Missed nursing care in emergency departments: a cross-sectional descriptive study.

BACKGROUND: Missed care refers to the omission or delay in performing any aspect of patient's care (either a part of the care or the entire care). Currently, missed care has become a growing concern at the international level, which threatens the quality and safety of care and cases many unwanted consequences. This study aims to investigate the frequency and types of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences. METHODS: This is a cross-sectional and descriptive- observational study that was conducted with the aim of determining the frequency and types of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences from January 2020 to June 2020. The research community included all nursing care offered in the designated areas, as well as all nurses working in the emergency departments of selected hospitals. Finally, 146 nurses were selected by census method. The information was collected by self-reporting method and the researcher's observation. Demographic information questionnaire, a researcher-made checklist were used to determine the frequency and types of missed nursing care. 384 observations were made for each item. Descriptive statistics methods were used to analyze the data. RESULTS: The area of checking equipment and emergency trolley(mean = 81.80) had the lowest and the area of patient communication(mean = 55.72) had the highest level of missed care. CONCLUSIONS: The level of missed nursing care in the emergency departments of selected hospitals affiliated to Tehran University of Medical Sciences was found to be high and the highest amount was related to the field of communication with the patient. Therefore, it is recommended that the details of missed nursing care in each area should be considered by nursing managers.

Effectiveness of Peer-Based and Conventional Video Education in Reducing Perioperative Depression and Anxiety Among Coronary Artery Bypass Grafting Patients: A Randomized Controlled Trial.

PURPOSE: Depression and anxiety are common comorbidities in patients undergoing coronary artery bypass grafting (CABG), with potential adverse effects on surgical outcomes. Effective interventions to reduce depression and anxiety in these patients are therefore warranted. This study investigated the effectiveness of peer-based video education compared to conventional video education in reducing perioperative depression and anxiety in CABG patients. DESIGN: A three-arm, parallel, randomized, controlled trial design was employed. METHODS: A total of 114 participants were randomly assigned to 1 of 3 groups (n = 38 per group): standard education (control), conventional video education, and peer-based video education. State anxiety levels were measured using the Spielberger State Anxiety Questionnaire at 1 day before surgery (baseline), 1 hour before surgery, and 4 weeks after surgery. Depression levels were measured using the Beck Depression Inventory Short-Form at baseline and 4 weeks after surgery. Statistical analyses, including χ2, Fisher's exact test, one-way analysis of variance, and repeated-measures analysis of variance, were applied to analyze the collected data. FINDINGS: Both peer-based and conventional video education groups demonstrated lower preoperative anxiety levels compared to the control group. However, only the peer-based video education group exhibited a statistically significant difference (P < .05). Four weeks after surgery, anxiety and depression levels decreased in all participants compared to baseline, with no statistically significant differences among the three groups. CONCLUSIONS: Our findings suggest that peer-based video education is more effective in controlling preoperative anxiety in patients undergoing CABG than conventional video education and standard education. Moreover, video-based education, whether conventional or peer-based, appears to be as effective as standard education in reducing anxiety and depression 4 weeks after CABG surgery. Further research is warranted to investigate the influence of content and presentation methods on patient outcomes and explore the potential long-term benefits of video-based education in promoting patient care.

Effect of patient-centered and family-centered self-care education program on the quality of life of patients with multiple sclerosis: a quasi-experimental study.

BACKGROUND: Performing self-care behaviors education improves the quality of life of MS patients and reduces their fatigue. This study was conducted with the aim of comparing the effect of patient-centered and family-centered self-care training programs on the quality of life and fatigue of patients with multiple sclerosis. METHODS: This is a quasi-experimental study that was conducted on the MS patients referred to the Iranian MS Association. Sampling was done by convenience method from November 2017 to September 2018. To create a random sequence in the three groups, blocks of nine were used. The control group received no intervention but the intervention groups 1 and 2 received the desired training in the form of workshop with the difference that in the intervention group 2, the patient participated in the training sessions along with one of his/her family members. The phone call follow-up was continued for 8 weeks after the last session. The questionnaire of quality of life in patients with MS (MSQOL-54), fatigue scale (FIS) and demographic information form were used for data collection. The collected data was analyzed by SPSS-16 statistical software, using descriptive (Mean and Standard deviation) and statistical statistics (paired t-test, Analysis of variance and Bonferroni). RESULT: A statistically significant difference in the mean scores of quality of life(53/16 ± 15/19 vs 56/03 ± 14/40 vs 52/48 ± 21/20)(P < 0.001) and fatigue(50/08 ± 3/28 vs 46/54 ± 28/69 vs 56/11 ± 27/93) (P < 0.001) was observed between both patient-centered and family-centered groups and the control group. CONCLUSIONS: Considering the importance and role of the family and nurses in the care and education of patients with multiple sclerosis, it is possible to improve the quality of life and reduce their fatigue by providing self-care training packages to patients and their families.

Transformational leadership in development of transformative education in nursing: a qualitative study.

BACKGROUND: Regarding the dynamic and increasing needs of communities, changes in the education system are essential to train competent healthcare professionals. The study aimed to explore the experience of educational directors, teachers, and students to gain insight into the implementation of educational transformative programs. METHOD: A qualitative approach with the grounded theory method was applied in this study. Twenty-four participants were selected by using a purposive and theoretical sampling method. The data were collected from April 2019 to May 2020 in nursing schools of Tehran, through in-depth semi-structured individual face-to-face interviews and field notes. Collected data were analyzed by Corbin and Strauss's (2015) approach. RESULTS: In this study, transformational leadership was extracted as the core concept. The core concept emerged from four sub-concepts including transformative management; educational policy requirements; providing a platform and community-centered education. CONCLUSIONS: Nurse educational directors need to achieve some competencies and capabilities for implementing transformative education in nursing schools. Also, achieving a transformative perspective by educational directors is essential.

The formation of health-related procrastination in patients with type-2 diabetes: a grounded theory research.

Considering the adverse effects of procrastination on the care and treatment of patients with type-2 diabetes, examining the how, why, and contributing factors of procrastination in this group of patients through in-depth studies seems essential. This is a grounded theory research in which 28 participants were selected by theoretical purposive sampling from patients with type-2 diabetes, their families, and healthcare personnel. Data were collected through interviews, observations, field notes and memos. The data were analyzed using Corbin and Strauss approach (2015) and MAXQDA 2010 software. The data obtained were classified into seven main categories. Health-related procrastination in patients with type-2 diabetes began to form in the patients when they perceived the hardships of self-care as their main concern. The ominous shadow of the disease, the prison of family care, patient-related factors, health system shortfalls, sociocultural background, and the onslaught of the COVID-19 pandemic laid the groundwork for abandoning diabetes self-care. Patients tried to abandon their diabetes self-care by adopting strategies such as escaping the reality of the disease, self-medication and procrastination. Wavering health-related procrastination was identified as the central category of this research. The formation of health-related procrastination in patients with type-2 diabetes is a multidimensional process depending on the patients' background that consists of their interactivity with their family, the health system, and the society. The findings of this research can be used for the design, implementation and monitoring of treatment and care programs for these patients.

Types of health-related procrastination in patients with type-2 diabetes: a qualitative content analysis.

Background and objectives: Health-related procrastination refers to a delay in the performance of health-related activities, which is a rather neglected subject despite being critical. Due to the adverse effects of procrastination on the care and treatment of patients with type-2 diabetes, it is necessary to explore procrastination among this group of patients through in-depth studies. The present research was conducted to explain different types of health-related procrastination in patients with type-2 diabetes. Materials and methods: This qualitative study applied content analysis with 13 patients with type-2 diabetes selected via purposive sampling. Data were collected through individual and semi-structured interviews. The data were then analyzed using Lundman and Graneheim content analysis method. Findings: Based on the analysis of the data, instances of health-related procrastination in patients with type-2 diabetes were classified into six main categories, including minimizing self-care, poor adherence to treatment, poor nutritional habits, poor adherence to drug regimen, disregard for disease monitoring, and a sedentary lifestyle. Conclusions: The results of this study provide an in-depth understanding of the various forms of health-related procrastination in patients with type-2 diabetes. These findings can be employed in the design, implementation, and monitoring of treatment and care programs targeting these patients.

Knowledge and practice of nursing students regarding bioterrorism and emergency preparedness: comparison of the effects of simulations and workshop.

BACKGROUND AND PURPOSE: Bioterrorism is a global threat. Nurses are one of the first groups that should be ready for it. College years are the best time to educate these issues. This study aimed to compare the effectiveness of simulation and workshop on knowledge and practice of nursing students regarding bioterrorism. MATERIALS AND METHODS: This was an experimental study. The study sample consisted of 40 last-year nursing students who were randomly assigned to two groups by using random numbers table. Data was collected using a demographic questionnaire, bioterrorism knowledge scale, and an OSCE checklist. Before the intervention, the students completed the study questionnaires and a six-station OSCE test. The workshop group (20 students) learned how to deal with bioterrorism through lectures. The simulation group (20 students) participated in a simulation learning program. After one month, the students completed the study tools again. Finally, collected data were analyzed using descriptive and inferential statistics in SPSS V.16. RESULTS: The difference between the knowledge and performance scores of both groups (workshop and simulation), before and after the intervention, was statistically significant (P < 0.001). Students in both groups had higher knowledge and performance scores after the intervention. The simulation group scores were higher than the workshop group scores in the knowledge and the most of performance domains. CONCLUSION: The simulation group had better results in terms of enhancing knowledge, preparedness, disaster triage, reporting, incident management, communication, mental disorders, and isolation domains compared to the workshop group.

Effective factors and challenges of forming transformational education in the nursing education system: a qualitative study.

OBJECTIVES: In the nursing education system, evolution is required to train qualified and professionally competent nurses who can face workplace challenges and evolving needs of societies. This study aimed to explore effective factors and challenges of the formation of transformational education in the nursing education system. METHODS: This was a qualitative study with a grounded theory approach. Twenty-four individuals participated through purposive and theoretical sampling. The authors collected data using semi-structured interviews and analyzed them by Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th ed.). Los Angeles: Sage Publication grounded-theory method. RESULTS: Findings showed the process of formation of transformational education which encompasses four concepts including, "transformational leadership", "effective learning", "necessity of foresight in education", and "inhibitors of educational transformation". Transformational education is a complex and multidimensional education. CONCLUSIONS: Implementation of this education requires preparing transformational leaders, planning to empower faculty members and students, and preparing for the challenges facing the education system.

The stakeholders' perceptions of the requirements of implementing innovative educational approaches in nursing: a qualitative content analysis study.

BACKGROUND: Improving the competencies of nurses requires improving educational methods through the use of novel methods in teaching and learning. We aim to explore the perceptions of stakeholders (including nursing education directors, faculty members and nursing students) of the requirements of implementing innovative educational approaches in nursing. METHODS: In this qualitative descriptive study, 19 participants, including educational directors, faculty members, and undergraduate and graduate nursing students, were selected through the purposeful sampling method. Achieving the theoretical saturation in extracted categories was considered as a criterion for determining the sample size and the completion of sampling. The data were collected from December 2019 to May 2020 in nursing schools of Tehran, Iran, through in-depth semi-structured individual face-to-face interviews and were then analyzed based on the Graneheim and Lundman method. RESULTS: Using qualitative content analysis, eight sub-themes and three themes were extracted. The extracted themes were 'novel educational policymaking', 'Innovative education-oriented platform', and 'managing barriers of innovative educational approaches'. CONCLUSIONS: Developing and implementing innovative educational approaches entail providing appropriate context, structure, and required facilities by the policymaking system and educational authorities. In addition, developing capacity and related competencies of faculty members and students as the major stakeholders in employing these approaches is crucial.

Cold Therapy and Respiratory Relaxation Exercise on Pain and Anxiety Related to Chest Tube Removal: A Clinical Trial.

BACKGROUND: Current strategies to control pain and anxiety of chest tube removal are not efficacious. The aim of this study is to determine the effects of cold therapy and respiratory relaxation exercise on pain and anxiety of chest tube removal. MATERIALS AND METHODS: A parallel single-blind clinical trial study was conducted in Imam Khomeini Hospital, Iran, on 120 patients. Participants were randomized into 4 groups of 30. Numeric Rating Scale was used to assess pain and anxiety. One-way ANOVA test and Fisher's exact test were used to analyze demographic data. The Kruskal-Wallis test was used to compare the severity of pain and anxiety between groups; the Friedman and Mann-Whitney test were used to compare the severity of pain and anxiety within groups with a significance level of 0.05. RESULTS: Pain intensity was weak before chest tube removal and there was no significant difference in basal pain. Pain immediately after chest tube removal was significantly higher than other times in each group (χ 2 = 57.16, χ 2 = 63.70, χ2 = 46.49, χ 2 = 59.04, df = 3, p < 0.001). There was no significant difference in pain score immediately (p = 0.052) and 15 min (p = 0.329) after Echest tube removal in experimental groups compared to the control group. No significant difference was found between control and experimental groups in anxiety score immediately (p = 0.995) and 15 min (p = 0.976) before chest tube removal. CONCLUSIONS: Mentioned methods were not effective in reducing pain and anxiety. It is suggested to investigate effects of different methods of removing chest tubes and applying cold with a larger sample size.

Comparison of the Effect of Enteral Feeding through the Bolus and Continuous Methods on Serum Phosphorus and Glucose Levels in Patients with Mechanical Ventilation: A Randomized Clinical Trial.

INTRODUCTION: Patients who are under mechanical ventilation in intensive care units need to have nutritional support. Also, feeding methods affect serum phosphorus and glucose levels, which are very important in weaning patients off the ventilator. Thus, this study is to compare the effects of both bolus and continuous enteral feeding methods on serum phosphorus and glucose levels in patients with mechanical ventilation. METHODS: In this clinical trial study, 34 patients in the intensive care unit of Imam Khomeini Hospital affiliated to the Tehran University of Medical Sciences satisfied inclusion criteria and were randomly divided into control and intervention groups. Sampling was done between October and February 2018. The intervention group received continuous enteral feeding for one week, and the control group received nutrition by the bolus method. The blood glucose level was measured every six hours, and the serum phosphorus level was recorded at the beginning and the end of the intervention, based on the data entry form with respect to all ethical considerations. Data analysis was done by SPSS-20 software. RESULTS: The serum phosphorus level was significantly increased in the intervention group (P=0.004) and in the control group (P < 0.001) and was compared with the previous intervention. No significant difference was found between the intervention and control groups before and after the intervention (P=0.22) and also one week after the intervention (P=0.14). There was also no significant difference between the glucose levels from day 1 to day 7 in the control group (P=0.33) and the intervention group (P=0.086). Discussion. Nutritional support in both bolus and continuous methods increased the serum phosphorus level. It indicates the importance of the nutritional method in controlling the phosphorus level in critically ill patients. However, there was no difference between the effects of dietary methods on blood glucose control.

Equity in nursing care: A grounded theory study.

BACKGROUND:: Equity in providing care is also a major value in the nursing profession. Equitable care aims to provide the entire population with safe, efficient, reliable, and quality nursing services at all levels of health. OBJECTIVES:: This study was conducted to explain the process of the realization of equity in nursing care. RESEARCH DESIGN:: This qualitative study uses Glaser's approach to grounded theory. PARTICIPANTS AND RESEARCH CONTEXT:: Sample selection began with convenience sampling and continued with purposive sampling. A total of 27 people were ultimately selected as the study subjects. Data were mainly collected through unstructured in-depth individual interviews plus observation and field notes. The data were then analyzed using the "Six C's" coding family of Glaser. ETHICAL CONSIDERATIONS:: The study protocol was approved by the Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all subjects. FINDINGS:: According to the findings, participants' main concern in providing equitable care is the rationing of nursing care. The identification of participants' main concern led to the emergence of the core category of the study, that is, "nurses' domination." The other categories revolving around the core category were conceptualized according to the six C's coding family: "nurses being dominated," "nurses' ineffective power in the health system," "low attention to equitable care in health system," "lack of clarity in measuring equitable care," "the health structure's inconsistency with equity," and "the inefficiency of the care system." CONCLUSION:: There is a mutual relationship between providing fair care and nurses' perceptions of equity. Nurses who have themselves experienced equity can provide their patients the experience of equity. This mutual relationship is actualized in a context in which fair care is clearly defined and demanded.

Ethics of rationing of nursing care.

BACKGROUND: Rationing of various needed services, for example, nursing care, is inevitable due to unlimited needs and limited resources. Rationing of nursing care is considered an ethical issue since it requires judgment about potential conflicts between personal and professional values. OBJECTIVES: The present research sought to explore aspects of rationing nursing care in Iran. RESEARCH DESIGN: This study applied qualitative content analysis, a method to explore people's perceptions of everyday life phenomena and interpret the subjective content of text data. Data collection was performed through in-depth, unstructured, face-to-face interviews with open-ended questions. Participants and research context: The study population included Iranian nurses of all nursing positions, from clinical nurses to nurse managers. Purposive sampling was employed to select 15 female and 3 male nurses (11 clinical nurses, 3 supervisors, 1 matron, 1 nurse, and 2 members of the Nursing Council) working in hospitals of three cities in Iran. Ethical considerations: The study protocol was approved by Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all participants. FINDINGS: According to the participants, rationing of nursing care consisted of two categories, that is, causes of rationing and consequences of rationing. The first category comprised three subcategories, namely, patient needs and demands, routinism, and VIP patients. The three subcategories forming the second category were missed nursing care, patient dissatisfaction, and nurses' feeling of guilt. CONCLUSION: Levels at which healthcare practices are rationed and clarity of the rationing are important structural considerations in the development of an equal, appropriate, and ethical healthcare system. Moreover, the procedure of rationing is critical as it not only influences people's lives but also reflects the values that dominate in the society. Therefore, in order to minimize the negative consequences of rationing of nursing care, further studies on the ethical dimensions of this phenomenon are warranted.

Nurses, the Oppressed Oppressors: A Qualitative Study.

Healthcare equity, defined as rightful and fair care provision, is a key objective in all health systems. Nurses commonly experience cases of equity/inequity when caring for patients. The present study was the first to explain nurses' experience of equal care. A qualitative study sought to describe the experiences of 18 clinical nurses and nurse managers who were selected through purposive sampling. The inclusion criteria were the nurses' familiarity with the subject of the study and willingness to participate. The data were collected through in-depth, unstructured, face-to-face interviews. The sampling continued up to data saturation. All the interviews were recorded and then transcribed word by word. The data were analyzed using thematic analysis. The major theme extracted in this study was the equation between submissiveness and oppression in nurses. It had two subthemes, namely the oppressed nurse and the oppressive nurse. The first subtheme comprised three categories including nurses' occupational dissatisfaction, discrimination between nursing personnel, and favoring physicians over nurses. The second subtheme consisted of three categories, namely habit-oriented care provision, inappropriate care delegation, and care rationing while neglecting patient needs. When equal care provision was concerned, the participating nurses fluctuated between states of oppression and submissiveness. Hence, equal conditions for nurses are essential to equal care provision. In fact, fair behavior toward nurses would lead to equity nursing care provision and increase satisfaction with the healthcare system.

Components of equity-oriented health care system: perspective of Iranian nurses.

Equity in health is one of key objectives in health care systems world wide. This study aimed to explain the perspective of Iranian nurses about equity in the health care system. A qualitative exploratory design with thematic analysis approach was used to collect and analyze data. Using a purposeful sampling helped the researchers to recruit 16 eligible participants. Data were collected via in-depth semi-structured interviews. Five main categories were extracted through data analysis process including (1) inequity against the nurse, (2) the recommended patient, (3) no claim for equity-oriented care in health system, (4) physicians' dominancy system; and (5) the need to define criteria to measure equity-oriented care. All health care systems around the world struggle to establish equity-oriented care. In perspective of Iranian nurses, the reform of structures in the health system is possible through providing the context of equitable care for caregivers and care recipients. Health system should commit the flow of equity at all of its levels. It should utilize policies to claim equity and consider the interests of all beneficiaries. Furthermore, certain criteria should be defined for equity-oriented care in the health care system, and also provides the possibility to measure and monitor it.