categories of making a stand and giving up), and reflection (with the four categories of remembering, telling the story, examining conflicts, and living with consequences). CONCLUSION: Ethically challenging situations alter the ease stage of moral reckoning among nurses, cause them mental and behavioral upset, and thereby, require them to make stand or give up. Then, they continuously examine events in their mind and finally, live with the positive and negative consequences of the events.

Psychometric validation of the Persian version of the ethical awareness scale for nurses working in Iranian intensive care units.

AIM: The purpose of this study was to translate and validate the ethical awareness scale for nurses working in Iranian intensive care units. DESIGN: A cross-sectional psychometric study. METHODS: The study was conducted in Oct 2020 to Sep 2021, involving the participation of 200 ICU nurses. The process included translation of the original version of the ethical awareness scale into Persian, following the World Health Organization guideline, for use in Iran. The translated version was then evaluated for reliability, face validity, content validity ratio, content validity index, convergent validity and construct validity. RESULTS: The initial reliability of the scale was established. In qualitative face validity, a few items changed slightly and all items were retained in the quantitative face validity assessment. Based on Lawshe's values, three items were removed from the scale during CVR assessment. All items exhibited acceptable CVI scores. Convergent validity was established with an average variance extracted greater than 0.5. The fit indices, such as CFI = 0.94, GFI = 0.94, RMSEA = 0.01, AGFI = 0.97 and CMIN/DF = 2.99, supported the structural model of the scale. The fit indices for the structural model of the scale were all within acceptable ranges, suggesting that the model fit the data well. Its reliability was confirmed through the test-retest method, with Cronbach's alpha = 0.84 and McDonald's omega coefficient >0.8. CONCLUSION: The findings of this study indicate the Persian version of the ethical awareness scale for Iran (EAS-IR) is comparable in content to the original version, demonstrating its validity and reliability for assessing ethical awareness among Iranian nurses in ICUs. The scale can be a valuable resource for measuring ethical awareness in the Iranian healthcare context and may contribute to improving ethical practices and decision-making in ICU settings. PATIENT OR PUBLIC CONTRIBUTION: In this project, no patient or public contribution was necessary, because it was not applied to our work.

Concept analysis of conscience-based nursing care: a hybrid approach of Schwartz-Barcott and Kim's hybrid model.

BACKGROUND: The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care. METHODS: This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived. RESULTS: The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care. CONCLUSION: Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.

From pervasive chaos to evolutionary transition: The experience of healthcare providers during the COVID-19 pandemic.

AIM: The outbreak of the COVID-19 pandemic confronted healthcare providers, especially physicians and nurses, with many unprecedented changes and physical and psychological pressures. This study aimed to explore the healthcare providers' experiences providing healthcare services for patients during the COVID-19 pandemic in "Golestan, Northeast Iran". DESIGN: Qualitative, conventional content analysis. METHODS: A total of 13 eligible participants were recruited through the purposeful sampling method. Data were gathered using semi-structured in-depth individual interviews. Transcripts were analysed using an inductive content analysis based on the Elo and Kyngas model. The COREQ checklist was used to prepare the manuscript. RESULTS: The analysis of the data in this study led to the development of 16 subthemes and 5 themes emerged as follows pervasive chaos, imposed difficulties, paradoxical perceptions, committed efforts, and constructive transition. CONCLUSION: The experience of HCPs during the COVID pandemic in "Iran" showed that despite the physical, mental, emotional, and social consequences, a kind of constructive evolution and transition has also taken place in personal, professional, and organizational dimensions. It is suggested that managers while strengthening and protecting the capabilities and skills that have emerged, to reduce the tensions of HCPs, have developed programs for comprehensive support from them in physical, psychological, social, and financial dimensions. RELEVANCE TO CLINICAL PRACTICE: It is necessary to improve inter-professional cooperation, empathy, teamwork, professional commitment, and continuous learning in crises.

Nurses' experience of integrating evidence-based changes into their practice: A qualitative study.

AIM: To explore the experiences of neonatal and NICU nurses on participating in evidence-based changes in their neonatal pain management practice. DESIGN: It is a qualitative conventional content analysis. METHODS: A purposive sample with nurses working in neonatal and NICUs was used. The data were collected through 11 semi-structured in-depth individual interviews, five focused group discussions, and observations and analyzed using the conventional content analysis method based on the Elo and Kyngäs model. The COREQ checklist was used for writing the report. RESULTS: Analysis of gathered data led to the emergence of four themes, including 'being in a supportive and encouraging atmosphere', 'a journey from resistance to adherence', 'achieving multi-dimensional improvements', and 'facing obstructive challenges'.

The Relationship Between Compassion Fatigue and Nursing Care Quality in Intensive Care Units: A Correlational Study in Northeast of Iran.

Intensive care unit (ICU) nurses are repetitively exposed to traumatic situations and stressful events, which can lead to compassion fatigue (CF). Compassion fatigue can negatively affect the nurses' emotional and physical health and job satisfaction. The aim of this study was to evaluate the relationship between CF and nursing care quality in ICU. This descriptive-correlational study was conducted on 46 ICU nurses and 138 ICU patients, in 2 referral hospitals in Gorgan, Northeast of Iran in 2020. Participants were selected using stratified random sampling. Data were collected using CF and nursing care quality questionnaires. The results of this study showed that most nurses were women (n = 31, 67.4%), with mean age of 28.58 ± 4.80 years. The mean patients' age was 49.22 ± 22.01 years and 87 (63%) of them were male. The severity of CF in most ICU nurses (54.3%) was moderate, with a mean score of 86.21 ± 16.78. Among of the subscales, psychosomatic score was higher than the rest of subscales (0.53 ± 0.26). Nursing care quality was at the optimal level (91.3%) with the mean score of 81.51 ± 9.93. The highest scores of nursing care were related to subscale of medications, intake, and output (0.92 ± 0.23). In this study, there was a weak and inverse relationship between CF and nursing care quality (r = -0.28; P = .058). The results of this study indicate a weak, nonsignificant inverse relationship between CF and nursing care quality in ICU.

Psychometric Properties of the 'Patients' Perspective of the Quality of Palliative Care Scale'.

Objectives: Palliative care is a basic human right for all patients suffering from progressive and excruciating pain, limitations in daily activities as well as requiring constant care. The development of palliative care is always associated with the physical, psychological, social and spiritual care quality level and requires continuous evaluation by the care-receiving patients. This study aimed to determine the psychometric properties of the patients' perspective of the quality of palliative care scale. Materials and Methods: This methodological study was conducted on 500 patients with chronic diseases admitted to the hospitals affiliated in Golestan University of Medical Sciences, between 2019 and 2020. Participants were selected through stratified sampling through proportional allocation as well as considering the bed occupancy rate in the two referral hospitals of the university. According to Wild approach, we translated the original version of the scale the patients' perspectives of the quality of the palliative care scale with 35 items and eight subscales. Using exploratory and confirmatory factor analysis, the psychometric properties of the scale (i.e., initial reliability and face, content, convergent and construct validities) were assessed. The reliability of the scale was calculated by applying Cronbach's alpha coefficient, McDonald's omega coefficient and the Intraclass correlation coefficient (ICC). SPSS-16 and AMOS-24 software programs were used to analyse the data. Results: Three items were omitted after assessing the initial reliability of the translated version of the perspectives of the quality of the palliative care scale using adjusted Cronbach's alpha. The qualitative face validity and impact score of the remaining items of the scale were confirmed by the target group. Meanwhile, a panel of experts confirmed the content validity ratio and content validity index. Convergent validity was approved by calculating the average variance extracted >0.5. Performing EFA led to the extraction of 7 subscales with 32 items. CFA and goodness of fit indices such as GFI = 0.98, CFI = 0.91, RMSEA = 0.048 and GFI = 0.97 confirmed the construct model by omitting three items. Hence, the Persian version of the patient's perspective of the quality of palliative care scale was finalised, including seven subscales with 29 items. ICC of >0.7 represented good reliability. Moreover, Cronbach's alpha and McDonald's omega coefficient confirmed the internal consistency of the scale. Conclusion: Based on the findings of this study, the Persian version of the patients' perspective of the quality of palliative care scale is introduced as a valid and reliable scale. It can accurately indicate and predict the meticulous quality of such care in hospitalised patients and can be used in the cure and care assessments in the health system.

Concept development of "Aging in place": Application of hybrid model.

There are various methods and services which help elders protect their independency and ability and take care. Like aging in place (AIP), that is a home and community-based model. Despite its importance, this concept is still ambiguous and there is no comprehensive definition for it. This study aims to clarify and conceptualize the meaning of AIP and to develop a context-based definition. In this qualitative study, the concept was developed using a hybrid model during three theoretical phases, fieldwork and final analysis. In the theoretical phase, 30 selected articles, following a systematic search in Web of sciences-Scopus-PubMed databases using the keywords "Aging in place", "Aging at home" and "Aging in community", during 2000-2019 were screened and analyzed. After providing the working definition, the fieldwork phase directed qualitative content analysis was performed on interviews conducted with seven eligible elderly. Finally, in the final phase, after comparing the findings of the previous two phases, the final definition was presented. The results of the hybrid model extracted and identified various definitions of AIP and attributes, antecedent and consequences of AIP. attributes included; independency, belonging to the place, maintaining network, living in one's own home and community, safety, comfort, non-institutionalization, first preference, and life routines continuity. Antecedents included; health, physical environment, financial ability, socialization, information support, technology, AIP antecedent prediction, community services and transportation. Finally, Consequences included; Individual acceptability and community acceptability. Also final definition was provided. If the AIP and its related factors are known and provided so that elders can stay in their homes, then they do not have to choose a nursing home and thus stay out of the community. As a result, following the AIP, both the elderly and community will be satisfied.

The effects of earplugs and eye masks on sleep quality of patients admitted to coronary care units: A randomised clinical trial.

Sleep is an essential need for patients admitted to coronary care units. The present clinical trial aimed to determine the effect of using eye masks and earplugs on the sleep quality of patients with coronary heart disease (CHD). A total of 68 eligible patients with CHD were randomly allocated into four groups of 17 (control, eye masks, earplugs, and eye masks with earplugs). All three interventions were performed during the night from 10:00 p.m. to 7:00 a.m. the next day. The outcomes were the quality of sleep, measured by the Verran and Snyder-Halpern (VSH) Sleep Scale, and the urinary levels of nocturnal melatonin and cortisol, measured by urine samples taken during the night (from 10:00 p.m. to 7:00 a.m.). The study outcomes were measured on the third and fourth days. Sleep disturbance was statistically significantly lower in patients with earplugs (visual analogue scale mean difference [MD]: 74.31 mm, SE: 11.34, p = 0.001). Sleep effectiveness was statistically significantly higher in patients with eye mask (MD: 36.88 mm, SE: 8.75, p = 0.001). The need for sleep supplementation was statistically significantly lower in patients with eye masks (MD: 39.79 mm, SE: 7.23, p = 0.001). There was a significant difference in melatonin levels between eye masks and the control group (p = 0.03). For urinary cortisol levels, there were significant differences between eye masks and the control group (p = 0.007), earplugs and the control group (p = 0.001), and eye masks with earplugs and the control group (p = 0.006). The mean scores for comfort, effectiveness, and ease of use were highest for the group that used eye masks (2.88, 2.94, and 3.18, respectively). As a result, all three interventions improved the sleep quality of patients. However, the interventions had different effects on the three dimensions of the VSH Sleep Scale, as well as the urinary levels of cortisol and melatonin.

Development and implementation of anxiety management program for women under gynecological surgery with spinal anesthesia: Protocol of action research study.

BACKGROUND: Anxiety is the most common health problem and the second leading cause of disability worldwide. Patients undergoing surgery often experience anxiety. It is necessary to use appropriate interventions to achieve the best results. The aim of this study is to develop, implement, and evaluate of anxiety management program for gynecological surgery patients under spinal anesthesia. MATERIALS AND METHODS: This participatory action research will be conducted through four phases; problem identification, planning, action, and evaluation phases in the Gonbad-e-Kavous Shahada, hospital in northeastern of Iran. These phases will be guided based on the Promoting Action on Research Implementation in Health Services framework. Participants will be included using purposive sampling method. We will use both of qualitative (semi-structured interview, observation) and quantitative (questionnaire) approaches for data collection through the study. CONCLUSION: For anxiety management of patients, context-based interventions should be performed. Combination of multidimension approach based on health-care providers, patients, and environment will have an effect to solve the problem in the clinical setting.

Comparison of Prevalence and Risk Factors of Acute Coronary Syndrome in Patients with Different Ethnicity: A Cross-sectional Study.

BACKGROUND: Although the main risk factors of acute coronary syndrome (ACS) have been previously identified, there is not yet strong and consistent evidence about the ethnical differences of these risk factors. The aim of this study was to identify and compare the distribution of risk factors of ACS among two ethnic groups in northern Iran. METHODS: This cross-sectional study was done on a total of 250 patients (100 Fars and 150 Turkmen ethnics) with ACS admitted in coronary care units (CCU) of medical centers in Gonbad-e Kavus, a city in the Northeast of Iran. The demographic characteristics, clinical parameters and anthropometric indices of patients in two ethnic groups were recorded. In addition, Beacke's questionnaire and Cohen's scale were used to evaluate and compare the patients' level of physical activity and perceived stress, respectively. RESULTS: The mean age of the patients was 60.9±11.9 years and they were mostly males (54.8%) and married (84.8%). Findings showed that the prevalence of myocardial infarction in Fars patients was significantly higher than Turkmens (24% versus 15.3%; P=0.04). In addition, there was a significant difference in terms of the history of using opium (P=0.07) and opium sap (P=0.03), socioeconomic status (P=0.009), the place of residence (P=0.001) and type of health insurance services (P=0.001) between two groups. However, the clinical parameters and anthropometric indices and the level of physical activity and perceived stress were not significantly different between two groups (P>0.05). CONCLUSION: This study showed a significant difference in the prevalence and risk factor of ACS in patients with different ethnicity in northern Iran. This finding points to the importance of paying attention to the ethnicity-based difference in ACS prevalence and risk factors, especially in patients who are at high to intermediate risk for ACS, such as Turkmens.

The effect of melatonin on quality of sleep in patients with sleep disturbance admitted to post coronary care units: A randomized controlled trial.

BACKGROUND AND OBJECTIVES: Patients with cardiovascular disease who required to be admitted in coronary care units (CCU) would have sleep deprivation. During the admission some factors such as continuous ambient light exposure can suppress melatonin release, in consequence sleep deprivation will be occurred and hinder the progress of patients' treatment. The aim of study was to evaluate the effect of melatonin on the sleep quality of patients admitted to post-CCU. MATERIALS AND METHODS: This randomized clinical trial was carried out on 110 patients admitted to post-CCU at SayyadeShirazi Hospital, Gorgan, Iran. Patients with a poor sleep quality (Pittsburgh sleep quality index (PSQI) global score>5) were randomly allocated into two intervention and placebo groups. Patients in the intervention group received melatonin (3 mg; 30 minutes before bedtime), and the placebo group received placebo for 2 weeks, and their sleep quality was re-evaluated after the end of intervention. Data were analyzed using paired t test, Wilcoxon, and Chi-square tests by SPSS version 21. RESULTS: The results showed that mean of the patients' PSQI scores decreased significantly in intervention group (from 14.95 ± 1.48 to 11.65 ± 1.50, P < 0.001), while in placebo group the difference was not significant (from 15.48 ± 1.47 to 15.24 ± 1.71, P = 0.129). Post-intervention score of patients in intervention group was also lower than the placebo group (P < 0.001). CONCLUSION: The melatonin can improve the sleep quality of the patients admitted to post-CCU who suffer from sleep disturbance.

The age-friendly cities characteristics from the viewpoint of elderly.

BACKGROUND: Elderly population is rising due to advancement of health care, medical services, and increasing life expectancy. World Health Organization (WHO) has initiated a global project to define "age-friendly city for improving the elderly's quality of life". OBJECTIVES: The purpose of the study was to determine the age-friendly cities characteristics from the elderly's point of view in Gorgan, Iran. METHODS: This cross-sectional study was conducted in 2019 on elderly people who referred to the health centers of Gorgan, Iran. 160 eligible elderly people were recruited through multi-stage random sampling. The viewpoint of participants about the characteristics of Gorgan in the four age-friendly city indicators; urban and outdoor buildings, transport and transportation systems, information and communication services, and social support and health services was compared with the standard of WHO. Data were collected using the age-friendly city questionnaire and analyzed in SPSS-18 using Chi-square and one-sample t-tests. RESULTS: From the elderly viewpoint, the mean score of 4 indicators; urban buildings and outdoor (58.50 ± 31.2), Transport and transportation system (43.3 ± 82.00), access to Information communication services (46.75 ± 15.1) and the level of access to social support and health services (81.43 ± 21.10). Considering age-friendly city indicators, the characteristics of Gorgan City were significantly lower than the WHO recommended standard (P < 0.001). The "Information and Communication" and "buildings and outdoor space" indicators had the highest and lowest differences from the standard, respectively. CONCLUSION: According to the present results it is recommended that managers and policymakers of urban planning and healthcare providers in their programs consider the elderly viewpoint to improve the urban characteristics as an age-friendly city.

Prevalence of Malnutrition Among Elderly People in Iran: Protocol for a Systematic Review and Meta-Analysis.

BACKGROUND: Malnutrition occurs following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals because of numerous factors. Thus, it has serious and life-threatening consequences. To plan for this issue, we need information on the burden of this problem. OBJECTIVE: The aim of this study is to determine the prevalence of malnutrition among elderly people in Iran. METHODS: For the purpose of this study, papers, including original articles, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 years and above, and have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly, and Iran. At first, the screening process will be conducted based on our inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully, and eligible articles will be selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed, and the required information will be extracted from those with acceptable quality. Finally, a meta-analysis will be performed using the Stata software (version 14) when optimum criteria are met. It should be noted that all stages of screening, selection, quality assessment of primary studies, and data extraction will be performed by two reviewers independently. RESULTS: This review is ongoing and will be completed at the end of 2019. CONCLUSIONS: This review aims to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran. This can help Iranian health managers and policy makers make informed decisions for preventing malnutrition and promoting the health status of elderly people. TRIAL REGISTRATION: PROSPERO CRD42018115358; https://tinyurl.com/y28su47m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15334.

Impact of Implementing the Critical Care Pain Observation Tool on Nurses' Performance in Assessing and Managing Pain in the Critically Ill Patients.

BACKGROUND AND AIMS: Pain management is one of the most important responsibilities of nurses in an intensive care unit (ICU). It is difficult to perform pain assessment appropriately in patients who are unable to report their pain. This study is aimed to determine the impact of implementing the critical care pain observation tool (CPOT) on the amount and frequency of analgesics' administration in ICUs. MATERIALS AND METHODS: This interventional study was conducted in 2014. Sixty nurses and 240 patients were studied. This study was carried out in three phases: first the data about amount and frequency of analgesic administration were extracted from patients' medical files. Then the CPOT was implemented into the nursing assessment process and finally, nurses' performance regarding the amount and frequency of analgesic administration was recorded. This data obtained before and after intervention were analyzed using chi-square and independent t-test p values less than 0.05 were considered significant. RESULTS: In this interventional study, we found that there was no difference in the demography and cause of ICU admission before and after implementation of CPOT (age p = 0.937, gender p = 0.996, and the cause of admission p = 0.996). We found that after implementing the CPOT into the nursing assessment process, the amount of analgesics administered (7.95 ± 8.77 mg vs. 11.01 ± 11.04 mg, p = 0.018) and the frequency of administration (2.91 ± 1.38 vs. 4.16 ± 0.99, p <0.001) increased significantly. Moreover, there was a significant increase in the frequency of pain assessment per patient per day in nursing practice after implementation of CPOT as compared to the practice before (7.2 ± 2.48 vs. 1.03 ± 1.63, p <0.001). The mean pain scores before and after the intervention (5.5 ± 1.08 vs.2.2 ± 0.48) were also significantly different. CONCLUSION: Applying CPOT, as an objective mean of pain assessment, was effective in improving the performance of ICU nurses in assessment and management of patients' pain. It increased the amount and frequency of analgesic administration. We can recommend that COPT is a useful tool for assessment and management of pain in ICU patients and should be implemented in all ICUs. HOW TO CITE THIS ARTICLE: Modanloo M, Mohsenpour A, et al. Impact of Implementing the Critical Care Pain Observation Tool on Nurses' Performance in Assessing and Managing Pain in the Critically Ill Patients. Indian J Crit Care Med 2019;23(4):165-169.

Exploring the concept of scholarship of teaching and learning (SoTL): Concept analysis.

Background: Researchers have contributed to the definition of SoTL; however, the literature is not conclusive on its definitions and attributes. Therefore, this study was an attempt to precisely define SoTL by its attributes, antecedents and consequences. Methods: The Walker and Avant (2011) concept analysis method was used. Results: The 9 emerged attributes are: Committed engagement in action, Critique-based, Disciplinary, Context-oriented, Critical enquiry process, Continuous deep reflection, Dynamic process, Shared publicly, and Learning focused. Conclusion: This study helps promote understanding and application of SoTL.

Studying the Power of the Integrative Weaning Index in Predicting the Success Rate of the Spontaneous Breathing Trial in Patients under Mechanical Ventilation.

BACKGROUND AND AIMS: The use of weaning predictive indicators can avoid early extubation and wrongful prolonged mechanical ventilation. This study aimed to determine the power of the integrative weaning index (IWI) in predicting the success rate of the spontaneous breathing trial (SBT) in patients under mechanical ventilation. MATERIALS AND METHODS: In this prospective study, 105 patients undergoing mechanical ventilation for over 48 h were enrolled. Before weaning initiation, the IWI was calculated and based on the defined cutoff point (≥25), the success rate of the SBT was predicted. In case of weaning from the device, 2-h SBT was performed and the physiologic and respiratory indices were continuously studied while being intubated. If they were in the normal range besides the patient's tolerance, the test was considered as a success. The result was then compared with the IWI and further analyzed. RESULTS: The SBT was successful in 90 (85.7%) and unsuccessful in 15 (14.3%) cases. The difference between the true patient outcome after SBT, and the IWI prediction was 0.143 according to the Kappa agreement coefficient (P < 0.001). Moreover, regarding the predictive power, IWI had high sensitivity (95.6%), specificity (40%), positive and negative predictive values (90.5% and 60), positive and negative likelihood ratios (1.59 and 0.11), and accuracy (86.7%). CONCLUSION: The IWI as a more objective indicator has acceptable accuracy and power for predicting the 2-h SBT result. Therefore, in addition to the reliable prediction of the final weaning outcome, it has favorable power to predict if the patient is ready to breathe spontaneously as the first step to weaning.

Knowledge translation in health care: a concept analysis.

BACKGROUND: Although knowledge translation is one of the most widely used concepts in health and medical literature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify the characteristics of KT. This will assist the theoretical development of it and shape its implementation into the health care system Methods: Walker and Avant's framework was used to analyze the concept and the related literature published between 2000 and 2010 was reviewed. A total of 112 papers were analyzed. RESULTS: Review of the literature showed that "KT is a process" and "implementing refined knowledge into a participatory context through a set of challenging activities" are the characteristics of KT. Moreover, to occur successfully, KT needs some necessary antecedents like an integrated source of knowledge, a receptive context, and preparedness. The main consequence of successful process is a change in four fields of healthcare, i.e. quality of patient care, professional practice, health system, and community. In addition, this study revealed some empirical referents which are helpful to evaluate the process. CONCLUSION: By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, consequences and empirical referents. Identifying the characteristics of this concept may resolve the existing ambiguities in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these findings can be used as a knowledge infrastructure for developing the KT-related models, theories, or tools.