Facilities, challenges, attitudes, and preferences of nursing students related to e-learning in the Covid-19 pandemic in Iranian context: a cross-sectional study.

BACKGROUND: During the Covid-19 pandemic, nursing schools worldwide were forced to deliver nursing courses in ways other than the traditional face-to-face classroom setting. Numerous lessons were learned by nurse educators regarding the use of electronic and online learning strategies. It is necessary to be aware of the factors affecting e-learning and identify the strengths and weaknesses to improve the student learning experience and process in nursing school. AIM OF STUDY: The present study aimed to identify the abilities, attitudes, challenges, and preferences of nursing students regarding e-learning during the Covid-19 pandemic. Recognition of these factors can help nurse educators make needed modifications to teach more effectively. METHODS: In this cross-sectional study, 228 undergraduate nursing students participated. The random sampling method used a standard questionnaire that students completed voluntarily. SPSS version 22 was used for data analysis. RESULTS: During the Covid-19 pandemic, the majority of nursing students of Zanjan University of Medical Sciences participated in electronic classes at home using mobile phones. Students reported that logistical problems increased by participating in e-classes by their phones due to difficulty typing and frequent internet outages. Online classroom management for instructors was difficult due to students spontaneously leaving the virtual online classroom rather than attending the entire learning session. Despite the technical challenges, the attitudes of students towards the e-learning format were positive. There was a noted correlation between student attitude by gender and educational background. Students preferred that professors used more PowerPoint, showed instructional videos, and had interactive group discussion sessions rather than lecture only. Students objected to attending more than two online classes in one day if the duration lasted more than 60 min and had a rest time of fewer than 30 min between classes. CONCLUSION: Despite the overall positive student satisfaction with e-learning, this method of education is still far from student preferences and requires planning for an effective learning experience that meets their priorities and preferences. Using a hybrid of face-to-face and e-learning approaches together can be a more effective teaching method than either strategy alone.

A comparison of risk factors for relapse in opiate-related and stimulant-related substance use disorders: A cross-sectional multicenter study.

INTRODUCTION: Recognizing the specific factors in relapse disorders related to each substance can help improve treatment methods and adopt more effective preventive strategies. This study aimed to compare the situational factors associated with relapse in opiate-related disorders with stimulant-related disorders (SRDs) of those referred to substance misuse treatment centers. DESIGN: This study was a cross-section type. METHODS: The study participants were 150 clients with SRDs and 150 with opiate-related disorders. Samples were selected using two stages random sampling method. Data were collected through a demographic questionnaire and the Inventory of Drug-Taking Situations (IDTS). RESULTS: The mean score of IDTS in the two groups was significantly different (X̄1  = 45.93 ± 11.12 vs. X̄2  = 48.34 ± 15.07; t = 3.32, p < 0.01). The mean scores of 'unpleasant emotions,' 'physical discomfort,' 'conflict with others,' and 'social pressure to use and urge/temptations' subscales were significantly higher in the stimulant group than in the opiate group (p < 0.05). However, the mean of the testing' personal control' subscale was higher in the opiate group than in the stimulant group (p < 0.05). CONCLUSION: This study reveals that despite some similarities, relapse-related situational factors in opiates and stimulants differ. Some situational factors, such as social pressure and coping with unpleasant emotions, play a more critical role in relapse to both stimulant and opiate groups.

Bullying and burnout in critical care nurses: A cross-sectional descriptive study.

BACKGROUND: Employee bullying and burnout are two crucial, prevalent and challenging concepts that adversely affect organizational staff behaviours. Also, adverse patient care is associated with nurse bullying and burnout. AIM: This study aimed to assess the incidence and association between workplace bullying and occupational burnout among nurses in critical care units in Iran. STUDY DESIGN: A cross-sectional descriptive study. METHODS: The subjects were 184 nurses from critical care units in 6 teaching hospitals in Iran. Three questionnaires were distributed among the study population; (a) demographic characteristics questionnaire, (b) Maslach Burnout Inventory (MBI) and (c) bullying at Workplace Questionnaire. Descriptive statistics were used to present the workplace bullying and occupational burnout status among nurses. Linear and logistic regression analyses were conducted to estimate the relationship between workplace bullying with MBI and nurses' demographic characteristics, respectively. RESULTS: 62% of the nurses had moderate emotional exhaustion, 59.8% had moderate depersonalization and 46.2% had a moderate individual achievement. 75.5% faced workplace bullying. There was a positive and significant association between bullying scores and burnout in total (Pearson's r = 0.598, p < 0.001). Linear regression test showed a positive and significant relationship between bullying with MBI dimensions (R = 0.613, p < 0.001) for emotional exhaustion, (R = 0.679, p < 0.001) for depersonalization and (R = -0.417, p < 0.001) for individual achievement. CONCLUSIONS: Among Iranian nurses, bullying is a prominent and substantial issue that significantly correlates with their negative performance by enhancing job burnout. RELEVANCE TO CLINICAL PRACTICE: It is suggested that some measures are adopted to avoid workplace bullying and to reduce occupational burnout for nurses. Managers should create an environment that encourages nurses to voice their concerns - informing nurses about their rights and creating a positive atmosphere in the hospital.

Patients' preferences on breaking bad news: a cross-sectional study from Iran.

BACKGROUND: The sensitivity and skill of care providers, especially physicians, while communicating bad news to patients can improve patients' acceptance of treatment and their emotional adjustment. We aimed to determine how to break bad news to cancer patients and consider their preferences in this regard. METHODS: This is a cross-sectional study in which 249 patients participated. The Poisson sampling method was used. Data were collected using the Measure of Patient Preferences (MPP) and patient demographic profile forms. RESULTS: Of the 249 participants, 178 (71.5%) were aware of their cancer diagnosis and 201 (80.7%) preferred to be informed of their cancer diagnosis. Patients' preferences included: "Having his/her doctor take the time to answer all of his/her questions completely", "Feeling confident about his/her doctor's technical competence and skill", and "His/her doctor telling him/her the best treatment option". CONCLUSION: According to our results, care providers should consider patients' preferences in communicating and delivering bad news. Achieving this goal requires managers to plan for improving the communication skills of healthcare providers.

The Effects of Spiritual Care on Fatigue and Pain among Patients with Cancer Receiving Chemotherapy: A Randomized Controlled Trial.

This study aimed at assessing the effects of spiritual care (SC) on fatigue and pain among patients with cancer receiving chemotherapy. This randomized controlled trial was conducted in 2018. Participants were 145 patients with cancer consecutively recruited from a large-scale public hospital in Zanjan, Iran, and randomly allocated to an intervention (n = 72) group and a control (n = 73) group through block randomization. Participants in the intervention group received SC for 3 days. The Fatigue Severity Scale and a visual analog scale were, respectively, used for fatigue and pain assessments before and after the study intervention. Chi-square test and the independent t test as well as the analysis of covariance were employed to analyze the data. The pretest mean score of fatigue was 5.18 ± 1.36 in the intervention group and 5.03 ± 1.29 in the control group with no significant between-group difference (P = .529). The posttest mean score of fatigue was 3.75 ± 1.05 in the intervention group and 4.80 ± 1.16 in the control group and the between-group difference was significant (P < .001). The pretest mean score of cancer-related pain in these groups was 2.64 ± 0.98 and 2.46 ± 1.22, which changed to 1.51 ± 1.006 and 2.32 ± 1.70, respectively, at posttest. The between-group difference respecting the mean score of pain was insignificant at pretest (P = .389) and significant at posttest (P = .001). Spiritual care is effective in significantly reducing fatigue and pain among patients with cancer receiving chemotherapy. Nurses and other health care providers can use SC to manage fatigue and pain of patients with cancer.

The effect of integrating midwifery counseling with a spiritual content on improving the antenatal quality of life: A randomized controlled trials.

BACKGROUND: Poor antenatal Quality of Life (QoL) is associated with adverse outcomes. OBJECTIVE: This study was performed to examine the effect of integrating midwifery counseling with spiritual content on improving the antenatal quality of life. METHOD: This randomized controlled trial was performed on 60 first-time pregnant women who were referred to two childbirth preparation centers in Zanjan city, Iran in 2019. The counseling was conducted in eight sessions. The QoL SF-36 questionnaire was completed before and two months after the intervention. Data were analyzed using the chi-square test, independent t-test, and paired-samples t-test. The level of significance was p<0.05. RESULTS: After intervention based on an independent t-test the total score of QoL was significantly greater in the intervention group compared to the control group (p=0.001). After the intervention, the mean scores of four domains of QoL (Role-Physical, General Health, Vitality, Role-Emotional, and Mental Health) were significantly higher than the control group(p=0.001). While in terms of Physical Functioning, Bodily Pain and Social Functioning domains were not statistically significant (p>0.05). CONCLUSION: Integrating midwifery counseling with spiritual content had a positive impact on improving the psychological aspect of quality of life more than the physical and social aspects. It can be used by providers for planning antenatal care programs.

The impact of work schedules, workplace bullying and some demographic characteristics on nurses' sleep quality in Iran.

Introduction: Sleep quality in nurses along with workplace bullying, are concerned with nursing care quality. There exist a few investigations on workplace bullying and its relationship with sleep quality. This study aims at determining the impact of work schedules, workplace bullying, and some demographic characteristics on nurses' sleep quality. Material and Methods: This study was conducted on 333 nurses who worked in a hospital in Tehran, Iran. Sampling conducted from February 12 to April 23, 2020. Instruments of this study were Pittsburg sleep quality index and Quine's workplace bullying scale. Results: 63% of nurses had low sleep quality. Male nurses had lower sleep quality in comparison with females; 90% of nurses had encountered workplace bullying. Bullying and work schedules did not have a statistically significant effect on nurses' sleep quality. Conclusion: According to this study, work schedules and workplace bullying had no significant effect on nurses' sleep quality; but regarding that low sleep quality and encountering bullying is a cause of mental and physical problems for nurses and reduces the quality of care, it is recommended that nurses' sleep quality and facing the bullying behavior should be taken into account by hospital authorities.

ARDS, Diffuse Alveolar Hemorrhage and Pericardial Effusion due to Anabolic-Androgenic Steroids Consumption: Legal and Ethical Policy in Medical Education.

Anabolic-androgenic steroids (AAS) are one of the ingredients of herbal and dietary supplements that are popular among sports trainers. AAS abuse predisposes everyone to several complications. Reviews of the literature on AAS users have shown mainly skin, renal, and hepatic complications. In this case report, we presented a case with simultaneous complications, including diffuse alveolar hemorrhage (DAH), acute respiratory distress syndrome (ARDS), pericardial effusion, gastrointestinal bleeding (GIB), and acute kidney injury (AKI). Given the potential for lethal complications and the consequences of ethical, civil, and criminal law, it seems that specific policies will be considered for the use of bodybuilding drugs. It is also suggested that this approach be added as a new part of the medical curriculum. Also, ARDS and DAH are unreported side effects in other studies, which is suggested to be considered by specialists.

Predictive Factors of Depression Among Relatives of Brain-Dead Persons: A Descriptive Correlational Study.

This study aimed to determine the predictive factors of depression among relatives of person deceased by brain death. In this study, 106 first-degree relatives of people who died of due to brain death were studied. Of the study units, 72.64% had levels of depression (severe, moderate, and mild). Among the dependent variables concerning deceased person, age and gender of the deceased were significantly correlated with the depression of their relatives. Among the variables concerning relatives, low level of education, unemployment and time elapsed after brain death have significant role in the incidence or prediction of their depression (p < 0.05). The results indicated a high prevalence of depression among relatives of men aged 30-50 who died because of brain death. It is recommended to consider this fact in planning to care relatives, especially among the low-educated, the unemployed and experiencing the first year of death, of people deceased by brain death.

Correlation of happiness and professional autonomy in Iranian nurses.

BACKGROUND: Happiness and professional autonomy in nurses increase job satisfaction, reduce turnover and improve the quality of healthcare services. AIMS: The present study aimed to examine the correlation between happiness and professional autonomy in Iranian nurses. METHODS: This descriptive-correlational study was conducted on 371 nurses in 2017. The participants were selected via two-step random sampling. Data were collected using the Oxford Happiness Inventory and Dempster Practice Behaviors Scale within the score ranges of 0-87 and 30-150, respectively. Data analysis was performed in SPSS version 16. RESULTS: Mean score of happiness among nurses was 43.1 ± 13.3 and the mean score of professional autonomy was 96.4 ± 13.5. According to Pearson's correlation coefficient, professional autonomy had a positive, significant correlation with happiness (r = 0.481; p < 0.001). In addition, the results of regression analysis indicated that professional autonomy could predict 23% of the happiness variance in the nurses (p < 0.001). CONCLUSIONS: According to the results, the level of happiness in Iranian nurses was favourable, whereas the level of professional autonomy was moderate. Considering the significant correlation between happiness and professional autonomy, attention should be paid to the simultaneous enhancement of these variables to improve the efficiency of nursing care.

Randomized Clinical Trial Comparison of the Effect of Verbal Education and Education Booklet on Preoperative Anxiety.

PURPOSE: Comparing the effect of verbal education and education booklet on preoperative anxiety. DESIGN: This study was a randomized clinical trial. METHODS: Sixty patients were randomly allocated into three groups: control, booklet, and verbal education. The data were collected using Spielberger's State-Trait Anxiety Inventory before and after intervention. SPSS (version 20; IBM, Armonk, NY) with analysis of variance and the dependent t test were used for analysis. FINDINGS: After intervention, there was a significant difference between the mean scores of state anxiety scale among the intervention groups (booklet and verbal) with the control group (P < .05). The mean difference between the two intervention groups (booklet and verbal) was not significant (P > .05). CONCLUSIONS: According to the results, and given that nurses work under time pressure in Iran and other societies, it is concluded that well-designed education booklets can be used to reduce the preoperative anxiety.

Attempting to Restore Integrity of the Self: A Grounded Theory Study of Recovery From Major Depressive Disorder.

BACKGROUND: The cultural and social background of the individual would seem to be important factors that can affect recovery from major depressive disorder (MDD). Currently, there is little information on the process of recovery from MDD in Middle Eastern countries, such as Iran. AIMS: This study was conducted to explore the process of recovery from MDD in Iran. METHOD: A grounded theory approach by Corbin and Strauss was used to explore recovery from MDD. Twenty patients were recruited using purposive and theoretical sampling methods. RESULTS: Several themes emerged from the data, the primary of which was "Attempting to restore integrity of the self," which included the two subthemes of "Attempting to restore health," and "Attempting to reacquire the lost abilities." Various contextual factors also affected recovery, including poverty, inefficient health care systems, perceived support, feelings of failure, and social stigma. During the recovery process, participants adopted both "effective strategies" and "ineffective strategies." Following the attempt to restore integrity, participants experienced different levels of integrity, ranging from "complete recovery" to "no recovery/relapse." CONCLUSIONS: The results from this study contribute to the body of knowledge regarding recovery from MDD in Iran. The data suggest that recovery from depressive disorder is a very personal experience that is affected by different and variable factors and conditions. However, the attempt to restore integrity of the self can result in achieving a higher level of performance and health.

Comparative Induction of Controlled Hypotension by Electroacupuncture at DU20 Acupoint and Remifentanil in Lumbar Laminectomy.

Hypotensive anesthesia is utilized to reduce bleeding during orthopedic surgery. One of the various drugs that have been used to reduce blood pressure is remifentanil. This study was an attempt to compare the effect of remifentanil with that of electroacupuncture (EA) at DU20 on reducing blood pressure. In this randomized controlled clinical trial, 54 patients undergoing lumbar laminectomy were allocated to two groups. Hypotensive anesthesia was performed through infusion of remifentanil 100 µg/kg/min for the control group, and EA at DU20 acupoint with a frequency of 2-10 Hz and intensity of 1-5 mA for the intervention group. Blood pressure, pulse rate, volume of blood lost and the quality of surgical field were evaluated every 10 min. There were no statistically significant differences between the two groups in terms of the changes in mean arterial pressure (MAP), pulse rate, and the quality of surgical field (P > 0.05). Therefore, EA can be as effective as remifentanil to reduce blood pressure in the patients undergoing lumbar laminectomy.

Hemolysis interference in measuring fish plasma biochemical indicators.

The present study aimed to determine hemolysis interference in measurement of plasma biochemical parameters in fish specimens. For this purpose, blood samples were harvested from 24 Huso huso juveniles. After centrifugation, each plasma sample was divided into seven portions to make seven levels of hemolysis. Hemolysis was induced by addition of different percentages of the corresponding whole blood [0 (non-hemolyzed control group), 1, 3, 5, 10, 15, and 20% of whole blood]. Albumin, total protein, calcium, phosphorus, glucose, sodium, potassium, chloride, alkaline phosphatase (ALP), aspartate transaminase (AST), and alanine transaminase (ALT) were measured in different samples. Results showed that plasma albumin, ALP, potassium, and AST significantly increased (more than 200% at the highest hemolysis level) in the hemolyzed samples. Also, plasma total protein and phosphorus showed significant elevation in the hemolyzed samples (more than 70% at the highest hemolysis level). Plasma glucose, calcium, chloride, and ALT showed narrow but significant increase in hemolyzed samples (11.8-35.2% at the highest hemolysis level). Plasma sodium showed no significant changes in the hemolyzed samples. In conclusion, the present results show that hemolysis markedly affects plasma parameters levels, which interferes with plasma results interpretation. Therefore, analysis of hemolyzed samples should be avoided or the results should be interpreted with caution. This study encourages further investigations to develop methods for omitting the effects of hemolysis by sample blanking and/or presenting correction coefficients for measurement of plasma parameters in samples with different levels of hemolysis.

Nurses' autonomy level in teaching hospitals and its relationship with the underlying factors.

This study aimed to determine the autonomy level of nurses in hospitals affiliated to Zanjan University of Medical Sciences, Iran. In this descriptive cross-sectional study, 252 subjects were recruited using systematic random sampling method. The data were collected using questionnaire including Dempster Practice Behavior Scale. For data analysis, descriptive statistics and to compare the overall score and its subscales according to the demographic variables, t-test and analysis of variance test were used. The nurses in this study had medium professional autonomy. Statistical tests showed significant differences in the research sample according to age, gender, work experience, working position and place of work. The results of this study revealed that most of the nurses who participated in the study compared with western societies have lower professional autonomy. More studies are needed to determine the factors related to this difference and how we can promote Iranian nurses' autonomy.

Major depressive disorder: a qualitative study on the experiences of Iranian patients.

Major depressive disorder (MDD) is one the most common mental disorders; it affects about 5-10% of the world population. This study explores the experiences of people with major depressive disorder in Zanjan, Iran. In order to identify recurring themes and patterns in individuals' experiences of major depressive disorder, semi-structured interviews with 18 patients were recorded and transcribed verbatim. The transcripts were then analyzed based on conventional qualitative content analysis. Five main categories emerged. The first category was called emotional paralysis and included the subcategories feeling severely depressed; feeling anxious; feeling impatient and irritable; and having dyshedonia. The second category was disturbance of thinking and was comprised of the subcategories of preoccupation, instable spiritual beliefs, and guilt. Cognitive decline was the third identified category and was further divided into subcategories of frustration, unawareness of the disorder, negative evaluation, indecisiveness, and loss of focus and loss of memory. Another major category was physical illnesses with the subcategories of physical discomfort, sleep problems, appetite disturbance, facial changes, sexual dysfunction, and medical conditions. The final category was failure in life, which had failure in personal affairs, jeopardized interpersonal relations, and unstable work life as subcategories. These findings provide a base for further research in this area. They also have clinical relevance for health care providers working with patients with MDD. Related cultural issues also are discussed.