Effect of triage training on nurses' practice and triage outcomes of patients with acute coronary syndrome.

BACKGROUND: Accurate assessment and prompt management of patients with acute coronary syndrome (ACS) is a complex process for emergency department (ED) nurses and has variable clinical outcomes. The aim of the present study was to determine the effectiveness of an educational intervention on nurses' practice during the triage of patients with ACS and the triage outcomes in this group of patients. METHODS: In this quasi-experimental study, a pretest-posttest group of 24 nurses were included by convenience sampling method and 960 patients with ACS were selected by sequential sampling during the pre-intervention (n = 480) and post-intervention (n = 480) phases. A case-based learning (CBL) intervention was performed for nurses for one month considering the role of the triage nurse according to the American College of Cardiology (ACC) and the American Heart Association (AHA) recommendations as well as the factors affecting the proper identification and management of patients with ACS. During patient triage in the pre- and post-intervention phases, the "Triage Nurse Practice Checklist" and the "Medical Electronic Records" were used to assess nurses' practice and the triage outcomes in patients, respectively. RESULTS: The overall mean score of the triage nurses' practice and its subscales, including Primary monitoring and assessment, cardiovascular risk factors assessment, evaluation of coronary heart disease (CHD) symptoms, chest pain management, and adherence to the ACC/AHA practice guidelines were significantly improved in the post-intervention phase compared with the pre-intervention phase (p < 0.001). There was no significant difference between the triage outcomes, including in-hospital mortality within 24 hours, death in ED, hospitalization in other wards, and discharge from ED in the pre and post-intervention phases (P = 0.723). CONCLUSION: The development of a cardiac triage-specific educational program could improve the performance of nurses in the evaluation and management of patients with ACS, but had no effect on the triage outcomes in this group of patients. We recommend a quality improvement project or a critical outcomes-based triage system to assess ACS patients' care needs in the ED.

Adherence to preventive behaviours and risk of COVID-19 infection: a case-control study.

Aim To investigate the relationship between adherence to preventive behaviors and risk of COVID-19 infection. Methods In this case-control study, 491 participants were selected through convenience sampling. First, the samples of the case group (COVID-19 patients) were selected, and then the control group was matched with the case group based on age, gender, and occupation. The criteria for diagnosing COVID-19 for the case group were self-reported positive PCR test or lung involvement on a chest CT scan. Descriptive statistics were used to summarize the results, and an odds ratio was calculated to quantify the magnitude of the association using a 95% confidence interval (CI) and a p<0.05. Results The results showed that, compared to those who always wear a mask, the risk of contracting SARS-CoV-2 was 3.153 times higher in those who used no masks (95% CI: 0.953-10.434) and 3.779 times higher in those who used masks occasionally (95% CI:1.929-7.37). The participants who never observed physical distancing and handwashing were 2.25 times more likely to get COVID-19 than those who always observed (95% CI:1.719-4.954; OR=2.258). Conclusion Participants who fail in following the protective measures, especially wearing a mask regardless of its type, had a higher risk of COVID-19 infection. Therefore, it is recommended to use a mask consistently, especially during the peak of COVID-19 waves.

Psychometric Properties of the Persian Version of the 11-Item de Jong Gierveld Loneliness Scale in Iranian Older Adults.

Loneliness is usually a chronic condition which may lead to physical and psychological undesirable consequences, and requires measurement and intervention. This study was conducted with the aim of preparing a Persian version of the 11-item de Jong Gierveld Loneliness Scale and evaluating its psychometric properties among the Iranian older adults. After applying the translation-back translation method, the prepared script was subjected to the face and content validity evaluations and a Persian version of the scale was prepared. Factor analysis, concurrent validity, internal consistency, and test-retest methods were used to validate the scale. The Persian version of the 11-item de Jong Gierveld Loneliness Scale showed acceptable content validity. The negative and significant correlations between the loneliness scores and the Philadelphia Geriatric Center Morale Scale indicated that the questionnaire had acceptable concurrent validity. The results of confirmatory factor analysis confirmed two factors for the scale. Also, the results of the intra-class correlation coefficient and Cronbach's alpha coefficient demonstrated that the scale had acceptable reliability. The Persian version of the 11-item de Jong Gierveld Loneliness Scale is an appropriate tool for measuring loneliness in the Iranian older adults.

The Role of Students with Practical Nursing Diplomas in the Process of Undergraduate Nursing Education: A Qualitative Study.

BACKGROUND: Awareness of the experiences of students and educators in the educational process plays an important role in facilitating and improving this process. This study aimed to explain and investigate the experiences of nursing educators and students about the presence of students with practical nursing diplomas in the process of undergraduate education. MATERIALS AND METHODS: In this qualitative study conducted from 2016 to 2018, which adopted a content analysis approach, 24 nursing students and educators of Lorestan University of Medical Sciences were selected using the purposive sampling method and were interviewed in depth. The data were manually recorded and analyzed using the Graneheim and Lundman method. RESULTS: The three main themes of "from contrast to alignment with professional competence," "peaceful coexistence in the educational process," and "reflection of the perceived reality of the clinical environment," along with six categories and 30 subcategories were extracted from the interviews. CONCLUSIONS: It seems that monitoring and managing undergraduate courses more thoroughly, as well as raising the awareness of educators about the positive and negative dimensions of the presence of nursing students with practical nursing diplomas in undergraduate nursing courses can make it possible to optimize and improve students' learning process.

Inter-professional ethical values in Iranian aged care: a qualitative study.

Aim Ethical values are the basis of the behaviour and performance of professional care staff. This study aimed to identify inter-professional ethical values in aged care. Methods This qualitative thematic content analysis study was conducted in Khorramabad, Iran, from September 2018 to June 2109, and 36 core members of the aged care team (including 24 nurses, 5 physicians, 3 physiotherapists, and 4 social workers) were selected through the purposive sampling method and interviewed in depth. The data were analysed using the directed content analysis and the method of Zhang and Wildemuth. Results Four main themes of providing professional care, preserving the integrity of the aged, observing the dignity of the aged, establishing human relationship, along with 21 subthemes were extracted as ethical values in aged care. Conclusion The results of this study indicate that providing ethical aged care is influenced by the specific conditions of this age group. In addition to general ethical values such as providing professional care, providing ethical aged care is based on ethical values such as promoting social interaction, promoting peace and comfort, preserving and promoting independence, and autonomy in aged care. Promoting collaborative care and paying more attention to the human dimensions of communication and interaction were other emphasized values.

The Use of a Nurse-Initiated Pain Protocol in the Emergency Department for Patients with Musculoskeletal Injury: A Pre-Post Intervention Study.

BACKGROUND AND AIM: As a common complaint of patients with traumatic injuries, pain remains undermanaged in emergency departments (EDs). Our aim was to evaluate the effects of a nurse-initiated pain management protocol in patients with musculoskeletal injuries in an ED in Iran. MATERIAL AND METHODS: This pre-post intervention design study was conducted on 240 patients with orthopedic injuries selected through sequential sampling over two phases. The intervention consisted of case study sessions and the implementation of the nurse-initiated pain management protocol. The outcomes were assessed based on the Numeric Rating Scale (NRS) pain scores, the pain management satisfaction questionnaire, the nursing performance checklist and the waiting time evaluation form. RESULTS: The mean pain intensity 30 and 60 min after triage and at discharge decreased significantly in the post-intervention group (p < .001). The patients' satisfaction with pain management (p < .01) and the nurses' performance (p < .001) improved in the post-intervention group. Waiting time: there was a significant reduction in the post-intervention group from the end of triage by the nurse to the visit by the physician, and from patient's arrival in ED to discharge or transferring, and also the time to initial analgesic. CONCLUSIONS: Education based on case study and the implementation of the nurse-initiated pain management protocol resulted in a significant increase in multimodal analgesia administration and a reduction in pain intensity, an increase in patient satisfaction, an improvement in the triage nurses' performance and the reduction of potential delays in pain management while maintaining the safety of patients with musculoskeletal trauma.

Factors associated with mental health of high-school students in the Islamic Republic of Iran.

BACKGROUND: Mental disorders of adulthood can be traced to childhood and adolescent disorders so attention to the mental health of young people is important. OBJECTIVES: We aimed to determine the mental health status of high-school students in Khorramabad and the factors that may affect it. METHODS: This cross-sectional study included 1 202 high-school students in Khorramabad in the 2015-2016 academic year. Students were selected using stratified and multistage cluster random sampling. Data were collected on sociodemographic characteristics of the students, and the General Health Questionnaire (GHQ-28) was used to assess symptoms of mental disorders. Logistic regression analysis was used to evaluate the relationship between the presence of symptoms of mental disorder and sociodemographic characteristics. RESULTS: The mean age of the students was 16.1 (SD 0.9) years and 52.7% were girls. Overall, 481 (40%) students (34% of males, 46% of females) had symptoms of mental disorders. Most had mild symptoms; 5% had severe symptoms. Symptoms of anxiety, depression and social impairment were seen in 40%, 33% and 32% of the students respectively; significantly more girls had these symptoms (P < 0.05). Female students, those in higher school grades, and those whose fathers were unemployed and mothers were housewives were significantly more likely to have symptoms of mental disorders (P < 0.05). CONCLUSIONS: This study found a high prevalence of symptoms associated with mental disorders in the adolescents in Khorramabad. Counselling centres in schools are needed to offer psychiatric counselling services to students and to implement regular mental health training programmes.

Ocular Motor Function in Patients with Bilateral Vestibular Weakness.

INTRODUCTION: Patients with bilateral weakness (BW) have many difficulties in gaze stability that interfere with their normal function. The aim of this study was to evaluate ocular motor functions in patients with BW to better understand the problem of gaze instability in these patients. MATERIALS AND METHODS: Patients were referred from the Otolaryngology Department for Vestibular Assessment to our clinic between November 2014 and March 2015. We assessed ocular motor function (gaze, saccade, and smooth pursuit) in patients over the age of 18 years with BW, as verified by a caloric test. RESULTS: Seventy-eight patients completed all the tests. The mean age of patients was 51.9 (±15.9) years, and 47 (60%) were female. Abnormal results were found in five (6.4%), 32 (41%), and seven (9%) patients with respect to gaze, smooth pursuit, and saccade, respectively. There were positive but relatively weak relationships between age and ocular motor results. CONCLUSION: Patients with BW suffer from dizziness and unsteadiness. These patients have abnormal function in ocular motor (especially smooth pursuit) tests. The ocular motor dysfunction is responsible for gaze instability in static positions such as standing.

The Effect of Acupressure on Pain and Anxiety Caused by Venipuncture.

The aim of this study was to determine the effect of massage of acupoints on pain and anxiety caused by venipuncture. In this double-blind clinical trial, 187 patients who were admitted to a hospital in Khorramabad, Iran, were selected and randomly divided into 3 groups: acupressure, placebo, and control. Blood samples were obtained twice from each patient in the 3 groups: once by the routine method from the left arm and once by performing interventions from the right arm. Results showed significant differences in pain scores (P = .004) between the 3 groups after the intervention only. No significant differences between the 3 groups were found after the intervention with regard to pulse rate, systolic blood pressure, or diastolic blood pressure (P > .05). The application of acupressure at the right acupoints may relieve pain caused by venipuncture. Although further studies are needed to confirm the findings of this study, it is recommended that nurses use this safe method to increase quality of nursing care and patient satisfaction.

Auditory steady-state response thresholds in adults with conductive and mild to moderate sensorineural hearing loss.

BACKGROUND: The Auditory steady state response (ASSR) provides a frequency-specific and automatic assessment of hearing sensitivity and is used in infants and difficult-to-test adults. OBJECTIVES: The aim of this study was to compare the ASSR thresholds among various types (normal, conductive, and sensorineural), degree (normal, mild, and moderate), and configuration (flat and sloping) of hearing sensitivity, and measuring the cutoff point between normal condition and hearing loss for different frequencies. PATIENTS AND METHODS: This clinical trial was performed in Iran and included patients who were referred from Ear, Nose, and Throat Department. A total of 54 adults (27 with sensorineural hearing loss, 17 with conductive hearing losses, and 10 with normal hearing) were randomly chosen to participate in our study. The type and degree of hearing loss were determined through testing by otoscopy, tympanometry, acoustic reflex, and pure tone audiometry. Then the ASSR was tested at carrier frequencies of 500, 1000, 2000, and 4000 Hz. RESULTS: The ASSR accurately estimates the behavioral thresholds as well as flat and sloping configurations. There was no correlation between types of hearing loss and difference of behavioral and ASSR thresholds (P = 0.69). The difference between ASSR and behavioral thresholds decreased as severity of hearing loss increased. The 40, 35, 30, and 35 dB could be considered as cutoffs between normal hearing and hearing loss for 500, 1000, 2000, and 4000 Hz, respectively. CONCLUSIONS: The ASSR can accurately predict the degree and configuration of hearing loss and discriminate the normal hearing from mild or moderate hearing loss and mild from moderate hearing loss, except for 500 Hz. The Air-conducted ASSR could not define the type of hearing loss.

Prevalence of nocturnal enuresis and its associated factors in primary school and preschool children of khorramabad in 2013.

Background. Nocturnal enuresis refers to an inability to control urination during sleep. This study aimed to determine the prevalence of nocturnal enuresis and its associated factors in children in the city of Khorramabad. Materials and Methods. In this descriptive-analytic, cross-sectional study, 710 male and female children were divided into two groups with equal numbers. The samples were selected from the schools of Khorramabad using the multistage cluster and stratified random sampling methods based on the diagnostic criteria of DSM-IV. The data was analyzed using the logistic regression. Results. The results showed that 8% of the children had nocturnal enuresis, including 5.2% of primary nocturnal enuresis and 2.8% of secondary nocturnal enuresis. The prevalence of nocturnal enuresis in the boys (10.7%) was higher compared with that in the girls (5.4%) (P = 0.009). There were statistically significant relationships between nocturnal enuresis and history of nocturnal enuresis in siblings (P = 0.023), respiratory infections (P = 0.036), deep sleep (P = 0.007), corporal punishment at school (P = 0.036), anal itching (P = 0.043), and history of seizures (P = 0.043). Conclusion. This study showed that the prevalence of nocturnal enuresis in the boys was higher compared with that in the girls.

Seidlitzia rosmarinus for lower urinary tract symptoms associated with benign prostatic hyperplasia: a pilot randomized controlled clinical trial.

OBJECTIVE: This study was performed to investigate the effect of Seidlitzia rosmarinus on the clinical symptoms of benign prostatic hyperplasia. METHODS: This single-blind clinical trial included 98 patients with voiding and storage symptoms in Shohada Ashayer Hospital of Khorramabad. The patients were randomly divided into two groups of treatment with prazosin 1mg/day plus Seidlitzia rosmarinus 3g/day and treatment with prazosin 1mg/day. The clinical symptoms were measured using the International Prostate Symptoms Score (IPSS) questionnaire. Serum prostate-specific antigen (PSA) level, prostate volume, and residual urine volume before and 2 months after the intervention were measured. RESULTS: The results of the study before the intervention did not show significant differences between the prazosin and Seidlitzia rosmarinus plus prazosin groups for the scores of clinical symptoms, PSA level, prostate volume, and residual urine volume (p>0.05). However, significant differences were found between the two groups after the intervention for the mean change scores of clinical symptoms (6.8 scores in the Seidlitzia rosmarinus group vs. 2 scores in the control group) (p<0.001), while no significant differences were found for the mean change scores of PSA level, prostate volume, and residual urine volume (p>0.05). CONCLUSION: The results of the study showed that the simultaneous consumption of Seidlitzia rosmarinus and prazosin, compared to the consumption of prazosin alone, results in significant improvements in the clinical symptoms of benign prostatic hyperplasia.

The Effects of Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns after Cesarean Delivery.

Background. The skin-to-skin contact (SSC) of mother and newborn is uncommon full-term newborns after delivering via cesarean section due to the possibility of hypothermia in the infants. The aim of this study was to compare mothers' and infant's temperatures after delivering via cesarean section. Material and Methods. In this randomized clinical trial, 90 infant/mothers dyads delivered via cesarean section were randomized to SSC (n = 46) and routine care (n = 44). In experimental group, skin-to-skin contact was performed for one hour and in the routine group the infant was dressed and put in the cot according to hospital routine care. The newborns' mothers' temperatures in both groups were taken at half-hour intervals. The data was analyzed using descriptive statistics, t-tests, and chi-square tests. Results. The means of the newborns' temperatures immediately after SSC (P = 0.86), half an hour (P = 0.31), and one hour (P = 0.52) after the intervention did not show statistically significant differences between the two groups. The mean scores of the infants' breastfeeding assessment in SSC (8.76±3.63) and routine care (7.25±3.5) groups did not show significant differences (P = 0.048). Conclusion. Mother and infant's skin-to-skin contact is possible after delivering via cesarean section and does not increase the risk of hypothermia.

The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services.

INTRODUCTION: Quality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today's workers. This study was conducted to investigate the effect of implementation of quality circles on nurses' quality of work-life and job satisfaction. MATERIALS AND METHODS: In this study, two emergency medical services (EMS) of Hamedan province were selected and randomly assigned as the experimental and control groups. After the experimental group was trained and quality circles were established in this group, the levels of quality of work-life and job satisfaction were measured in the two groups. Then, the statistical analyses were performed using t-test. RESULTS: After the intervention, the results showed significant differences between the scores of motivational factors (p=0.001), the total scores of job satisfaction (p=0.003), and the scores of some quality of work life (QWL) conceptual categories including the use and development of capacities (p=0.008), the total space of life (p=0.003), and the total scores of QWL (p=0.031) in the experimental group compared to those in the control group. CONCLUSION: This study confirms the effectiveness of quality circles in improving quality of work-life and job satisfaction of nurses working in EMS, and offers their application as a management method that can be used by EMS managers.