Effect of Oral Care with Povidone-Iodine in the Prevention of Ventilator-Associated Pneumonia; a Systematic Review and Meta-Analysis.

Introduction: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections affecting one-third of patients with mechanical ventilation. This study aimed to synthesize available evidence regarding the effect of treatment with povidone-iodine (PI) among adult patients admitted to intensive care units (ICUs) for the prevention of VAP. Methods: An extensive search was conducted in online databases, including PubMed, Web of Science and Scopus, from the earliest records until January 1, 2023. STATA software v14 was used for statistical analysis. Publication bias was assessed via funnel plot, Begg's and Egger's tests. A P-value less than 0.1 was considered statistically significant for publication bias value. Results: Four studies were included in the meta-analysis. Three studies showed rhat PI decreased VAP compared to the placebo group, but it was not statistically significant (RR: 0.61, 95%CI: 0.25 to 1.47, Z=1.10, P=0.27, I2:71.5%). One study compared the effect of PI with chlorhexidine on the rate of VAP, the difference between which was not statistically significant (RR: 1.50, 95%CI: 0.46 to 4.87, Z=0.67, P=0.50, I2:0). Two studies demonstrated that the use of PI intervention compared to placebo decreased the average length of stay in ICU; however, it was not statistically significant (WMD: -0.35, 95%CI:-3.90 to 3.20, Z=0.19, P=0.85, I2:0). Also, three studies showed that using PI had almost no effect on mortality rate compared to placebo (RR: 1.05, 95%CI: 0.66 to 1.53, Z=0.8, P=0.27, I2:29.0%). Conclusion: More rigorously designed randomized clinical trials and further evidence are required to make a better decision/comparison about using PI as a suitable choice for preventing VAP among adult patients admitted to the ICU.

Development and psychometric testing of nurses' professional commitment inventory.

Background: Promotion of nurses' professional commitment is one of the strategies for retaining nurses and preventing their turnover. The aim of this study was the development and psychometric testing of the Nurses' Professional Commitment Inventory. Methods: This mixed method study was performed in an item generation and a psychometric testing phase. In the first phase, a 34-item inventory was developed based on the results of a grounded theory and the existing literature. Search date was 2010 to May 2018. In the second phase, we recruited 272 clinical nurses and tested the psychometric properties of the inventory. Construct validity was tested via the exploratory factor analysis. Reliability testing was performed through test-retest stability and internal consistency testing. SPSS version 21.0 (SPPS Corp) was used for statistical analysis. Significance level was set at p<0.05. Results: In the first phase, a 74-item pull was extracted. After reviewing, the primary version of the Nurses' Professional Commitment Inventory (NPCI) with 34 items was developed. Eight items were deleted during psychometric testing. In factor analysis, the remaining 26 items were loaded on 3 factors, namely professional attachment, professional performance, and internalization of the profession. These factors explained 53.92% of the total variance of professional commitment. The Cronbach's alpha and mean test-retest intraclass correlation coefficient for NPCI were 0.92 and 0.88, respectively. Conclusion: The Nurses' Professional Commitment Inventory has acceptable validity and reliability. This inventory includes dimensions that indicate the formation of professional commitment. The items of the scale can reveal nurses' strengths and weaknesses related to professional commitment.

Comparing the effects of traditional lecture and flipped classroom on nursing students' critical thinking disposition: A quasi-experimental study.

BACKGROUND: One of the most principal key aims of nursing education is to promote nursing students' and nurses' critical thinking. Therefore, nursing education needs to develop an appropriate curriculum and use effective instructional strategies for critical thinking promotion. Flipped classroom is a teaching method which substitutes individual learning for group learning in a dynamic, interactive environment where the teacher guides students to understand and use concepts. OBJECTIVES: The present study aimed to compare the effects of traditional lecture and flipped classroom on Iranian nursing students' critical thinking disposition. METHODS: This nonequivalent control group pretest-posttest quasi-experimental study was done in 2016 on 85 second-year bachelor's nursing students who had signed up for the Musculoskeletal Medical-Surgical Nursing theoretical training course. Because of their large number, students had been divided at the beginning of the first semester of their four-year program into two 42- and 43-student groups and attended separate theoretical training classes. These two classes were randomly allocated to either a traditional lecture or a flipped classroom group. The instructional strategies in these groups were the traditional lecture and the flipped class strategies, respectively. A demographic questionnaire and Ricketts' Critical Thinking Disposition Inventory were used for data collection. RESULTS: After the intervention, the mean scores of critical thinking disposition and its engagement domain in the flipped class group were significantly higher than the traditional lecture group (P < 0.0001). CONCLUSIONS: This study shows the positive effects of flipped classroom on nursing students' critical thinking disposition. It is recommended that future studies assess the effects of flipped classroom on other nursing education outcomes.

"Doubtful accepting": A grounded theory study of living with cardiac resynchronization therapy.

Heart failure is associated with low quality of life and a high mortality rate. There is limited information about patients' experiences of living with cardiac resynchronization therapy (CRT). In the present study, we sought to explore the process of living with CRT defibrillator. This qualitative study was completed from December 2014 to April 2016 using a grounded theory approach. Twenty semistructured interviews were held with 17 patients with heart failure. Data analysis was done via a previously-published approach. The core category of the process of living with the device is "doubtful accepting". This process includes three sequential phases: losing integrity, attempting to cope with the device, and coexisting. The process takes place in a context of barriers and facilitators, and results in a wide spectrum of outcomes, from frustration to empowerment. Nurses' awareness of this process can help them provide higher quality care, strengthen facilitators and reduce barriers to the process, and enable patients to effectively use coping strategies.

Living with cardiac resynchronization therapy: Challenges for people with heart failure.

The number of people with heart failure requiring implantation of a cardiac resynchronization device is increasing in Iran. Although this intervention is an effective life-saving treatment, several challenges are associated with patients' lifestyle after insertion. This study identified the challenges and coping mechanisms of Iranians with heart failure living with cardiac resynchronization therapy. A qualitative approach using conventional content analysis was adopted. Seventeen people with heart failure and three nurses were recruited between December 2014 and November 2015 from a teaching hospital and a private clinic in Rasht, Iran. Participants were interviewed using semi-structured interviews lasting 30-60 min. Five themes emerged: (i) fear of implantation, (ii) the panic of receiving a shock from the device, (iii) lack of control over life, (iv) inadequacies of the healthcare system, and (v) psychosocial coping. A heightened understanding of these challenges and coping strategies could prepare healthcare professionals to provide better routine care, education, and support to the recipients of cardiac resynchronization therapy prior to implantation, during the recovery period, and for long-term management.