Ageism and lookism as stereotypes of health disparity in intensive care units in Iran: a critical ethnography.

BACKGROUND: The intensive care unit presents structural complexities, and the prevailing power imbalance between patients and staff can lead to health disparities. Hence, unveiling the underlying factors that give rise to and reinforce these disparities can contribute to their prevention. This study aims to shed light on the stereotypes linked to ageism and lookism, which perpetuate health disparities within the intensive care unit setting in Iran. METHODS: This critical ethnographic study employed Carsepkan's approach and was carried out in intensive care units in the west of Iran from 2022 to 2023. The data collection and analysis were conducted through three interconnected stages. In the initial stage, more than 300 h of observations were made at the research site. In the subsequent stage, a horizon analysis was performed. Conversations with 14 informants were conducted in the final stage to enrich the dataset further. Then the analysis process was carried out as in the previous step to uncover an implicit culture of health disparity. To verify the validity and reliability of the study, credibility, conformability, dependability, and transferability were all taken into account. FINDINGS: The ageism and lookism stereotypes emerged from seven main themes; youth-centric; negative ageism; age-friendliness; age-related priority; centered care for pediatric patients and families; appearance-centeredness; and a contradiction between belief and behavior. CONCLUSION: This critical study showed that ageism and lookism stereotypes permeated the intensive care unit's culture. These stereotypes have the potential to influence equality dynamics, as well as to foster and support health disparity in the intensive care unit.

Family engagement in the care of infectious patients in intensive care units: A hybrid concept analysis.

AIM: This study aims to define and investigate characteristics, antecedents, and consequences of the concept of family engagement in caring for patients with infectious diseases hospitalised in intensive care units. DESIGN: This is a three-phase hybrid model study (theoretical, fieldwork, and analytical phase). METHODS: The York University Guidelines were used in the theoretical phase, and ultimately, 16 pieces of literature related to the subject under study from 2011 to 2021 were reviewed. The content analysis was used for fieldwork phases; eight participants were interviewed. Then, the theoretical and fieldwork findings were compared, integrated, and analysed. RESULTS: This concept has characteristics such as; awareness, belief, perception, and willingness of the nurse to engage the family; a sense of responsibility, willingness, and sacrifice of the family; the physical or virtual presence of the family; triangular interaction between the nurse, patient, and family; perception and identifying the goals; education and information transfer; team collaboration; delegation of responsibility to the family; decision making; and protection of the family. Antecedents include the availability of infrastructure; patient, family, and nurse conditions; and the quality implementation of engagement. The consequences include positive consequences related to the patient, family, nursing, and society, as well as some negative consequences. This study provided a comprehensive perception of family engagement in the care of patients with infectious diseases in intensive care units and defined it more clearly, showing its characteristics, antecedents, and consequences. PATIENT OR PUBLIC CONTRIBUTION: Eight participants were interviewed, including five nurses, two family caregivers, and one patient.

Comparison of the effect of mint extract and chamomile drops on the gastric residual volume of traumatic patients under mechanical ventilation and nasogastric tube feeding in the intensive care unit: A triple -blind, randomized, crossover trial.

Objective: Mint and chamomile can effectively reduce the gastric residual volume (GRV). This study aimed to determine the effect of mint extract and chamomile drops on the GRV of trauma patients under mechanical ventilation and nasogastric tube feeding in the intensive care unit. Materials and Methods: This study was a triple-blinded randomized clinical trial with a 2×2 crossover design. Eighty patients were randomly divided to receive mint extract and chamomile drops. Five drops of mint extract and 11 drops of chamomile were gavaged every 6 hr. GRV was measured using a syringe-aspiration method before and 3 hr after each intervention. After a 24-hour washout period, the two groups changed places. Results: In the first phase of the study, before the interventions, the GRV in the mint and chamomile groups was 14.60±7.89 and 13.79±7.12 ml, and after the interventions were 8.13±6.31 and 6.61±4.68 ml, respectively. In the study's second phase, before the interventions, the GRV in the mint and chamomile groups was 10.03±4.93 and 11.46±7.17 ml and after the interventions, GRV was 4.97±4.05 and 6.98±4.60 ml, respectively. The difference in the GRV before and after the intervention was not significantly different between the two groups. Both herbal drugs effectively reduced the GRV (p=0.382). Conclusion: Mint extract and chamomile drops are similarly effective in reducing the GRV in trauma patients under mechanical ventilation and nasogastric tube (NGT) feeding in the intensive care unit.

Exploration of the Strategies of Iranian Nurses in Providing Palliative Care to Children with Cancer: A Qualitative Study.

AIM: This study aimed to explain the strategies of Iranian nurses in providing palliative care to children with cancer. METHOD: This study is a qualitative research with an approach to the conventional content analysis. The main participants were nine nurses working in ward pediatric oncology. Also based on data analysis, five parents of children, two children, one social worker, one physician, one psychologist, and one nutritionist were also included. Data were collected through semi-structured interviews and observation and were analyzed by the Elo and Kyngäs approach. Lincoln and Guba criteria were used for the trustworthiness of data analysis. RESULTS: Three conceptual categories were developed with qualitative analysis: "prevention and relief of pain and physical symptoms", "spontaneous compassion", and "strengthen parental resilience"; that were derived from the main categories: "attention to precautionary considerations," "friendly relationship of nurses with parents of children, create enjoyable moments, spontaneous assistance," "facilitate coping with current situation, perceived confrontation with child death." CONCLUSION: In this study, the results showed that nurses' strategies in providing palliative care to children with cancer were a combination of professional and spontaneous strategies.

Changes in the prehospital emergency technician's resilience during the COVID-19 pandemic: A web-based cross-sectional study.

Background and Aims: Resilience is a process that enables people to control the stressors of their lives. During the COVID-19 crisis, work stress increased among prehospital emergency technicians. So, it was possible to reduce their resilience. This study aimed to investigate the changes in the prehospital emergency technicians' resilience during the pandemic of COVID-19. Methods: A cross-sectional study was conducted at the prehospital emergency department in Qazvin province. For 6 months, 234 emergency technicians participated in this study. Data collection tools included a demographic questionnaire and the emergency medical services resilience scale (EMSRS). Results: The Friedman test indicated no significant difference between the mean scores of EMS employees' resilience during 6 months (p > 0.05). However, the correlation matrix between the scores of EMSRS during 6 months indicated that the resilience scores of EMS employees were positively correlated during the study (p < 0.01). Conclusions: The EMS technicians' resilience was almost constant and moderate during the 6 months of care for patients with COVID-19 and their transfer to the hospital, indicating that the COVID-19 crisis could suppress the emergency medical technicians ability to increase resilience.

The relationship between the emergency nurses' sleep quality and the sleep quality of their spouses: A cross-sectional descriptive-analytical study.

Background and Aims: Due to the heavy working shifts, emergency nurses may have to sleep at unusual times of the day, affecting their spouse's sleep. This study proposed to detect the relationship between the woman emergency nurse's sleep quality and the sleep quality of their spouses. Methods: This cross-sectional descriptive-analytical study has lasted for 4 months since June 21, 2020. The study population was all women nurses working at a hospital emergency department. The data was collected by a demographic questionnaire and Pittsburgh sleep quality index (PSQI) for nurses and their spouses. The data were analyzed by descriptive and inferential statistics. Results: The prevalence of sleep quality disorder among female emergency department nurses and their husbands was 82.7% and 80.6%, respectively. The mean sleep quality score of female nurses and their husbands was 8.46 ± 4.43 and 6.50 ± 2.52, respectively. A strong and positive correlation was found between the PSQI score of female nurses and their husbands (p < 0.001). The regression model showed that increasing the body mass index (BMI) of female emergency nurses can decrease their sleep quality. However, increasing the BMI of female emergency nurses' spouses and their work experience in the emergency department can improve their sleep quality. Conclusion: The sleep quality of female emergency department nurses was directly correlated with their husbands' sleep quality. Therefore, the sleep quality of nurses working in the emergency departments and their spouses should be examined periodically.

Palliative care strategies of Iranian nurses for children dying from cancer: a qualitative study.

Background: Children with cancer, who are at the end-of-life and facing death, need access to palliative care services, and nurses play an important role in providing these services. Aims: To explore the palliative care strategies of Iranian nurses for children dying from cancer. Methods: This was a qualitative study with conventional content analysis. Participants were 8 nurses, 1 social worker, 1 psychologist, 2 children, and 4 mothers from the Paediatric Oncology Unit in Semnan, Islamic Republic of Iran, who had experience in palliative care for children with cancer. Data were collected from individuals using in-depth, unstructured and semi-structured interviews and analysed using the Graneheim and Lundman approach. Data rigour increased with credibility, dependability, transferability, and confirmability criteria. Results: Data analysis led to the emergence of the concept of "perceived compassion". This theme was derived from the 2 main categories of "feeling the shadow of death on the child" and "comforting accompaniment". Feeling the shadow of death on the child included the subcategories of "pre-death arrangements" and "an opportunity to continue interactions". Comforting accompaniment was derived from 3 subcategories: "preparing to announce the child's death", "extra-role sympathy" and " post-death interactions". Conclusion: Perceived compassion was the main strategy used by Iranian nurses to provide palliative care to children dying from cancer.

Assessing the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care.

BACKGROUND: Management of cancer complications requires the provision of palliative care as a comprehensive care by the main and trained members of this method of care. The aim of the present study was to assess the compliance of educational curricula of selected disciplines with the content standards of cancer-related palliative care. MATERIALS AND METHODS: In this descriptive-comparative study, the content standards of palliative care for nurses, physicians, and social workers were identified based on the World Health Organization guideline and Oxford Textbook of Palliative Nursing. For this purpose, a separate checklist was prepared for the disciplines with different dimensions. Then the face and content validity of the checklists were checked. Finally, we examined the coordination between selected curricula available on the website of Education Deputy of the Ministry of Health, Treatment and Medical Education with the dimensions of the checklists. RESULTS: All three curricula in most domains were relevant with the content standards, but there was the biggest education need in the areas related to the dimensions of "planning and educational," "educating physician in palliative care," and "considering patient preferences" in these disciplines. CONCLUSIONS: To meet the educational needs, it is suggested to change some course topics, hold training courses, or joint workshops.

The Effect of Psychological Hotwash on Resilience of Emergency Medical Services Personnel.

INTRODUCTION: Emergency medical services (EMS) personnel are exposed to stress. Job stress in EMS personnel can reduce their resilience and have adverse effects on their clinical performance and mental health, thus reducing the quality of their work. The present research was performed to determine the effect of psychological hotwash on resilience of emergency medical services personnel. METHODS: This study was a quasiexperimental. Sixty-four EMS personnel were randomly divided into two groups of hotwash and control. The psychological hotwash program was performed in the intervention group for a month based on the protocol; however, the control group continued their usual work and received no intervention. A day and six weeks after the psychological hotwash in the intervention group, the resilience of the EMS personnel was remeasured in both groups. RESULTS: Before the intervention, the participants' mean resilience score was 138.37 ± 7.04 in the intervention group and 137.34 ± 8.48 in the control group. There was a statistically significant difference between the mean scores of resilience in the intervention and control groups a day after the intervention (P=0.003). There was no statistically significant difference between the mean scores of resilience in the intervention and control groups 6 weeks after the intervention (P=0.102). CONCLUSION: The EMS personnel's attendance at psychological hotwash sessions could increase their resilience. Nevertheless, the sessions should not be interrupted because the 6-week interruption of the sessions caused the nonsignificant scores of resilience in the hotwash and control groups. Hence, it is recommended to continue the investigation of the effects of hotwash on resilience, stress reduction, and job burnout reduction in EMS personnel by other researchers in different settings.

Compliance of palliative care standards in children with cancer in select Middle Eastern countries: a comparative study.

BACKGROUND: Palliative care is one of the necessary elements in the treatment of children with cancer. Adaptation of country-specific palliative care practices to universal standards can provide valuable information for health care stakeholders. AIM: This study proposed to evaluate the global compliance of palliative care for children with cancer among select Middle Eastern countries. METHODS: In this comparative study, information about palliative care principles in Iran, Jordan, Saudi Arabia, Lebanon and Turkey was extracted from the literature. Data were collected using a checklist based on the conceptual framework of palliative care inspired by Wolff and Browne's (2011) standards. Then the extracted information was compared and analysed. FINDINGS: The palliative care standards in the selected countries did not show full compliance with global standards. In all selected countires, the child's and family's needs were considered, and a comprehensive care approach was followed. However, in none of the selected countries was the child's agreement to discharge from the hospital obtained, and neither was it ensured that the needs of the child and family were met. CONCLUSIONS: Palliative care principles in the selected Middle Eastern countries are far from meeting universal standards. Accordingly, planning and training are recommended in different domains of nursing education as well as clinical nursing in the care of children. Healthcare authorities and politicians must provide the appropriate conditions for better provision of palliative care for children with cancer.

Comparing the Ability and Accuracy of mSOFA, qSOFA, and qSOFA-65 in Predicting the Status of Nontraumatic Patients Referred to a Hospital Emergency Department: A Prospective Study.

INTRODUCTION: This study was proposed to compare the ability and accuracy of modified sequential organ failure assessment (mSOFA), quick SOFA (qSOFA), and qSOFA-65 in predicting the status of nontraumatic patients referred to hospital emergency departments (EDs). MATERIALS AND METHODS: This study was a prospective design that performed on the 746 nontraumatic patients referred to the ED. Each patient data was collected using a demographic questionnaire, mSOFA, qSOFA, and qSOFA-65 scales. Related variables of each scale were recorded based on patients' medical records. Then, the outcome of each patient in the ED was followed up and recorded. The severity and specificity of each scale were estimated by the area under receiver operating characteristic (AUROC) curve at 99% confidence interval (CI). RESULTS: The mean and standard deviation of scores were as follows: mSOFA = 4.40 ± 2.58, qSOFA = 0.50 ± 0.70, and qSOFA-65 = 0.92 ± 0.96. Patients requiring admission to the intensive care unit (ICU) were identified with AUROC curve as follows: mSOFA = 0.882 (99% CI = 0.778-0.865); qSOFA = 0.717 (99% CI = 0.662-0.773); and qSOFA-65 = 0.771 (99% CI = 0.721-0.820), which showed that mSOFA has higher sensitivity and specificity than the other two scales in identifying patients requiring admission to the ICU. CONCLUSION: All three scales were found to be reliable for identifying nontraumatic patients at risk of death and patients requiring admission to the ICU. However, since the time and data required to complete qSOFA and qSOFA-65 are much less than those of mSOFA, it is recommended that qSOFA and especially qSOFA-65 be used in ED to identify critically ill nontraumatic patients. HOW TO CITE THIS ARTICLE: Ebrahimian A, Shahcheragh SMT, Fakhr-Movahedi A. Comparing the Ability and Accuracy of mSOFA, qSOFA, and qSOFA-65 in Predicting the Status of Nontraumatic Patients Referred to a Hospital Emergency Department: A Prospective Study. Indian J Crit Care Med 2020;24(11):1045-1050.

The relationship between chest pain intensity and physiological indicators after coronary artery bypass grafting: A correlational study.

BACKGROUND: This study aims to evaluate the relationship between chest pain intensity and physiological indicators in patients undergoing coronary artery bypass grafting. METHODS: In this correlational study, chest pain intensity and physiological responses of a total of 126 coronary artery bypass grafting patients (104 males, 22 females; mean age 62.3±8.5 years; range, 45 to 80 years) during respiratory exercise were evaluated in a referral hospital setting between December 2016 and March 2018. On the second day after surgery, pain intensity was measured by a numerical rating scale. Physiological indicators were collected using the Nihon Kohden (MU65) monitoring device. RESULTS: The mean pain intensity score was 7.8±1.9 (range, 1 to 10). There was no significant correlation between the pain intensity and physiological indicators (p>0.05). There was a negative correlation between the pain intensity and age of the patient (r=- 0.183 and p=0.04). Pain intensity was not significantly different between male and female gender (p=0.064). CONCLUSION: Our study results show no significant relationship between the chest pain intensity and physiological responses in patients undergoing coronary artery bypass grafting.

Effect of milk-honey mixture on the sleep quality of coronary patients: A clinical trial study.

BACKGROUND: Admission of patients in coronary care units can lead to sleep disorders due to advanced monitoring and interventions. Inappropriate sleep quality in cardiac patients may be influenced by their health status. So, this study was performed to detect the effect of Milk-honey mixture on sleep status of acute coronary syndrome patients in the coronary care unit. METHODS: A clinical trial study (registered under IRCT.ir with identifier no. IRCT201309285134N7) was conducted with 68 hospitalized patients with the acute coronary syndrome in the coronary care unit of a referral hospital in Semnan, Iran. After hospitalization of patients and selected eligible patients, sleep status of them was measured by Richards-Campbell Sleep Questionnaire in range of 0 to 100 score. Then patients were divided into the intervention and control groups randomly. Patients in the intervention group were received milk-honey mixture twice a day for three days. The control group patients were received routine care. In the third day, sleep quality of patients in the two groups was measured again. Finally, the data were analyzed by descriptive and inferential statistics. RESULTS: The mean and standard deviation of patients' age was 63.12 ± 32.63. There was no significant difference in sleep scores on the first day of admission between the two groups (P = 0.914). But, on the third day of admission, there was a significant difference in sleep scores between the intervention and the control groups (P = 0.001). CONCLUSION: The mixture of milk and honey improves the sleep status of patients. So, it can be considered as an effective and affordable intervention to enhance the sleep quality of patients with the acute coronary syndrome in coronary care units.

Development a Reverse Triage System Based on Modified Sequential Organ Failure Assessment for Increasing the Critical Care Surge Capacity.

CONTEXT: The capacity completeness are one of the serious problems in the bed's managements of the critical care units in a crisis and disaster situation. Reverse triage can help to hospital surge capacity in this situations. AIMS: The aim of this study was to develop a reverse triage system based on Modified Sequential Organ Failure Assessment (MSOFA) for increasing critical care surge capacity. SETTINGS AND DESIGN: This study was a prospective design that performed on the medical patients in critical care unit. SUBJECTS AND METHODS: The MSOFA score for each patient was calculated in admission time and be continued until discharging time from critical care unit. STATISTICAL ANALYSIS USED: The Cox regression method was used to determine the relative risk values. At last, the patients were divided into three levels for reverse triage. RESULTS: Four hundred and twenty patients were participated in this study. The mean of patients' MSOFA scores in the 1st day of admission in Critical Care was 5.40 ± 3.8. The relative risk of internal patients discharge from critical care was (8.2%). Death relative risks were <25%, higher than 70% and between 25.1% and 69.9% for three color level of green, black, and red, respectively. CONCLUSION: The MSOFA scores can contribute to the design a leveling system for discharging patients from critical care unit. Based on this system, the members of the caring team can predict the final health status of the patient.

Exploring Nurse's Communicative Role in Nurse-Patient Relations: A Qualitative Study.

Introduction: Recognition the nurses' communicative roles can influence quality of patient's care. Therefore, this study was aimed to explore nurse's role in nurse-patient relations. Methods: This study was a qualitative research in which collected data was analyzed by content analysis method. The participants were 23 nurses, patients and their families in medical and surgical wards of a referral hospital in Tehran, Iran. Data were collected by semi-structured interview and observation. Results: Data analysis was led to the emergence of a main conceptual category: The patient's need-based communication. This category was derived from two categories: 1) Identifying the patient's needs; and 2) Communicative behavior in the face of the patient's needs. "Identifying the patient's needs" was related to "type of the patient's problem", "patients' inquiring about their health status" and "monitoring the patient's health status". "Communicative behavior in the face of the patient's needs" was composed of four subcategories: "caring attention", "informal education of the patient", "inducing calmness to the patient", and "obtaining the trust of the patient". Conclusion: The nurse's role in relationship with patients is designed according to patients' needs. Therefore, if the patients' needs in clinical settings are defined and clarified appropriately, the nurse-patient relations will be enhanced and thereby the quality of care will be improved.

Effect of Patient-Focused Clinical Pathway on Anxiety, Depression and Satisfaction of Patients With Coronary Artery Disease: A Quasi-Experimental Study.

BACKGROUND: Coronary artery diseases (CAD) are associated with psychological problems such as anxiety and depression in patients. Thus, management of these problems can consider as an important intervention by health care workers, especially nurses. OBJECTIVES: The purpose of this study was to investigate the effectiveness of patient-focused clinical pathway on anxiety, depression and satisfaction of patients with CAD. PATIENTS AND METHODS: In this quasi-experimental study, 138 patients suffering from CAD in a coronary care unit of a referral teaching hospital affiliated to Semnan University of Medical Sciences in Semnan, Iran, were recruited using a convenience sampling method. The participants were assigned to two groups: Clinical pathway (CP) and routine (RUT) care. The level of anxiety and depression of patients were measured in admission and discharge in both groups. Also, the level of patients' satisfaction was measured at the time of discharge. Data were analyzed using descriptive and inferential statistics. RESULTS: Prevalence rates of anxiety and depression in total of patients were 7.2% and 8.7%, respectively. In terms of anxiety, the mean of difference between pretest and posttest scores in the CP group (0.52 ± 1.39) was higher compared to the RUT group (-0.17 ± 1.69) and there was a significant difference between the two group (P = 0.009). In terms of depression, the mean of this difference in the CP group (0.75 ± 2.05) was higher compared to the RUT group (0.00 ± 1.08), as there was a significant difference between the two group (P = 0.024). Also, the mean of patients' satisfaction scores in the CP group (3.69 ± 0.39) was higher compared to the RUT group (3.45 ± 0.47) and there was a significant difference between the two groups (P = 0.002). CONCLUSIONS: According to the positive effects of CP on patients with CADs, it can be considered as a useful, safe and simple instrument for the improvement of patients' outcomes. Thus, the findings of this study can provide a new insight in patient care for clinical nurses.

Factors affecting nurses' coping with transition: an exploratory qualitative study.

AIM: One of the most important factors contributing to staff shortage is nurses' ineffective coping with transitions. Changes in nurses' official positions are usually associated with varying degrees of transition. Identification of affecting factors on nurses' coping in responding to transition can promote quality of nursing activity and prevent nurses' shortage. So the aim of this study was to explore factors affecting nurses' coping with transitions. METHODS: The participant of this exploratory qualitative study consisted of sixteen nurses that were work in medical wards of four hospitals in Qazvin, Iran. Data collected by semi-structured interviews. The data were analyzed by qualitative content analysis approach. RESULTS: The main theme of the study was 'inadequate preparation for transition'. This theme consisted of six categories including "staff training and development", "professional relationships", "perceived level of support", "professional accountability and commitment", "welfare services", and "nursing staff shortage". CONCLUSION: Nursing managers and policy makers need to pay special attention to the affecting factors on nurses' coping with transition and develop effective strategies for facilitating it.