Development and Psychometric Evaluation of the Motivation for Healing Scale in Patients with Cancer.

Introduction: This study was conducted to develop and validate a Motivation for Healing Scale (MHS) in Cancer. Methods: in this methodological study, the MHS draft was developed based on the approach of Waltz and colleagues using existing scales and concept analysis. The psychometric features, including face validity (qualitative and quantitative), content validity (qualitative and quantitative), structural validity (exploratory and confirmatory factors), and construct validity (convergent and discriminant validity) were assessed. Finally, the reliability was evaluated using internal consistency, and stability. Results: Based on the results of the qualitative phase, an initial item pool was generated with 55 items, Exploratory and confirmatory factor analyses were performed on the data collected from 404 patients. 25 Items were excluded during the psychometric evaluation phases. Reliability assessment and internal consistency assessment revealed that Cronbach's alpha value of the 25-item MHS was 0.912. The results of intraclass correlation coefficient (0.93, 95% CI: 0.86- 0.96) showed the stability was strong. Conclution: The 25-item MHS is a valid and reliable scale for the assessment of motivation for healing in patients with cancer.

Translation and Psychometric Evaluation of the Comfort Questionnaire in a Sample of Iranian Nurses: A Methodological Study.

Background and Purpose: This study was conducted to translate the Nurses' Comfort Questionnaire (NCQ) into Persian and examine its psychometric properties. Methods: In this methodological study, after translation, and face and content validity of the instrument, 300 nurses were randomly selected from the various hospitals in Kashan, during 2022. The construct validity and reliability of the instrument were examined. Results: The extracted five factors in exploratory factor analysis were able to explain 35.7% of the total variance of the questionnaire score. Cronbach's alpha, intraclass correlation coefficient, standard error of measurement, and the smallest measurable change of the psychometric of NCQ (P-NCQ) were calculated as .872, .899, ±4.284, and 5.737, respectively. Conclusions: The P-NCQ has 30 items in five subscales and can be used as a valid and reliable instrument to measure the comfort of nurses.

Risk factors of bruxism in children and adolescents: A case-control study.

Objectives: This study aimed to investigate the risk factors of bruxism in children and adolescents under 15 years old in Iran. Materials & Methods: This case-control study was conducted in day clinics of Shahid Beheshti Hospital in 2020. Fifty children with bruxism in the case group and 50 without in the control group were compared to five risk factors, including intestinal parasites, sucking the fingers, biting objects, a family history of bruxism, and secondhand smoking (SHS). The statistical tests of smoking, odds ratio, and logistic regression were used for data analysis. Results: The mean age of the subjects was 10.6±3.2 and 10.8±2.9 years in the case and control groups, respectively. The bruxism showed significant relation with sucking the fingers, the family history of bruxism, and intestinal parasites. The SHS and biting objects showed no significant relation with bruxism. The logistic regression indicated that the study variables could explain the 22.6 to 30.1% of risk factors in bruxism. Conclusion: Bruxism is a common disorder in children and adolescents. The intestinal parasites might be associated with bruxism. These infestations should be diagnosed and treated in children with bruxism.

Identification and analysis of human errors in emergency department nurses using SHERPA method.

BACKGROUND: Human errors are the underlying cause of many occupational accidents. In recent years, human errors have increased in the healthcare sector. AIM: This study aimed to identify human errors committed by emergency department (ED) nurses working at Shahid Beheshti Hospital in Kashan using the SHERPA method. METHOD: This study is a descriptive cross-sectional study performed in the emergency department of Shahid Beheshti Hospital. Human errors were first identified and analyzed using the Hierarchical Task Analysis (HTA) technique and then studied using the SHERPA method. RESULTS: In total, 426 errors were identified including 263 action errors, 108 checking errors, 35 selection errors, 12 retrieval errors, and eight communication errors. Also, based on the levels presented in the risk matrix in terms of severity of consequences, the highest percentage (36.34%) belonged to the borderline category. CONCLUSION: The majority of identified errors were action errors, which can be reduced by providing appropriate instructions and training nurses, compiling reports and building error recording systems, improving management controls, and promoting a safety culture.

Self-Care and Its Predictive Factors in Hemodialysis Patients.

Introduction: Chronic kidney disease is a serious problem and patients need active self-care. This study focuses on the relationship between self-care and its predictive factors in hemodialysis (HD) patients. Methods: This multicenter correlational study was conducted on 201 HD patients referring to HD centers in the west of Tehran, Iran. A multi-stage sampling method was used to select the samples. Data were collected using self-care Scale, Paloutzian-Ellison Spiritual Well-Being Scale, and Connor Davidson Resilience Questionnaires. Data were analyzed using SPSS software version 13 and descriptive statistics and linear regression with stepwise method. Results: The mean (SD) scores of self-care, resilience, and spiritual well-being were 35.5 (5.69), 53.4 (12.94), and 97.4 (17.9), respectively. Univariate analysis showed that self-care had a statistically significant relationship with gender, occupation, education, being diabetic, and hyperlipidemia. Self-care positively correlated with the resilience and negatively correlated with age. Multivariate regression indicated that the resilience (ß = 0.78, P = 0.001), being diabetic (ß = -0.09, P = 0.01), and age (ß = -0.11, P = 0.005) could be predictors of self-care. These variables accounted for 78% of variance in self-care in HD patients. Conclusion: Our results showed that resilience was positively correlated with self-care, but being diabetic and age were negatively correlated with self-care in HD patients. Therefore, the health care providers should pay more attention to HD patients who are diabetic and older, as they are at a higher risk of having impaired self-care.

A study on improving nursing clinical competencies in a surgical department: A participatory action research.

Aims: The purpose of the present study was to improve clinical competencies in nursing staff in a selected surgical department in Kashan/Iran during 2016-2018. Design: This was a participatory action research. Methods: This action research was implemented in four steps of problem identification, planning, action and reflection. Interviews, focus groups and observation were used for the qualitative part. Conditions of Work Effectiveness Questionnaire-II, job satisfaction and patients' satisfaction questionnaires were completed before and after the study. Qualitative content analysis, paired and independent t test were used for data analysis. Results: Three main problems could affect the clinical competencies including professional insufficiency, basic shortages and external influences. Three changes were implemented in the surgical department including improving education, involving nursing students in patients' education and increasing the motivations by peer evaluation and selecting the nurse of the week. The changes significantly increased patients' satisfaction, nurses' job satisfaction and work effectiveness.

Predictors of Patient Satisfaction with Nursing Care in an Orthopedic and Urologic Population.

BACKGROUND: Patient satisfaction is a multi-dimensional concept that can be influenced by social, cultural, and economic factors. This study was designed to evaluate the determinants that could predict patient satisfaction with nursing care in an orthopedic and urologic Population at a selected surgical ward in Kashan, Iran during 2018. MATERIALS AND METHODS: This cross-sectional study was performed on 250 male patients with orthopedic and urologic diagnosis that were hospitalized in men surgical ward of Shahid Beheshti hospital affiliated to Kashan University of Medical Sciences. Patients satisfaction was assessed by a researcher-made questionnaire. The data was analyzed by the independent t-test, analysis of variance, correlation, and multiple regression analysis statistical tests. RESULT: The mean score of patient satisfaction was 136.05±48.10 (possible range 45-225). The age, marital status, education, diagnosis, the length of stay in the hospital, and the verbal communication of nurses with patients showed a significant correlation with patient satisfaction (P<0.001). Regression analysis revealed that age (P=0.013), marital status (P<0.001), education level (P=0.038), the length of stay in hospital (P=0.002), and verbal communication (P<0.001) could make a meaningful model with patient satisfaction in surgical wards. CONCLUSION: Many personal and professional factors can determine patient satisfaction in orthopedic and urologic population. Verbal communication between nurses and patients is an important factor for patient satisfaction.

Pain management of trauma patients in the emergency department: a study in a public hospital in Iran.

BACKGROUND: Pain is a common problem which the patients in emergency departments (ED) face, especially trauma patients under treatment may suffer from physical, psychological and ethical issues. The purpose of this study was to evaluate traumatic pain management in the emergency department at a public hospital in Iran in 2014. METHODS: This observational prospective study was conducted on 450 trauma patients admitted to a trauma emergency department. The tool used in this study has three parts: demographic data, data of trauma, and VRS (Verbal Rating Scales) score at a 7-point scale-at the arrival time to 4h later. The statistical analysis was conducted by using Mann-Whitney and Kruskal-Wallis tests, repeated measures, survival analysis, and multiple regression analysis. RESULTS: The majority of the samples were male (83.3%) with the mean age of 35.2years. The patients mostly suffered from contusions and strains (42.4%). The majority of the patients [274 patients (60.8%)] received no intervention for pain relief and only 60 patients (13.3%) received analgesics. The mean time period of the first analgesic utilization was 41 (±20.4) minutes. Pain in admission, pain assessment, and receiving intervention could explain the 32% of pain reduction. No other variables such as age, sex, education, kind of trauma, and the shift of admission were involved in pain reduction. CONCLUSIONS: This research study demonstrated that comprehensive, adequate pain management remains an obscure goal within the emergency nursing setting. There is a need to undertake further research and develop educational programs on effective analgesic practice in pain management.

Physical Activity Patterns in the Elderly Kashan Population.

BACKGROUND: Physical activity is an important component of health in old age that provides personal independence, physical ability, and quality of life. OBJECTIVES: The current study aimed to evaluate physical activity and associated factors among the elderly population in Kashan, Iran. PATIENTS AND METHODS: This is a descriptive cross-sectional study. The sample was 400 elderly people (aged more than 60 years) living in Kashan, Iran in 2014. The subjects randomly selected via multi-stage cluster sampling from healthcare centers in three regions of Kashan. The sample size differed by gender and residence type. Each participant's demographic characteristics and level of physical activity were recorded in a questionnaire, and the data were analyzed by SPSS version 16. Descriptive statistics, chi-square tests, Pearson correlations, and ordinal regression were used in the data analysis. The significance level for all the tests was P < 0.05. RESULTS: 237 (59.2%) of the subjects were female. The average age of the study population was 67.6 ± 6.8 years. Their average physical activity energy consumption was 326.21 ± 364.84 according to the metabolic equivalent of hours per week. 20 subjects (5%) reported no physical activity. 320 (80%) and 59 (14.8%) subjects had low and moderate physical activity levels, respectively. Only 1 subject (0.2%) had extreme levels of physical activity. Men (n = 43, 26.4%) were more likely to be moderately or extremely physically active than women were (n = 17, 7.2%). There was a significant relationship between physical activity and sex (P < 0.0001), marital status (P < 0.0001), educational status (P < 0.002), current occupation (P < 0.0001), and personal independence (P < 0.00001). Of course, effective predictive variations included age (P = 0.034), gender (P = 0.001), marital status (P = 0.033), independent status (P = 0), and local environment (P =0.001). CONCLUSIONS: The study revealed low physical activity in the elderly population in Kashan. The pattern of physical activity in the elderly depends on their lifestyle. A promotion of active lifestyles should be a part of health care planning for the elderly.

Effects of Psychoeducation on Mental Health in Patients With Coronary Heart Disease.

BACKGROUND: Patients with coronary heart disease are at high risk for mental health disorders, such as depression and anxiety. Psychoeducation is a well-known intervention for psychiatric patients, but its use has been limited in other health conditions, such as coronary heart disease. OBJECTIVES: The aim of this study was to evaluate the effect of psychoeducation on mental health in coronary heart disease patients. PATIENTS AND METHODS: This randomized clinical trial included 70 patients with coronary heart disease at Shahid Beheshti hospital, in Kashan, Iran, in 2014. The patients were randomly assigned into two groups: the experimental group, which received eight sessions of psychoeducation, and the control group, which received routine care. Data were collected with the Goldberg mental health questionnaire (GHQ) and were analyzed using independent and paired t-tests performed with SPSS version 16. RESULTS: The means of overall GHQ scores were significantly decreased post-test in the intervention group, and the differences between the two groups were statistically significant in the overall GHQ scores (P = 0.0001). A significant difference was observed between the mean GHQ scores of the intervention group prior to and after the psychoeducational program (PEP) intervention (30 ± 4.66 vs. 20.50 ± 3.30) (P = 0.0001). No significant changes were observed in the control group pre- and post-test (P = 0.07). CONCLUSIONS: Psychoeducation resulted in improved mental health in patients with coronary heart disease. Therefore, it is recommended that this approach be performed as a complementary, effective, non-invasive, low-cost nursing intervention to reduce psychological problems in these patients.

Predictive Factors of Dependency in Activities of Daily Living Following Limb Trauma in the Elderly.

BACKGROUND: Traumatic injuries in the elderly often lead to permanent disabilities and long-term treatments that can adversely influence their activities of daily of living (ADL). The effect on ADL is an important outcome in elderly trauma. OBJECTIVES: The present study was designed to evaluate the predictive factors of dependency in ADL following limb trauma in elderly referred to Shahid Beheshti Hospital, Kashan, Iran, in 2013. PATIENTS AND METHODS: This descriptive study was conducted on 200 traumatic patients admitted to the trauma emergency ward of Shahid Beheshti hospital in 2013. The questionnaire used in this study had three parts: demographic data, information related to trauma, and an independence scale of ADL (ISADL). The ISADL was completed in the emergency ward to declare pre-traumatic status; it was also completed one and three months after trauma. Statistical analysis was conducted by the t-test and analysis of variance (ANOVA). The repeated measure was used to study the trend of the ISADL and other demographic variables. The multiple regression analysis was also used to declare the predictive variables related to the ISADL. RESULTS: The study population consisted of 81 males (40.5%) and 119 females (59.5%). The participants' average age was 70.57 ± 9.05 years. In total, 80.5% of the elderly were completely independent in ADL before trauma; this decreased to 13.5% one month after trauma. The repeated measure analysis showed a significant improvement in the ISADL three months after trauma. Gender, age, and education had significant interaction with the ISADL. The multiple regression analysis showed that type of trauma and location of injured organ had predictive values related to the ISADL, one and three months after trauma. The place and cause of trauma, and having surgery showed a significant relationship with the ISADL three months after trauma. CONCLUSIONS: Many factors, such as gender, age, education, type of trauma, and location of injured organ, may predict ADL following limb trauma.

Clinical Self-Efficacy in Senior Nursing Students: A Mixed- Methods Study.

BACKGROUND: Clinical education has a basic role in nursing education, and effective clinical training establishes a sense of clinical self-efficacy in senior nursing students. Self-efficacy is a key component for acting independently in the nursing profession. OBJECTIVES: This study was designed to outline senior nursing students' views about clinical self-efficacy and to determine its level in nursing students. PATIENTS AND METHODS: A mixed-methods approach, including a quantitative cross-sectional study and qualitative content analysis,was used in this study. Participants were senior nursing students who were in their two last semesters. During the initial quantitative stage, all students in the 7th and 8th semesters of the nursing major were invited to participate. They were asked to complete the Nursing Clinical Self-Efficacy Scale (NCSES) and, during the subsequent qualitative stage, the 14 students in the 7th and 8th semesters were asked to participate in semi-structured interviews. RESULTS: In the quantitative part, 58 students completed the self-efficacy questionnaire; the mean score was 219.28 ± 35.8, which showed moderate self-efficacy in students. Self-efficacy was different across skills. In the qualitative part, the 355 open codes that were extracted from the interviews were clustered to 12 categories and 3 themes. The main themes included the factors related to self-efficacy, outcomes of self-efficacy, and ways to improve self-efficacy. CONCLUSIONS: Students had moderate self-efficacy. Several factors such as environment, nursing colleagues, and clinical educators could influence the creation of clinical self-efficacy in nursing students.

The Etiology and Clinical Evaluations of Neonatal Seizures in Kashan, IRAN.

OBJECTIVE: Detection of seizure, its etiology, and clinical types is important for guiding therapy. This study was designed to evaluate the etiology and clinical evaluations of neonatal seizures in Kashan, Iran. MATERIALS AND METHODS: The data of 100 hospitalized neonates with a complaint of seizures in Kashan City, from January 2006 to January 2011 were evaluated. The pediatric neurologist made the final diagnosis. The gestational age, neonate admission age, type of delivery, and laboratory and radiological investigations were reviewed from the medical records. The relation of seizure etiology and other variables were compared using the Chi-square test. All the statistical analyses were performed using SPSS (ver 11.5). RESULTS: A total of 100 neonates were hospitalized with a diagnosis of seizures. The overall incidence rate of seizures was 2.6 per 1,000 live births. A total of 59% of seizures happened in the first three days of life. The etiologies of seizures were hypoxicischemic encephalopathy (HIE) (36%), hyponatremia (12%), hypoglycemia (11%), intracranial hemorrhage (11%), infections (10%), hypocalcemia (8%), metabolic disorders (7%), the structural anomalies (5%), and hypomagnesaemia (4%). In 23% of neonates, no specific etiology was found and 23% had multiple etiologies. In 45% of neonates, the EEG was not recorded. The type of the seizures were focal-clonic (26%), tonic (25%), multifocal clonic (34%), subtle (11%), and myoclonic (4%). The types of the seizure were unrelated to the paraclinical findings. CONCLUSION: Neonatal seizures are common and HIE was the main cause of seizures in this study. The clinical evaluation of neonatal seizures needs improvement.

Comparing the effects of active and passive intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life.

BACKGROUND: The effect of exercise during hemodialysis has been a controversial issue, however, there are just few studies about the effect of active exercise during hemodialysis. OBJECTIVES: This study aimed to compare the effects of passive and active intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life in hemodialysis patients. PATIENTS AND METHODS: This quasi-experimental study was conducted on 16 hemodialysis patients in Akhavan hemodialysis center in Kashan from April to November 2013. Active or passive intradialytic pedaling exercise was performed using a Mini-Bike for 30 minutes during the first two hours of the dialysis sessions. The quality of life (QOL) was assessed before and after the intervention. Blood pressure was examined at the beginning and then hourly during the dialysis sessions. Dialysis efficacy, levels of phosphorus, calcium, sodium, potassium and Blood urea nitrogen (BUN) were measured at the end of the intervention. Kolmogorov-Smirnov test, paired t test, Wilcoxon signed rank and Friedman tests and repeated measure analysis of variancewere used to analyze the data. RESULTS: No significant changes were observed in serum potassium, phosphorus and calcium levels at the end of the passive exercise program compared to the baseline. However, phosphorus levels were significantly decreased in the active exercise program (P < 0.05). Moreover, the mean diastolic blood pressure was significantly decreased after the passive exercise (P = 0.039). Passive exercise did not significantly change the dialysis efficacy, urea reduction rate, hemoglobin and calcium levels. The mean overall QOL was 63.78 ± 21.15 at the beginning of the study, which was increased to 77.07 ± 21.14 at the end of eight weeks of the intradialytic exercise (P = 0.007). CONCLUSIONS: The passive intradialytic exercise had a positive effect on blood pressure. The active exercise could decrease the serum phosphorus and potassium levels. Moreover, both exercise programs could significantly improve the QOL. Both active and passive intradialytic exercises can have some beneficial effects.

Fatigue and Vitamin D Status in Iranian Female Nurses.

INTRODUCTION: Given that nurses are among professions with frequent problems of fatigue, and given the nature of their profession that provides little exposure to sunlight and the subsequent deficiency of vitamin D, the present study examined the relation between fatigue and circulating vitamin D levels in female nurses working in Shahid Beheshti Hospital, Kashan, Iran in 2013. MATERIAL & METHODS: This cross-sectional study was conducted in 200 female nurses working in Shahid Beheshti Hospital. To measure fatigue, fatigue questionnaire containing 9 questions eliciting the subject's feeling in scales of 1 to 7, getting a possible score of 9 to 63, and Visual Analogue Scale in which nurses specified their fatigue in a band of zero to 10 were used. The 25-hydroxyvitamin D, which is the most important vitamin D metabolite, also was determined. The data was analyzed by SPSS-16. The Pearson's correlation of coefficients, t-test, and multiple regression analysis were used in this study. RESULTS: The mean fatigue score of nurses was 38.76±12.66 in questionnaire and 5.73±2.12 in Visual Analog Scale. The 89 per cent of nurses suffered from vitamin D deficiency, 9.5 percent of them had normal level and 1.5 per cent had toxicity level of vitamin D. There was a significant relationship between vitamin D level and fatigue scores (P<0.0001), and visual fatigue scores (P<0.0001). According to multivariate regression analysis, vitamin D level accounted for 13 per cent of the fatigue based on data on questionnaire and 18.6 per cent of fatigue according to Visual Analog Scale. CONCLUSION: High prevalence of fatigue among nurses could be attributed to vitamin D deficiency.

Effect of mode of delivery on postpartum depression in Iranian women.

AIM: The aim of this study was to determine the relation between mode of delivery (cesarean section [CS] or unassisted vaginal delivery) and postpartum depression (PPD). MATERIAL AND METHODS: In a prospective study, 300 women who had experienced vaginal delivery (VD) or CS were recruited in Kashan, Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS). A score of 13 or more was defined as PPD. Data collection was conducted at two assessment points: 2 months and 4 months postpartum. Mean scores of EPDS and PPD were compared between the VD and CS groups. RESULTS: Differences in mean scores of EPDS between CS (n = 150) and VD (n = 150) groups at the first and the second assessments were not significant. The depression mean scores differences from the first to the second assessment were compared between the two groups; VD group showed more decrease on EPDS score (P = 0.006). Comparing the two assessments, the VD group showed a more decreased EPDS from the first to the second one. PPD prevalence rates (score ≥ 13) among the VD and CS groups were 24% and 20.7% for the first and 14.7% and 16.7% for the second assessment, respectively, which were not significantly different. The logistic regression showed that an unwanted pregnancy and PPD 2 months after delivery were determinants for PPD 4 months after delivery. CONCLUSION: There was no relation between delivery mode and PPD at 2 and 4 months after delivery; however, the VD group showed greater decrease in EPDS score from 2 to 4 months after delivery.

An audit of eye dryness and corneal abrasion in ICU patients in Iran.

BACKGROUND: The use of sedation and muscle relaxants can predispose intensive care unit (ICU) patients to poor eyelid closure and eye disorders. These complications may not get the nursing care and attention that they require; this and the predisposing factors need to be further investigated. AIMS AND OBJECTIVES: The aim of this audit was to use the standard eye-care technique and determine the incidence of eye dryness and corneal abrasion, on day 5 after admission, in comatose patients in the ICU. DESIGN AND METHODS: This was an audit, in the four ICUs in two teaching hospitals in the cities of Kashan and Tehran. An ophthalmologist examined the corneal abrasion and eye dryness on the day of admission and then day 5. The eye-care method and other variables such as sex and age were also recorded. Statistical tests of χ(2) , spearman and multiple linear regressions were used to determine the relationships between variables. RESULTS: Eighty-seven patients participated in the audit. On day 5, 28 patients (32·2%) had dry eyes and 12 patients had developed corneal abrasion (13·8%). The mean of Schirmer tear value on admission was 21 ± 4·5 mm. This value decreased to 16·1 ± 5·6 mm on day 5. About 10·3% of patients who received eye lubricant products, and 20·7% of those receiving adhesive tape as eye-care method developed corneal abrasion. CONCLUSIONS: Corneal abrasion and eye dryness were common problems in ICU patients. Eye dryness was the main risk factor for the development of corneal abrasion. Patients receiving adhesive tape as an eye-care method were twice more likely to develop corneal abrasion. RELEVANCE TO CLINICAL PRACTICE: Eye care and eye assessment should be essential parts of nursing care for patients in ICU. To prevent corneal abrasion, using eye lubricants is more effective than closing eyes by adhesive tape.