The Effect of a Training Program Based on the Theory of Planned Behavior on the Self-Care of Patients with Cerebrovascular Accident: A Randomized Controlled Trial.

Background: Cerebrovascular accident dramatically impacts patients' lives. However, this chronic disease could be managed by boosting self-care and following healthy behaviors. Accordingly, this trial sought to specify the impact of a training program established on the theory of planned behavior on the self-care of clients with this condition. Materials and Methods: This trial was performed on 80 clients, who were selected using a random numbers table and divided into two equal groups to receive either usual care alone or usual care plus a training program based on the theory of planned behavior (five in-hospital individual sessions for 5 weeks and weekly phone follow-ups for 2 months after discharge). Self-care and the dimensions of the theory of planned behavior were investigated at baseline and 2 months after the last in-hospital session using the standardized Shah version of the modified Barthel index and a researcher-made questionnaire, respectively. Results: The mean score of self-care was significantly higher in the experimental arm at the posttest (Mann-Whitney = 506.00, p = 0.005). Also, the increase in mean change of self-care from baseline to posttest was significantly more in the experimental arm (t78= -6.6, p < 0.001). Such findings were also found for all dimensions of the theory of planned behavior. Conclusions: Based on results, nurses and health policymakers can incorporate training based on the theory of planned behavior into routine care programs for patients with cerebrovascular accident to boost their self-care. The implemented intervention also could be reproduced in other contexts. Hence, further trials are requested to specify the sustainability of the findings.

The effect of a training program on the self-care efficacy of hemodialysis patients with mineral and bone disorders: A quasi-experimental study.

Background and Aims: Patients who have chronic kidney disease (CKD) and mineral and bone disorders (MBD) often do not know much about their diseases. A training program can help them improve their quality of life. This study aimed to assess the effect of a training program on the self-care efficacy of the hemodialysis patients with MBDs in southeastern Iran. Method: We conducted a quasi-experimental study involving 49 patients with CKD-MBD in southeastern Iran in 2021. The patients were randomly assigned to either the control or intervention group. The intervention group received 12 self-care training sessions delivered through WhatsApp, whereas the control group received routine information. We administered CKD-MBD knowledge and behavior questionnaires of the intervention, and measured laboratory parameters before and 1 month after the intervention. The data were analyzed by SPSS15 with descriptive and analytical statistics. Paired t test, independent t, analysis of covariance, and Mann-Whitney U tests were using for data analysis. Results: The mean knowledge scores of the control group were 4.78 ± 1.78 and 6.22 ± 2.11 before and after the intervention, respectively (p = 0.200), whereas the mean knowledge scores of the intervention group were 6.08 ± 2.24 and 22.23 ± 4.55 before and after the intervention, respectively (p = 0.001). The mean behavior scores of the control and intervention groups were 75.61 ± 7.13 and 73.85 ± 7.49 before the intervention, respectively (p = 0.070), but they received the mean scores of 78.87 ± 5.58 and 82.50 ± 5.35 after the intervention, respectively (p = 0.001). The result showed a significant increase in the mean knowledge and behavior scores after the intervention. The researchers found no significant difference in the mean scores of the laboratory parameters between them before and after the intervention (p = 0.090); therefore, the intervention could not affect the laboratory parameters. Conclusion: To sum up, the study found that the training program improved the knowledge and behavior of hemodialysis patients with MBD. WhatsApp was a good and cheap way to teach them self-care, and it helped them do it better. These results implied that this training program could help the patients have a better quality of life.

Assessing virtual education on nurses' perception and knowledge of developmental care of preterm infants: a quasi-experimental study.

BACKGROUND: To implement developmental care accurately, neonatal intensive care unit nurses should have a proper understanding and sufficient knowledge in this field. Applying new approaches in education such as offline and online education help nurses improve their skills and knowledge. This study aimed to investigate the effect of virtual education on the perception and knowledge of neonatal developmental care in nurses working in neonatal intensive care units. METHODS: This quasi-experimental study was conducted using a pretest-posttest design with two groups. The participants were 60 nurses working in neonatal intensive care units who were selected using convenience sampling (30 persons in each group). The data were collected before and 1 month after the intervention. The participants in the intervention group received developmental care training using an electronic file uploaded to Navid Learning Management System, while the members of the control group received no intervention. The instruments used to collect the data were the Demographic Information Questionnaire, the Developmental Care Knowledge Scale, and the Developmental Care Perception Scale. The collected data were analyzed using SPSS V25 software. All statistical tests were performed at the significance level of 0.05. RESULTS: The Developmental Care perception scores before the intervention in the control and intervention groups were 83.40 ± 11.36 and 84.53 ± 9.48, respectively, showing no statistically significant difference (P = 0.67). Also, Developmental Care perception scores after the intervention in the control and intervention groups were 83.16 ± 13.73, and 94.70 ± 6.89, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant (P < 0.903), while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention (P < 0.001). The Developmental Care Knowledge scores before the intervention in the control and intervention groups were 52.66 ± 18.08 and 77.16 ± 17.20, respectively, showing a statistically significant difference (P = 0.001). Also, Developmental Care Knowledge scores after the intervention in the control and intervention groups were 53.66 ± 26.55and 90.33 ± 13.82, respectively, showing a statistically significant difference (P < 0.001). The results of paired t-test showed that the mean knowledge score in the control group before and after the intervention was not statistically significant, while in the intervention group there was a statistically significant difference between the mean knowledge score before and after the intervention. CONCLUSION: The results of this study showed that virtual education for the developmental care of premature infants plays an effective role in the perception and knowledge of nurses working in the neonatal intensive care unit. Therefore, the development of e-learning packages for developmental care and their availability for nurses can be a step to improve the quality of nursing care for infants admitted to the NICU.

How Do Mothers Take Care of Their Infants with Colic Pain? A Mixed-Method Study.

BACKGROUND: Colic pain is one of the main reasons for stress and anxiety in infants' parents, especially mothers, and there is still no specific treatment. Thus, mothers always try their best to relieve their infants' pain.The researchers attempted to investigate how mothers take care of their infants with colic. METHODS: This study was conducted with a mixed-method approach and a sequential explanatory design. In the quantitative phase, a cross-sectional study was conducted to assess how to control pain. One hundred fifty mothers of infants with colic living in Kerman, Iran, were chosen by convenience sampling. In the qualitative phase, the researchers interviewed 18 mothers using semi-structured in-depth, and face-to-face approaches. These participants were selected by purposive sampling method. The interviews were analyzed by the conventional content analysis method. RESULTS: In the quantitative phase, the mothers' most common methods to relieve colic pain were herbal medicines (3.55±0.51) and the change of position (3.35±0.67). The least methods used were probiotics (1.4±0.2) and acupuncture (0). In the qualitative phase, the main theme was "mothers support needs for care," which includes the following subcategories: "lack of trust in doctor"; "full-time care"; "feeling of inadequacy," "persistent anxiety, "care without help," and "looking for ways to control pain." CONCLUSION: Mothers need support to relieve their infants' colic. The provision of educational and psychological supportive packages can be helpful for the mothers. In addition, nurses can help mothers improve their quality of care.

The effect of a training program on maternal role adaptation and self-esteem of mothers with preterm infants: a quasi-experimental study.

BACKGROUND: Admission of preterm infants in the neonatal intensive care unit limits the mother's interaction with their infants, delaying accepting and playing the motherhood role. Besides, mothers of preterm infants have low self-esteem due to their infants' condition. Accordingly, the present study explored the effect of implementing the training program on maternal role adaptation and self-esteem of mothers of preterm infants admitted to the neonatal intensive care unit. METHODS: This study employed a quasi-experimental design with two groups. The participants were 80 mothers of preterm infants. The participants were selected using convenience sampling and simply randomly assigned to the intervention and control groups. The instruments included a demographic information questionnaire, the Rosenberg Self-Esteem Scale, and the Maternal Role Adaptation Scale. The participants in the intervention group attended the training program, while the control group did not receive any intervention. The questionnaires were completed by the two groups before and 2 weeks after the intervention. The collected data were analyzed using SPSS software version 21, a significance level of 0.05. RESULTS: The maternal role adaptation scores before the intervention in the control and intervention groups were 134.222 ± 11.84 and 138.800 ± 12.42, respectively, showing no statistically significant difference (P = 0.096). The corresponding scores after the intervention for the control and intervention groups were 139.17 ± 12.46 and 154.05 ± 8.57, showing a significant intergroup difference (P < 0.001). Similarly, the pre-intervention self-esteem scores in the control and intervention groups were 30.30 ± 3.79 and 30.95 ± 8.61, showing no statistically significant difference between the two groups (P = 0.664). Besides, the post-intervention self-esteem scores in the control and intervention groups were 31.52 ± 3.42 and 36.001 ± 7.74, respectively, indicating a statistically significant difference between the two groups (P < 0.001). CONCLUSION: Given the insight from this study, implementing training programs is a suitable solution for improving maternal role adaptation and increasing mothers' self-esteem. Furthermore, nurses' training packages can help the mother accept the maternal role more quickly and improve the mother's self-esteem for better care of the baby. Trial registration The registration number for this study was obtained from Kerman University of Medical Sciences, and the number of the grant was 98000150.

How Parents Cope with the Care of a Child with Epilepsy: Based upon Grounded Theory.

BACKGROUND: Parents of children with seizure face the complicated health issues of their children. Adaptation strategies of parents as major care providers impact not only their handling of stresses on themselves but also children's quality of life. This study investigated the adaptation processes of parents of children with seizure at two educational hospitals affiliated with Kerman University of Medical Sciences in Iran. METHODS: Twenty parents (15 mothers and 5 fathers), and three nurses were selected using purposive sampling method. Data was collected using qualitative semi-structured interviews and analyzed using the method suggested by Corbin and Strauss version 2008. The interviews were conducted until thematic saturation was achieved. RESULTS: The adaptation process had five phases: "Disbelief, Patience on what happened, change to preserve, acceptance of the current situation, and self- empowerment." In summary, the parents of children with seizure had a 5-phase adaptation strategy. The core category achieved was "continued efforts of parents to restore calm." CONCLUSION: Properly assessing the stresses' resources on parents of children with seizure is necessary. Informing their adaptation strategies may help medical staff and social services to provide more targeted support and promote the balance of the family function.

Effect of classmate as peer-led education on clinical performance: A mixed-method study.

BACKGROUND: Achieving an excellent clinical education by nursing students is one of the primary goals of any nursing school. Nursing educators try to use different methods to enhance clinical skills. One of them is a peer-led method that can be used in theoretical and clinical education. It is developing as a suitable educational method to promote health. This study assessed the effect of classmates as peer-led education on the clinical performance of nursing students. MATERIALS AND METHODS: This study was conducted using a mixed-method approach and a sequential explanatory design. In the quantitative phase, a quasi-experimental study with a two-group pre- and post-test design was conducted. The sample of this phase consisted of 70 nursing students (35 persons in each group) who were selected through random convenience sampling. The intervention group participated in a peer-led education program. The control group received routine training. The members of both groups completed the clinical performance checklist before, and after the intervention, The collected data were analyzed using SPSS V21 software using descriptive and inferential statistics. In the qualitative phase, the researchers interviewed 18 undergraduate students using semi-structured in-depth and face-to-face approaches. These participants were selected by purposive sampling method. Data were analyzed using conventional content analysis. MAX DATA 10 was used to categorize the data. To establish the reliability and validity of findings, Graneheim, and Landman's criteria were considered. RESULTS: In the quantitative phase of the study, the results showed that the mean score of clinical performance was not statistically significant between the control and intervention groups before the intervention (P > 0.05). At the same time, it was significantly different after the intervention (P < 0.05), implying that the peer-led education of the intervention group significantly increased compared to that of the control. The main theme was "learning based on friendship," which included two categories, namely "deep learning" and "learn in the shadow of relaxing." CONCLUSION: Classmate as peer-led education could increase the ability of nursing students in clinical performance, and was able to enhance deep learning among them.

Comparing the effectiveness of mother's live lullaby and recorded lullaby on physiological responses and sleep of preterm infants: a clinical trial study.

OBJECTIVES: Environmental stimuli in neonatal intensive care units can disrupt the physiological stability and sleep of infants. It is essential to perform nursing interventions to reduce the adverse effects of such stimuli. This study aimed to compare the effect of recorded lullabies and mothers' live lullabies on physiological responses and sleep duration of preterm infants. METHODS: This study was a randomized clinical trial. The participants were 90 preterm infants selected using convenience sampling. In the intervention groups, music (recorded lullabies and mother's live lullabies) was played for 14 days, 20 min a day, while the control group did not receive any intervention. The data were collected using physiological criteria and infant sleep checklists before, during, and after the intervention. The data were analyzed using SPSS software (Version 21.0). RESULTS: The mean scores of physiological parameters (O2 saturation and heart rate) were not significantly different in the three groups before, during, and after the intervention (p>0.05). However, there was an improvement in O2-saturation and a decrease in the heart rate in two intervention groups. The mean duration of the infants' overnight sleep was not statistically significant between the groups before the intervention (p>0.05). However, there was a statistically significant difference in the intervention groups after the intervention, (p<0.05), and the infants' overnight sleep was longer in the recorded-lullaby group than the other two groups. CONCLUSIONS: Although performing interventions, including recorded lullaby and mother's live lullaby did not differ significantly with that of the control group in physiological criteria, it can be clinically important. In addition, recorded-lullaby increased the infants' overnight sleeping. Thus, it is suggested that further studies be conducted to confirm the effect of recorded lullaby and mother's live lullaby interventions on physiological parameters and sleep duration of hospitalized infants.

Simulation-based mastery improves nursing skills in BSc nursing students: a quasi-experimental study.

BACKGROUND: Clinical education is an essential part of nursing education. Selected clinical teaching methods influence the quality of education. Simulation-based mastery learning has been used to improve clinical skills among nursing students and may provide a novel way to enhance nursing skills. This study aimed to assess the effect of simulation-based mastery learning on the clinical skills of undergraduate nursing students from 2017 to 2019. METHODS: This quasi-experimental study was conducted with two groups (the control and intervention). A hundred and five students were selected by random convenience sampling, and written consent was obtained. The intervention group participated in a simulation-based mastery learning intervention, and the control group received no intervention except for traditional training. The students of both groups completed the demographic information questionnaire and the checklist before and after the intervention. The results were analyzed by SPSS version 21 and descriptive and inferential statistics. RESULTS: The results showed no significant differences between the two groups before the intervention (p> 0.05). In addition, students' performance in the intervention and control groups improved significantly at the post-test compared with the baseline (p< 0.05). Furthermore, the Cohen test implied that the simulation-based mastery model used by the intervention group was significantly more effective than the traditional training used by the control. CONCLUSION: These findings showed that mastery learning was more effective in improving clinical skills in undergraduate nursing students. The results suggest that other nursing and health programs can be developed by implementing a mastery-based learning model.

Prodromal symptoms as unfamiliar feelings: Experiences of Iranian myocardial infarction patients.

BACKGROUND: Patients affected by myocardial infarction (MI) report prodromal symptoms before heart attack. Deep understanding of these symptoms can increase the likelihood of early recognition and treatment of coronary heart disease (CHD). The purpose of this study was to describe the prodromal symptoms of MI experienced by Iranian adults. METHODS: In this qualitative conventional content analysis, data was collected through an in-depth semi-structured interview with 14 men and women (aged 40-82 years). The patients were interviewed at the hospital 2 or 3 days after hospitalization due to MI. MAXQDA software was used for data analysis. RESULTS: Data analysis led to the emergence of the 4 categories of 'Misperception of the symptoms', 'Reactions to the symptoms', 'Heart disease knowledge deficit', and 'Ideas and beliefs about heart disease'. The participants had not recognized the prodromal symptoms of MI and they attributed their symptoms to non-cardiac causes. They did not consider themselves at risk of heart disease, so they did not seek health services. CONCLUSION: The participants were unaware of their prodromal symptoms. Clinicians should be attentive that men and women at risk of MI may experience a range of unfamiliar and vague prodromal symptoms, so they must give greater attention to their narratives. A greater understanding of the prodromal symptoms experienced may lead to a more truthful and timely interpretation of their symptoms and earlier detection by physicians.

Educational challenges of postgraduate neonatal intensive care nursing students: A qualitative study.

INTRODUCTION: Despite the progress of health care and the application of new technology in the care of patients, the need to train highly skilled and specialized nurses is inevitable. Given that a master's degree in neonatal intensive care nursing has been recently established in Iran, the aim of the study was to explain the educational challenges of neonatal intensive care postgraduate nursing students in their perspective. MATERIALS AND METHODS: This conventional content analysis was performed by conducting semi-structured interviews with 18 students of neonatal intensive care in X University of Medical Sciences from 2018 to 2019. Data were analyzed using conventional content analysis. To establish the reliability and validity of findings, Graneheim and Landman criteria were considered. RESULTS: Following the data analysis, two main categories were extracted: "theoretical education challenges" and "clinical education challenges." The first main category was comprised of the following subcategories: "detachment of nursing department and hospital," "defects in weekly scheduling," "combination of care and treatment approaches in education," "inconsistency between the content of theoretical courses," "limited collaboration between basic science and medical departments," "low number of lecturers," "lecturers' unrealistic expectations," and "the importance of the scoring system." "Extended work shifts," "a large number of students," "lack of opportunity to do clinical practices," "lack of training classes," and "limited amenities in the hospital" were recognized as subcategories of the second category. CONCLUSION: Managers can address some of the students' challenges and provide the opportunity to enhance the quality of education through being familiar with, considering and meetings the needs and expectations of these students.

The relationship between clinical dishonesty and perceived clinical stress among nursing students in southeast of Iran.

BACKGROUND: Clinical dishonesty is a complex problem that threatens the health and safety of patients. This study aimed to investigate the relationship between clinical dishonesty and perceived clinical stress in nursing students. METHOD: This cross-sectional correlational study was conducted on 395 nursing students from 4 nursing colleges. The data were collected using a demographic information questionnaire, Nursing Student's Perception of Clinical Stressors, and a 12-item researcher-made questionnaire to evaluate the frequency of clinical dishonesty in the previous semester, the frequency of witnessing dishonest behavior among peers, and the perceived severity of unethical behavior. RESULTS: In this study, 89.1% of the students stated that they had committed at least one dishonest clinical behavior in the previous semester. The frequency of clinical dishonesty was significantly correlated with the frequency of observing dishonesty among peers (r = 0.053, p<0.01), perceived severity of unethical behavior (r = - 0.4, p<0.01), and perceived stress of students in the clinical setting (r = 0.28, p<0.01). Moreover, there were significant differences in the frequency of clinical dishonesty by gender (p = 0.006), the interest in the field of study (p = 0.004), and academic year (p = 0.002). CONCLUSION: The frequency of clinical dishonesty among nursing students is high and needs attention. Furthermore, considering the positive relationship between dishonesty and perceived clinical stress, it is essential to teach effective strategies to nursing students to empower them to cope with clinical stress.

Self-care status in children with congenital heart disease: A mixed-method study.

BACKGROUND: Suffering congenital heart disease leads to physical and mental disabilities in children. Children's self-care can result in appropriate care behaviors for limiting disease-induced problems. Given the ability of children to care for themselves, we investigated self-care statues in children who are suffering from congenital heart disease. METHOD: This study was conducted using a mixed-method approach and a sequential explanatory design. A cross-sectional study was conducted to assess self-care status in 124 CHD children who were living in Kerman, Iran. In the qualitative phase, the researchers interviewed 13 of these children and three parents using semi-structured in-depth and face-to-face approaches. RESULTS: The mean of self-care scores in these school-age children was optimal (10/7 ± 2/6). In the qualitative phase, three main themes were extracted: captive to health issues physical and mental sufferings and wishing for peace of mind. CONCLUSION: The results showed that self-care status in these children was optimal. As the main pillar of patient education, nurses can help enhance self-care behaviors and reduce the complications and problems induced by the disease by implementing educational and support interventions for children with CHD and their families.

The Association between Risk Factors and Prodromal Myocardial Infarction Symptoms: A Cross-Sectional Study in Iran.

BACKGROUND: Prodromal symptoms in individuals with risk factors remain challenging, even though myocardial infarction has been noted in research. This study determined the association of risk factors with patients' baseline myocardial infarction related prodromal symptoms. METHODS: In a cross-sectional study, 154 Iranian men and women, mean age 59.62 ± 12.74 years were assessed in 2016-2017. The frequency besides severity of 33 prodromal symptoms and risk factors was assessed using McSweeney Prodromal Myocardial Infarction Symptom Survey. RESULTS: The main cardiac prodromal symptoms experienced by patients were chest pain/discomfort (n = 99, 64.30%), unusual fatigue (n = 78, 50.60%), and sleep disturbance (n = 33, 20.40%). Women experienced more prodromal symptoms than men (33.26 ± 21.88 vs. 25.48 ± 17.75). Among risk factors, only sex was associated with prodromal symptoms score (P < 0.05). CONCLUSION: The frequently experienced prodromal symptoms, i.e., before MI were chest pain/discomfort, unusual fatigue, and sleep disturbance. A crucial finding was the significant association between sex and prodromal symptoms. Identifying prodromal symptoms in patients with risk factors can prevent the incidence of myocardial infarction.

Effects of technology on nursing care and caring attributes of a sample of Iranian critical care nurses.

PURPOSE: To examine the association between attitudes of critical care nurses about influences of technology and their caring attributes. STUDY DESIGN AND METHODOLOGY: In a cross-sectional study, firstly the psychometric properties of caring attributes questionnaire, which was developed to examine caring attributes of a sample of international nurses, was refined in a sample of 200 critical care nurses working in educational hospitals of a city in the southwest of Iran. Results of factor analysis with Varimax rotation decreased 60 items of caring attributes to 47 items which loaded under five subscales of caring negation, caring compassionate, caring advocacy, caring essence and caring communication. Secondly, attitudes of these nurses toward influences of technology on nursing care were assessed using a 22-item questionnaire, developed by the study researchers. Finally, the association between scores of caring attributes and attitudes toward influences of technology of this sample was determined. RESULTS: There was a positive association between caring attributes and influences of technology among our study nurses. Caring attributes scores were higher in female single nurses. Although caring attributes' scores had decreased along with age and work experience, caring commitment was higher in older more experienced nurses. Furthermore, female nurses had a better attitude toward influences of technology on their care. In contrast, younger and less experienced nurses had negative views on the effects of technology on nursing care. CONCLUSION: Continuing education and life-long learning on application of new technological equipment in nursing care and harmonising their use with caring values are necessary for nursing students and registered nurses to ensure delivering a patient-centred care, in a technologically driven environment.