Effective Strategies for Physical Activity Adherence in Heart Failure Patients: An Umbrella Review.

Background: Despite the importance of physical activity in heart failure treatment, physical activity adherence in heart failure patients is low. The purpose of this umbrella review was to obtain the best strategies for enhancing physical activity adherence among HF patients. Methods: Databases were investigated from 2010 to Jan 2022. The full text of the papers was investigated in terms of inclusion and exclusion criteria. Eventually, out of 74 relevant papers, 7-review study with 20977 patients were eligible and included in the study. Results: Five key effective approaches were identified in two subsets for enhancing physical activity adherence as follows: 1) exercise-based approaches including 1.1) Exergames, whereby the extent of adherence to exergames was between 84 and 98%. 1.2) Tele-rehabilitation with 70%-100% adherence the intervention groups 1.3) Tai chi and Qigong practices (TQPs), whereby the exercise adherence in TQP groups was 67-100%, 2. Theoretical-behavioral approaches 2.1) approaches based on behavioral and psychological theories, which were a combination of an exercise program alongside a behavior modification intervention, 2.2) Self-efficacy. Conclusion: Approaches that are based on exercise alongside behavioral and theoretical interventions could enhance physical activity adherence among HF patients. It is suggested to evaluate mix methods of exercise-based approaches and theoretical-behavioral approaches mentioned in this study in future clinical trial studies. Use of capacity of TR programs improve to physical activity adherence should receive more attention.

The development and validation of a standardised eight-station OSCE for registration of undergraduate nursing students: A Delphi study.

AIM: To develop and validate a set of OSCEs for use as a nationally applicable final exam of undergraduate nursing students' clinical and professional competencies. BACKGROUND: Tertiary recommendations for nursing registration require student achievement of a prerequisite level of both nursing knowledge and skill. Assessment of nursing skills prior to provision of nursing registration is an increasingly important focus of university nursing education. Objective Structured Clinical Examinations (OSCEs) are an appropriate tool for assessing the competencies of nursing students, but the mode and content of OSCEs varies widely. Thus, for nationally-based registration, development of a standardized set of OSCEs to determine the clinical competence of nursing students is important. DESIGN: A modified Delphi study, informed by a systematic scoping review of relevant literature. METHODS: A two-phase study was conducted. Initially, a scoping review was conducted to establish internationally agreed competences for graduating nursing students. These were included in an online questionnaire send to national experts to develop a validated and accepted nursing competency framework and associated implementation strategies. This was round 1 of a three-round modified Delphi study. A Content Validity Index (CVI) was calculated and thematic analysis was used to analyze the experts' opinions. RESULTS: Details of a set of OSCEs for final exam of undergraduate nursing students were developed and validated. These OSCEs included nine competencies addressed in eight 10-minute stations. CONCLUSION: A 'best-practice' OSCE evaluation system, designed from both international literature and the opinions of nation-wide experts was achieved. This well-designed OSCE was shown to be a reliable and valid method for assessing the clinical competence of nursing students. It reflected global procedures as well as the local conditions and Iranian expectations. The results of this study can be used by nursing schools across the country. They can also be used to model equivalent development of locally relevant OSCEs in countries around the world.

The physical and psychological outcomes of art therapy in pediatric palliative care: A systematic review.

Background: The integration of art therapy in health care is a growing trend in the care of cancer patients. Therefore, this study aimed to identify the physical and mental benefits of art in children with cancer. Materials and Methods: A systematic review of English articles using Google Scholar, MEDLINE via PubMed, Scopus, the Cochrane Database of Systematic Reviews, and the Web of Science was conducted. Relevant keywords for cancer, child, art therapy and their synonyms were used accordingly. All searches were conducted to December 31, 2021.Relevant articles were included studies published in English and involving children aged 0-18 years. Studies evaluated the effects of art therapy in children with cancer. Results: Seventeen studies had inclusion criteria, of which 12 studies were performed by clinical trial and 5 studies were performed by quasi-experimental method. Sixteen studies evaluated one type of art-therapy intervention, while one study used a combination of art-therapy approaches.The results showed that art-based interventions in the physical dimension lead to more physical activity, stability in breathing, and heart rate, and these children reported less pain. In the dimensions of psychology had less anxiety, depression, and anger but at the same time had a better quality of life and more coping-related behaviors. Conclusion: It seems that the use of art therapy in pediatric palliative care with cancer can have good physical and psychological results for the child, but it is suggested to evaluate the effects of these interventions in children at the end of life.

Educational challenges of family caregivers of vegetative state patients for home care preparedness: A qualitative content analysis.

BACKGROUND: Patients with a vegetative state (VS) are completely dependent on caregivers in all physical aspects of their lives. Caring for such patients comes with a great deal of difficulty for family caregivers. As a result, family caregivers must be fully trained and prepared for this role. The present qualitative study was conducted to investigate the educational challenges faced by family caregivers of VS patients for home care preparedness. MATERIALS AND METHODS: The present qualitative study was conducted through the conventional content analysis method from August 2020 to September 2021 in two provinces of Iran (Sistan and Baluchestan Province; and Razavi Khorasan Province). Fourteen family caregivers of patients in a VS were included in the study. Semi-structured and in-depth interviews were employed to collect data. The Graneheim and Lundman method was utilized to conduct the data analysis using MAXQDA2020 software. Data collection continued until data saturation and the identification of main categories. RESULTS: As indicated by the data analysis, three categories of "unmet educational needs," "confused caregiver," and "searching for practical knowledge" which included 19 sub-categories described the experiences of family caregivers of patients in a VS concerning challenges they went through in preparation for patient care at home. Participants' experiences revealed that despite the inadequacy of educations provided by health-care providers on knowledge and skills required by family caregivers, they were committed to caring for the patient and trying to acquire the required knowledge. CONCLUSION: Results indicated that inadequate education and the lack of family caregivers' contribution to caring for the patient in the VS during their stay in the hospital impedes their acquisition of adequate knowledge and skill to care for patients at home. Therefore, healthcare system policymakers should be planning to eliminate the educational barriers faced by family caregivers and expand the educational activities of hospitals' homecare centers to provide educational support of family caregivers after the patient's discharge.

Positive Consequences of the Hidden Curriculum in Undergraduate Nursing Education: An Integrative Review.

Background: Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education. Materials and Methods: A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology. Results: Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity. Conclusions: Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.

3D Printed Models for Teaching Orbital Anatomy, Anomalies and Fractures.

PURPOSE: The aim of this study was to determine the efficacy of using 3D printing models in the learning process of orbital anatomy and pathology by ophthalmology residents. METHODS: A quasi-experimental study was performed with 24 residents of ophthalmology at Mashhad University of Medical Sciences. Each stratum was randomized into two groups. The educational booklets were distributed, and various forms of orbital 3D models were printed from orbital computed tomography (CT) scans. Knowledge enhancement on the topics was measured by comparing pretest and posttest scores. RESULTS: Thirteen residents who were trained using traditional methods were deemed the control group; while 11 residents who were trained using the 3D printed models were classed as the intervention group. The control group was younger than the intervention group (P = 0.047). The results showed that there was a statistically significant difference in the total posttest scores between the two groups. Based on the repeated measures of the analysis of variance (ANOVA), score variables were significant between the two groups (P = 0.008). Interestingly, the use of the 3D educational model was more effective and statistically significant with the year one residents as compared to the year two residents (P = 0.002). CONCLUSION: This study is the first one in Iran quantifying the effects of learning using 3D printed models in medical education. In fact, 3D modeling training is seemingly effective in teaching ophthalmic residents. As residents have never encountered such technology before, their experience using 3D models proved to be satisfactory and had a surprising positive effect on the learning process through visual training.

Designing internet-enabled patient education for self-management of T2D diabetes-The case of the Razavi-Khorasan province in Iran.

BACKGROUND: The number of people with diabetes is estimated to increase to 642 million by 2040, with most having type 2 diabetes. Patients with diabetes require continuous monitoring and possible treatment changes. Patient education is the process of enabling individuals to make informed decisions about their personal health-related behaviours and internet-enabled interventions have the potential to provide support and information to patients with diabetes. OBJECTIVE: The aim of the study was to design a portal prototype based onto two models of care and a contextualised education programme to support the self-management of diabetes patients by involving stakeholders in the Iranian province of Razavi-Khorasan. METHODS: A Design-Based Research framework was adopted. A qualitative research method was used to analyse interviews with patients and care givers. Mock-ups were developed first and designed with features of user-driven and self-care models of care. The mock-ups also had adaptation features, such as for control of the disease, ability to cure self, and family support. The portal prototype was developed iteratively by building on the mock-ups and evaluated through interviews. The features and elements of the mock-ups and the portal prototype were evaluated in an outpatient diabetes clinic in Mashhad. RESULTS: Thirty-three participants were involved in the study. The evaluation of the mock-ups resulted in two themes and seven categories: 1) self-care improvement, including self-care requirements and self-management, and 2) educational usefulness, including medical information, information mode, mobility, interaction, and efficiency. The mock-up evaluation was used as a basis for designing a portal prototype. Next, the portal prototype was evaluated, and three categories emerged from the interview data: 1) user experience, 2) functionality, and 3) interactivity. Participants were not able to prioritise between the two care models. Some functionalities of the portal could benefit from the development within a cultural context to determine differences to the best way to present material. CONCLUSIONS: A portal prototype has been designed to include two care models to support self-management and functionalities that support aspects of culture-specific diabetes self-care. This study provides guidance on developing an internet-enabled educational portal, aimed at providing support for patients in their social context.

Strategies for sustaining and enhancing nursing students' engagement in academic and clinical settings: a narrative review.

Students' engagement in academic-related learning activities is one of the important determinants of students' success. Identifying the best teaching strategies to sustain and promote nursing students' engagement in academic and clinical settings has always been a challenge for nurse educators. Hence, it is essential to provide a set of strategies for maintaining and enhancing the academic engagement of nursing students. The purpose of this review was to explore and summarize the strategies that nurse educators use to sustain and promote nursing students' engagement in academic and clinical settings. A narrative literature review was conducted. CINAHL (nursing content), ProQuest, Medline, the Cochrane, Google Scholar, and Scopus were searched. Of 1,185 retrieved articles, 32 teaching strategies were identified and extracted from the nursing literature. We used thematic analysis approach to organize these strategies into five main categories as follows: technology-based strategies (15 articles), collaborative strategies (10 articles), simulation-based strategies (two articles), research-based strategies (two articles), and miscellanea learning strategies (three articles). As a general comment, these strategies have the potential to promote nursing students' engagement. Among the strategies discussed in this review, the use of technology, particularly the response system and online learning, was more common among nursing educators, which is in line with today's advances in smart technologies. The collection presented in this review can be used as a starting point for future research to evaluate the effectiveness of an educational intervention on the academic engagement of nursing students. Nevertheless, due to the lack of experimental studies, the optimal strategies remain to be elucidated through future high-quality experimental study.

Subjective hemodialysis adequacy can also be measured: Development and psychometric properties evaluation of subjective adequacy questionnaire.

Long-term prognosis of chronic hemodialysis patients is affected by dialysis adequacy that can have effect on the hemodialysis (HD) outcomes, especially mortality rate. Given the limited knowledge about HD patient's perceptions and experiences about subjective HD adequacy (SHA) and the lack of SHA measuring questionnaire (SHAMQ), this study was conducted with the aim of developing the SHAMQ and evaluating its psychometric properties based on the operational definition of SAH concept. This mixed-method sequential exploratory design study was conducted from 2016 to 2018 in eight HD units of Mashhad, Iran. In qualitative phase, conventional content analysis method was used, and participants were recruited through purposive, snowball, and selective sampling techniques. Data were collected through semi-structured interviews with 25 HD patients, dialysis nurses, caregivers, and nephrologists, and analyzed using MAXQDA software (V10). SHAMQ was developed based on operational definitions extracted from qualitative phase. Quantitative and qualitative face and content validity; construct validity; internal consistency; and stability were used for psychometric properties evaluation of SHAMQ. Data were analyzed using Statistical Package for Social Sciences version 22.0 (IBM Corp., Armonk, NY, USA). Physical vitality, inner consistency, a sense of well-being, positive social interactions, effective self-empowerment, and weathering financial crisis were 6 generic categories emerged from qualitative phase. The final version of SHAMQ included 30 itemsin four factors (subscales). Scale-content validity index, Θ, and intraclass correlation were 0.92, 0.88, and 0.91, respectively. The results of this study showed that factors such as well-being, self-enforcement to effective care, physical vitality, and spiritual health are the most important SHA outcomes. The development of a scale for measuring SHA can help to the better evaluation of HD patients' conditions and accordingly perform effective interventions.

Adapting life to the reality of diabetes.

BACKGROUND: Diabetes is one of the most challenging and burdensome chronic diseases of the 21st century. Adaptation to disease is a mental, multidimensional, interactive process and is influenced by social and cultural factors. It should be explained in the cultural context of each society with qualitative studies. AIMS: In this study, we explored the subjective experiences of adaptation to type 2 diabetes among Iranian patients. METHODS: This was a qualitative study using a grounded theory approach. Purposeful sampling was used initially, followed by theoretical sampling based on derived codes and categories as the sampling method. Twenty patients as main participants and 7 from the healthcare system and family members were selected based on a purposeful and theoretical sampling method. Data were collected through semistructured and deep interviews. Data were analysed using the approach of Strauss and Corbin simultaneous with data collection. RESULTS: Five categories that emerged from the data included: perceived threat of disease, reality compliance, comprehensive reconstruction, normalization of living with illness, and return to resources. Finally, data analysis on selective coding led to recognition of "endeavour to reconstruction of life" as the core variable. The core variable showed the way participants adapted to diabetes. CONCLUSIONS: This study showed that the process of adaptation to diabetes has a dynamic nature in which participants make major changes in their cognitive, emotional and behavioural structures in order to have a normal life.

Student-related factors affecting academic engagement: A qualitative study exploring the experiences of Iranian undergraduate nursing students.

BACKGROUND AND AIM: Academic engagement is an important indicator of quality of higher education. This study aimed to explain the experiences of undergraduate nursing students in terms of student-related factors affecting academic engagement. METHODS: This qualitative study was conducted in 2017 at Mashhad University of Medical Sciences in Iran. Data were collected using semi-structured interviews and focus groups with 7 and 16 undergraduate nursing students at Mashhad School of Nursing and Midwifery; respectively. Undergraduate nursing students of both genders who enrolled in different academic semesters with various academic achievements were selected. Data were analyzed using conventional content analysis approach proposed by Graneheim and Lundman, with the support of MAXQDA software. RESULTS: After analyzing the data, 374 initial codes were extracted, which ultimately conceptualized within six main categories including: "learning motivation", "interest in learning", "student participation in extracurricular scientific programs", "self-directedness", "mental concentration", and "demonstration of emotions". CONCLUSION: The findings of this study indicated that student-related factors such as individual motivation and interest, mental concentration, participation in extracurricular activities, and self-directedness in learning, as well as students' sense of satisfaction with learning could play important roles in the creation of academic engagement in undergraduate nursing students that need to be of interest to nursing educators and planners.

Exploration of nurses' perception about professionalism in home care nursing in Iran: a qualitative study.

BACKGROUND: Professionalism is one of the basic concepts of home care nursing, as a growing model of community-based nursing. This phenomenon results from the nurse-patient interaction in home and community environments with multiple dimensions. OBJECTIVE: The purpose of this study was to explore the professional experiences of home care nurses in Iran. METHODS: In this study, the qualitative content analysis method was used based on the 2004 Graneheim & Lundman approach. The study was conducted between September 2016 and September 2017 in Khorasan Razavi province, Iran. Participants were selected by Purposeful Sampling. The main method of data collection was semi-structured interviews with 21 nurses who had home-based care experience. Eventually, after reaching saturation, the data were analyzed in-depth. RESULTS: In total, 3 main categories and 11 subcategories were extracted. Generally, nurses considered the concept of professionalism in home care nursing by attention to basic values, social capital, and maintaining quality and standards of care. CONCLUSION: Professionalism in home care nursing is one of today's challenges in the health system of the country, and professionalism requires more attention and conditions for its prosperity.

Medical faculties' view about the importance of educational roles.

BACKGROUND: Changes in medical education have drawn attention to student-based learning. It is necessary that teachers' educational roles be redefined to conform to these changes. While numerous educational activities are listed for medical teachers, it seems that they involve themselves in only some of these roles. We conducted this study to assess the importance of different educational roles in the view of medical faculties. METHODS: A questionnaire that consisted of a total of 12 roles classified into six categories including information provider, role model, facilitator, examiner, planner, and resource developer was prepared. Faculty members were asked to score the importance of each role using a 1-10 scale. RESULTS: Participants assigned the highest score to "on-the-job role model" (9.47) and the lowest score to "curriculum planner" (8.31) from their own point of view. They also assigned the highest score to "planning or participating in student exams" (8.10) and the lowest score to "learning facilitator" (6.51) from the perspective of the importance of roles in their school's programs. CONCLUSION: Faculty members are generally familiar with different educational roles but they need to be informed about some of the roles which have gained lower scores in this study.

The challenges of clinical education in a baccalaureate surgical technology students in Iran: a qualitative study.

BACKGROUND: Clinical education is an integral part of the surgical technology curriculum, in which students combine and integrate knowledge, skills, attitudes, values and philosophies of the profession. It is difficult to learn and adapt to different types of skills and roles in the operating room environment. OBJECTIVE: This qualitative study examines the difference between the clinical education of Surgical Technology and other clinical settings, and the challenges faced by students in the field, within the course. METHODS: This was a qualitative content analysis study conducted in 2016. The participants in this study were 16 baccalaureate surgical technology students of the University for Medical Sciences in Khorasan Razavi province. A semi-structured interview method was run to collect the required data. The sampling was initially purposive, then in the snowball method which continued until data saturation. All interviews were recorded, then transcribed, and analyzed using a continuous comparative method and conventional qualitative content analysis method. RESULTS: From the deep and rich descriptions of the participants, three themes including "stressful environment", "controversy between anticipation of role and reality", and "humiliating experiences" as well as a general theme of "bitter education" were obtained. CONCLUSION: Students' orientation before attending the operating room, accompanying, supporting, and a full-time attendance of the specialist instructor, strengthening the prerequisite knowledge and skills for the students in this field, teaching ethics, and professional interactions, play an important role in the student's acceptance of the operating room, in the surgery team and the improvement of the quality of clinical education of these students.

Exploration of the process of interprofessional collaboration among nurses and physicians in Iran.

INTRODUCTION: The development of interprofessional collaboration is of great significance for facilitating the flow of information and provision of collaborated services. In fact, only one single profession cannot respond to all demands. Thus, this study was aimed to investigate clinical nurse-physician collaboration in Iran. METHODS: This study was performed with nurses and physicians of university hospitals affiliated to Mashhad University of Medical Sciences, Mashhad, Iran, during September 2013-March 2015, using grounded and synthesis theory. The data were obtained using semi-structured interviews and field notes, and MAXQ DA version 10 was employed for data analysis. RESULTS: The core variable was defined as "management of strategic goals", and the main categories included perception of challenging organizational structures, providing a comprehensive supportive net for patients, seeking professional communication, and building solid confidence. Based on views of the participants, they were aiming to apply a stress management strategy, while maintaining their position in the organization, by making passive compromises to protect themselves against the perceived threats. CONCLUSION: The participants were trying to overcome barriers through reducing and managing the tension, while maintaining their position in the organization using forced, passive coping strategies to protect themselves against the perceived threats.

Developing the concept of caring in nursing education.

BACKGROUND: Caring is a value-based concept in the nursing field and in education. Exact understanding of caring in education and developing this concept in nursing will result in the evolution of the position of nursing science and profession. AIM: The aim of this study was to attempt to develop the concept of caring in nursing education. METHODS: This qualitative study was conducted in 2016 using directed content analysis. Participants were thirteen subjects (6 instructors and 7 senior and junior nursing students) who were selected using purposeful sampling method. Research environment was the Faculty of Nursing and Midwifery in Mashhad. Data collection method was semi-structured interviews for thirty to ninety minutes and sampling continued until data saturation. Interviews were conducted in Persian language and they were immediately transcribed and analyzed using MAXDA10 software. The text of interviews was reviewed several times. First, open codes were extracted, and after several reviews based on similarity in meaning, they were classified into subcategories and finally, similar subcategories were placed in main classes based on meaning. RESULTS: Results of this study led to the identification of four themes: 1, ethical and religious commitment, 2, development of knowing and cultural sensitivity, 3, soft assertion, 4, clear describing of objectives, expectations, and educational rules for students. CONCLUSION: Results of this study showed that the cultural and religious background of instructors affects their interaction with students. Instructors' commitment and compliance to values in interacting with students and other educational colleagues has an origin beyond ethical and human subjects and it is originated from their religious education and training.