Challenges in the Management of Care of Brain-Dead Patients in the Donation Process: A Qualitative Content Analysis.

BACKGROUND: In care of brain-dead patients, nurses face several challenges. It is important to determine the context behind these challenges since they affect the performance of nurses and the organ donation process. OBJECTIVE: To identify factors affecting the emergence of challenges related to the management of brain-dead patients by nurses in the donation process. METHODS: In this qualitative conventional content analysis, data were collected by performing 28 semi-structured and in-depth interviews with nurses working in the ICUs. Purposive sampling started from March 2014 until saturation, which was reached in June 2016. Data analysis occurred simultaneously with data collection. RESULTS: Qualitative analysis of contents provided from interviews led to the extraction of themes that showed the experience of nurses about the challenges of caring for brain-dead patients in the donation process. These themes included "doubt and conflict in accepting the situation" and "defects in an effective and targeted care system." In the end, the main theme of "inconsistency and incompatibility of care management" was abstracted. CONCLUSION: According to the results of the study, factors involved in the emergence of challenges for nurses in care management included defects in education or managerial problems, which increased tension for nurses.

Nursing interventions for smoking cessation in hospitalized patients: a systematic review.

AIM: This study aimed to clarify the role of nurses in planning and implementation of nursing interventions related to smoking cessation. BACKGROUND AND INTRODUCTION: Nearly half of all smokers die from smoking-related illnesses. Quitting smoking can reduce these problems. Smoking cessation interventions include various types helping smokers successfully quit. Studies suggest that hospitalization can be a golden opportunity for nurses helping patients to quit smoking because of No Smoking regulations. METHOD: A systematic review of the literature was carried through Web of Knowledge, ProQuest, Medscape, MedlinePlus, Ovid SID, Magiran, PubMed, and Science Direct databases between 1990-2015 on the subject of interest by keywords: role of nursing in smoking cessation, nursing intervention in smoking cessation, smoking cessation, smoking quitting and interventions planned by nurse. RESULT: Nineteen papers were systematic examined, dealing with smoking cessation interventions by nurses. Totally, 17 studies used counselling for quitting smoking. Most studies involved other methods such as manuals, pamphlets, brochures training or printed educational materials, audio and video file. Some studies used nicotine replacement methods for patients such as nicotine skin tags, chewing nicotine or bupropion. Moreover, 17 studies were conducted by telephone at patients' follow-up after hospital discharge. CONCLUSION: Nurses' interventions for smoking cessation play an important role in helping patients quit smoking successfully. There are a variety of interventions that nurses can employ according to the patient's condition and diagnosis of different diseases. IMPLICATION FOR NURSING AND HEALTH POLICY: Quitting smoking can reduce lung cancers and other health problems. Nurses play an important role in helping patients to quit smoking.

Effect of transcranial direct current stimulation on pain anxiety during burn wound care.

BACKGROUND: Changes in neuronal activity by cathodal transcranial direct current stimulation (tDCS) of the sensory cortex can relieve acute pain. Studies have demonstrated high correlation between burn pain and anxiety in burn patients. The aim of this study was to assess the effect of tDCS on pain anxiety in patients with severe burn. METHODS: In a controlled randomized clinical trial, 60 subjects who were hospitalized during the year 2014 in the Department of Burn and Reconstructive Surgery of Imam Reza Hospital of Mashhad were selected as the sample for this study. The patients were randomly assigned to one of the two groups. A cathodal stimulation group that received real 1.0mA tDCS over sensory cortex lasted 20min and the control group received sham tDCS. Pain anxiety was obtained by self-report pain anxiety questionnaire before and after stimulation. It was also completed immediately after burn dressing. The data were analyzed by performing the Chi-square, Fisher's exact, independent samples t, paired samples t, Mann-Whitney and Wilcoxon tests using SPSS 11.5 software. RESULTS: Pain anxiety score reduced significantly in the real tDCS compared with sham group (23.4±3.8 versus 29.3±2.0, p≤0.001). After stimulation there was a decrease in pain anxiety score in real tDCS group (p=0.010). CONCLUSION: According to our study, cathodal cortical stimulation with tDCS is associated with significant reduction in pain anxiety in burn patients.

Exploring the needs and perceptions of Iranian families faced with brain death news and request to donate organ: a qualitative study.

BACKGROUND: Learning that one of your beloved ones is passing away and you have to decide on organ donation is a very stressful experience. OBJECTIVE: To explore the specific needs of families with a brain-dead patient during organ donation process. METHODS: A qualitative research using content analysis was used to obtain data from 26 purposely selected families in a transplantation center in Mashhad, northeastern Iran, regarding how they would face organ donation decisions. RESULTS: Data saturation was reached after 38 unstructured in-depth interviews and field notes, once data was transcribed and tabulated. Four major themes emerged as 1) family needs for emotional support, 2) empathy and compassion, 3) team efforts to assure family, and 4) shouldering grief. CONCLUSION: Study results highlighted the essential need for an expert team with specialized training to help families in despair deciding in favor or against organ donation. Moreover, discovering and explaining these specific needs help policy makers and administrators to plan interventions in relation to condition-building to facilitate safe passing of the families through this difficult situation.