Current status of acute ischemic stroke management in Iran: Findings from a single-center study.

OBJECTIVES: This study investigated the current status of acute ischemic stroke (AIS) management in an Iranian emergency department (ED). METHODS: A descriptive study using a retrospective chart review was conducted on medical records of 270 patients with AIS who presented to the ED of a tertiary university hospital in the northeast of Iran from March 22 to September 22, 2019. The steps of this review process included instrument identification, medical records retrieval, data extraction, and data verification. RESULTS: Of patients with AIS, 88.9% (n = 240) did not receive stroke code activation. For the 11.1% of patients (n = 30) who received activation, 7% of codes (n = 19) were canceled by the acute stroke team and IV recombinant tissue plasminogen activator (r-tPA) was only administered for 4.1% of patients (n = 11). ED arrival outside 4.5 h from symptom onset was the main barrier to IV r-tPA administration for 83.8% of potentially eligible patients with AIS (n = 217). The median door-to-needle time was 70 min (interquartile range: 47-90 min). CONCLUSIONS: There was a better clinical performance in terms of critical time goals in potentially eligible patients with AIS if managed with stroke team activation compared to no stroke team activation.

Caring Needs of Cancer Patients from the Perspective of Home Care Nurses: A Qualitative Study.

OBJECTIVE: Cancer is the third leading cause of death in Iran. Todays, caregiving to patients with cancer is shifting towards home based care, and home care needs from a caregiver's perspective can help improve the patient care. This qualitative study aimed to examine the home care needs of cancer patients from the perspective of home care nurses. METHODS: This is a qualitative descriptive study carried out at home care centers in the northwest of Iran. A total of 15 participants were recruited through purposive sampling and underwent face-to-face semi-structured interviews. Data were analyzed through Conventional content analysis method in MAXQDA software.  Measures of trustworthiness were established throughout the study using Lincoln and Guba's (1985) criteria (dependability, credibility, transferability, and confirmability). RESULTS: Data analysis resulted in the extraction of four main categories including physical needs (pain relief, gastrointestinal problems including nausea and anorexia and nutritional problems, lethargy, wound care), psychological support (need for hope and emotional support), educational needs (need for information and self-care) and financial support (service insurance coverage, charity support). To promote these patients home care, insurance coverage of nursing home care services was emphasized by the participants. CONCLUSION: Various aspects of cancer patients home care needs were identified. Interdisciplinary home-based palliative care collaboration is needed to address their physical, psychological, and moral needs.

Level of resilience in nurses working at COVID-19 referral centers in Iran.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led many healthcare systems to become overwhelmed, and caused many frontline providers to feel fatigued and exhausted and experience severe emotional trauma. Nurses are the largest group of the world's frontline providers and it is clear that their resilience to threatening factors is critical in the current crisis. Therefore, the purpose of this study was to determine the level of resilience in nurses working in COVID-19 centers in Iran. METHODS: A cross-sectional study was conducted with 250 nurses working at three COVID-19 centers in northwest Iran. The participants were recruited using simple random sampling. The Connor-Davidson Resilience Scale was used to collect the data. RESULTS: The highest level of resilience was related to spiritual influences, while the lowest was the trust in their instincts and tolerance of negative emotions. Furthermore, the level of resilience was significantly higher in nurses with better family support (p < 0.01). CONCLUSION: Given the role of resilience in nurses' mental health, it is vital to support the nursing staff in critical situations and improve their resilience by focusing particularly on psychological and spiritual support.

Workplace Ostracism in Nurses and Its Determining Factors.

AIM AND OBJECTIVES: This study attempted to identify workplace ostracism in nurses and its determining factors. BACKGROUND: Ostracism, which is a form of mistreatment in the nursing workplace, is neglected in the nursing profession although it can affect the quality of healthcare services. DESIGN: The present study was a descriptive correlational study. METHODS: Nurses in healthcare centers (n = 340) that had at least 12 months of clinical care experience were selected through proportionate stratified random sampling for the period from 2018 to 2019. The study instruments were a modified questionnaire based on the workplace ostracism scale and a questionnaire that assessed personal-social factors. To analyze the data, descriptive and inferential statistics were used. RESULTS: Participants' average ostracism score was 9.03 ± 36.63, and there were statistically significant relationships between ostracism and employment status, university of education, a record of getting an incentive, nurses' current physical disorders, and feelings of colleagues' envy and managers' discrimination. CONCLUSIONS: Applying some approaches to educate nurses about interpersonal relationships and clearly communicating mutual expectations between the staff and nursing management could help solve this problem. IMPLICATIONS FOR PRACTICE: The study results will serve to guide legislators and managers in developing interventions to create supportive and safe work environments, both for nurses and patients.

"Me First, Others Later" A focused ethnography of ongoing cultural features of waiting in an Iranian emergency department.

BACKGROUND: Waiting is an inevitable experience in all emergency departments (EDs). This waiting time may negatively influence the patients and their relatives' satisfaction, healthcare professionals' (HCPs) performance, and the quality of care provided. This study aims to explore, gain understanding of and describe what it is like to wait in an Iranian emergency department (ED) with particular focus on cultural features. METHOD: A focused ethnographic approach based on Spradley's (1980) developmental research sequence was conducted in the ED of a tertiary academic medical center in northwest Iran over a 9-month study period from July 2017 to March 2018. Participant observation, ethnographic interviews and examination of related documents and artefacts were used to collect data. All the data were recorded in either field notes or verbatim transcripts and were analysed using Spradley's ethnographic data analysis method concurrently. RESULTS: The overarching theme of "Me first, others later" emerged. Within this overarching theme there were seven sub-themes as follows: human-related factors, system-related factors, patients and their relatives' beliefs and behaviors, HCPs' beliefs and behaviors, consequences for patients and their relatives, consequences for HCPs, and consequences for ED environment and care process. CONCLUSION: The mentality 'me first, others later' as the main cultural barrier to emergency care, strenuously undermined our positive practice environment. An accountable patient/relative support liaison, a clearly-delineated process of ED care delivery, guidelines for providing culturally competent ED care, and public awareness programs are needed to address the concerns and conflicts which establish a mutual trust and rapport.

The Correlation between Respecting the Dignity of Cancer Patients and the Quality of Nurse-Patient Communication.

CONTEXT: Nurse-patient communication is one of the important factors affects the promotion and maintenance of the dignity of cancer patients in the hospital settings. AIMS: This study aimed to determine the perceptions of cancer patients regarding respecting their dignity and its correlation with nurse-patient communication in the hospital settings. SUBJECTS AND METHODS: This correlational study was conducted on 250 cancer patients admitted to the Oncology Departments of Tabriz Shahid Ghazi University Hospital, Iran. These patients were selected using a convenience sampling method. The Patient Dignity Inventory and Nurse Quality of Communication with Patient Questionnaire were used for collecting the data. STATISTICAL ANALYSIS USED: Descriptive and inferential statistics were applied to the data. RESULTS: The score of nurse-patient relationship is significantly correlated with patient's dignity score (R = -0.21, P = 0.001). CONCLUSIONS: Due to the importance of nurse-patient communication on maintenance of the dignity of cancer patients, it is a necessary requirement to take proper actions in this area, particularly by promoting "nurse's communication skills."

Treatment Delays for Patients With Acute Ischemic Stroke in an Iranian Emergency Department: A Retrospective Chart Review.

STUDY OBJECTIVE: We evaluate the extent and nature of treatment delays and the contributing factors influencing them for patients with acute ischemic stroke, as well as main barriers to stroke care in an Iranian emergency department (ED). METHODS: A retrospective chart review was conducted on 394 patients with acute ischemic stroke who were referred to the ED of a tertiary academic medical center in northwest Iran from March 21 to June 21, 2017. The steps of this review process included instrument development, medical records retrieval, data extraction, and data verification. Primary outcomes were identified treatment delays and causes of loss of eligibility for intravenous recombinant tissue plasminogen activator (r-tPA). RESULTS: Of patients with acute ischemic stroke, 80.2% did not meet intravenous r-tPA eligibility; the most common cause was delayed (>4.5 hours) ED arrival after symptom onset (71.82%; n=283). Of 19.8% of subjects for whom the stroke code was activated, intravenous r-tPA was administered in only 5.3%. The average time from patients' arrival to first emergency medicine resident visit, notification of acute stroke team, presence of neurology resident, and computed tomography scan interpretation was lower for patients who met criteria of intravenous r-tPA than for those who lost eligibility for fibrinolytic therapy. The average door-to-needle time was 69 minutes (interquartile range 46 to 91 minutes). CONCLUSION: Our ED and acute stroke team had a favorable clinical performance meeting established critical time goals of inhospital care for potentially eligible patients, but a poor clinical performance for the majority of patients who were not candidates for fibrinolytic therapy.

A Comparative Study on the Meaning in Life of Patients with Cancer and Their Family Members.

Introduction: The overwhelming effects of cancer could be catastrophic for the patients and their family members, putting them at risk of experiencing uncertainty, loss, and an interruption in life. Also, it can influence their sense of meaning, a fundamental need equated with the purpose in life. Accordingly, this study aimed to compare the meaning in life (MiL) of patients with cancer and their family members. Methods: This descriptive comparative study was conducted on 400 patients with cancer and their family members admitted to university hospitals in Tabriz and Ardebil provinces, Iran. The participants were sampled conveniently and the Life Evaluation Questionnaire (LEQ) were used for collecting data analyzed through descriptive and inferential statistics in SPSS ver. 13 Software. Results: The mean score for the MiL of the patients with cancer and their family members was 119 (16.92) and 146.2 (17.07), respectively. There was a significant difference between patients with cancer and their family members in terms of MiL. Conclusion: The MiL of patients with cancer is lower than that of their family members, which indicates the need for further attention to the psychological processes and their modification in Iranian healthcare systems.