Barriers to effective clinical supervision from the perspective of nurses: A descriptive qualitative study.

AIM: The present study aimed to explain the barriers to effective clinical supervision from the perspective of nurses. DESIGN: Qualitative descriptive study. METHODS: The present study enrolled 21 nurses selected by purposive sampling. Data were collected through semi-structured interviews, which were digitally recorded and immediately transcribed verbatim, and analysed using content analysis method. RESULTS: From the nurses' perspective, the influential barriers included poor academic, ethical, communicational, professional competencies at the passive management level, defects in supervision prerequisites, conventional beliefs, ineffective organization, shortage of workforce at the level of inappropriate context, lack of motivation and poor accountability at inadequate professional maturity level. PUBLIC CONTRIBUTION: The following items affect how clinical supervision is implemented: Motivation, accountability at the personal level, sufficient workforce, conducive conditions, effective organization of resources, and preparing the individual for supervision at the organizational level to implement effective clinical supervision.

Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units.

BACKGROUND: Incorrect adjustment of the respiratory parameters of the mechanical ventilator increases respiratory distress and work of breathing (WOB) in mechanically ventilated patients. The accurate adjustment of pressure support increases thepatient's comfort and decreases respiratory distress and WOB, etc.; thus, the present study was conducted to compare the effects of two pressure support adjustment methods on respiratory distress in patients under mechanical ventilation to investigate whether the rapid shallow breathing index (RSBI)method can reduce patients' respiratory distress more and faster than the tidal volume (VT) and respiratory rate (RR) methods. PATIENTS AND METHODS: The study was conducted in 2020 on 56 mechanically ventilated patients with respiratory distress. The patients' respiratory distress was first measured using RSBI and the respiratory distress observation scale (RDOS). The pressuresupport was then adjusted in the patients according to the RSBI (in the trial group, n = 33)and VT and RR (in the control group, n = 23). The patients' respiratory distress was measured again in both groups 15 and 30 minutes after the pressure support adjustment. RESULTS: The results showed no significant differences between the two groups in the mean RSBI and RDOS before (p = 0.374, p = 0.657 respectively) and 30 (p = 0.103, p = 0.218 respectively) minutes after the adjustment of the pressure support, but these mean values differed significantly (p = 0.025 for RSBI and p = 0.044 for RDOS) between the groups 15 minutes after the adjustment. Moreover, the interaction effect of the group * time for RDOS has become significant nonlinearly (p = 0.037), but none of the interaction effects of the group * time were significant for RSBI (linear: p = 0.531; nonlinear: p = 0.272). CONCLUSION: These two methods finally reduced the patients' respiratory distress almost equally, but RSBI method can relieve the patients' respiratory distress faster than the VT and RR methods. HOW TO CITE THIS ARTICLE: Barati P, Ghafari S, Saghaei M. Comparative Assessment of the Effects of Two Methods of Pressure Support Adjustment on Respiratory Distress in Patients under Mechanical Ventilation Admitted to Intensive Care Units. Indian J Crit Care Med 2021;25(9):1026-1030. KEY MESSAGE: VT, RR, and RSBI methods finally reduced the patients' respiratory distress almost equally, but RSBI method can relieve the patients' respiratory distress faster than the VT and RR methods.

Effects of Open and Closed Tracheal Suctioning on Pain in Mechanically Ventilated Patients.

BACKGROUND: Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients. MATERIALS AND METHODS: The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t-test, and Chi-squared test. RESULTS: The pain score was significantly higher in the open suctioning group during (t = 2.59, p = 0.01) and 10 min after suctioning (t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0.001). CONCLUSIONS: The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.

The effect of acupressure on quality of life among female nurses with chronic back pain.

BACKGROUND: Chronic back pain is one of the most common work-related diseases and most important of musculoskeletal disorders in nursing professionals and because of the physical and psychological effects, has a significant impact on quality of life (QOL). Acupressure is a holistic form of complementary medicine. This study aimed to investigate the effect of acupressure on QOL among female nurses with chronic back pain. MATERIALS AND METHODS: This randomized single-blind clinical trial was conducted on 50 nurses with chronic back pain working at the selected hospitals in Isfahan, Iran. After convenient sampling, the subjects were randomly allocated, through lottery, to the two groups of experimental (n = 25) and sham (n = 25). In the experimental group, acupressure techniques were performed during 9 sessions, 3 times a week for 14 min for each patient. In the sham group, points within 1 cm of the main points were only touched. Data were collected using the SF36 questioner, before, and immediately, 2 weeks, and 4 weeks after the intervention. Data analysis was performed using SPSS software. RESULTS: Independent t-test showed that the mean total score of QOL before the intervention was not significantly different between the two groups before the intervention (P = .68). However, it was significantly higher in the experimental group compared to the Sham group, immediately, 2 weeks, and 1 month after the intervention (P < .001). CONCLUSIONS: Acupressure on specific points of the foot and back improves back pain and as a result, increases QOL. Therefore, acupressure can be used as a drug-free and low-cost approach without side effects to improve QOL in nurses with chronic back pain.

Education promotion based on "mobile technology" in the Critical Care Nursing Department: Four-phase intervention.

INTRODUCTION: Evaluation of students' clinical performance is an essential part of nursing education. Mobile technology is one of the new methods of evaluation that has opened a new horizon for nursing professors. Therefore, this study aimed to design, implement, and evaluate mobile health technology in critical care nursing department in four-phase intervention. METHODS: This study was a four-stage educational intervention in which all postgraduate students of intensive care nursing in Isfahan University of Medical Sciences participated in the study. The four steps were designing and developing a logbook, needs assessment, designing and implementing an Android app, and evaluating users (students) of the Android app. Subjects' satisfaction scores were collected using a researcher-made questionnaire with 14 questions. Data were analyzed using SPSS 14 software. RESULTS: In this study, a clinical practice evaluation app was designed at four levels of access (student, professor, department manager, and faculty dean). The results showed that more than half of app users reported this technology in terms of an overall response to the tool (87.5%), tool specificity (100%), the amount of information displayed (75%), page layout (62.5%), information rate (75%), recall information (87.5%), and ease of doing instructions (100%) were positive. CONCLUSION: Evaluation of clinical practice using technology was associated with increasing students' satisfaction with evaluation method. In addition, this application enabled the simultaneous interaction between the professor with the higher and lower ranks, including the department manager and student and vice versa and the simultaneous recording of this interaction.

Association Between CYP3A5 Genetic Polymorphisms with Tacrolimus Dose Requirement and Allograft Outcomes in Iranian Kidney Transplant Recipients.

INTRODUCTION: Tacrolimus is the cornerstone of immunosuppressive therapy in organ transplantation with variable inter-individual pharmacokinetics. This study assessed the relationship between CYP3A5/3A4 polymorphisms and tacrolimus dose requirement as well as 6-month transplant outcomes in Iranian kidney transplant recipients. METHODS: In this prospective study, 110 adult kidney transplant recipients treated with tacrolimus were genotyped for the presence of common SNPs: rs776746: A > G (CYP3A5*3). Patients who carried at least one CYP3A5*1 allele were known as CYP3A5 expressers while those who were CYP3A5*3/*3 homozygotes were classified as CYP3A5 non-expressers. RESULTS: The daily tacrolimus dose was significantly higher and tacrolimus dose adjusted trough levels (C/D ratio) was significantly lower in CYP3A5 expressers compared with non-expressers (P < .05). Although the incidence of clinically suggested acute allograft rejection was significantly higher (OR = 0.365 [95% CI: 0.14 - 0.93]; P < .05) and median time to first acute rejection was sooner among CYP3A5 expressers compared with non-expressers (12.17 vs. 26.83 days, P < .05); however, estimated glomerular filtration rate, incidence of biopsy proven acute rejection and delayed graft function and 6-month patients' and grafts' survival did not differ between the two groups. CONCLUSION: CYP3A5 genetic polymorphism is significantly associated with required tacrolimus dose. After achieving desired tacrolimus blood level, although some transplant outcomes such as the incidence of clinically suggested acute rejection and time to first rejection were different between CYP3A5 expressers and non-expressers, however, other clinical outcomes did not differ between groups. Therefore, it is not the time to routinely assess kidney transplant recipients for CYP3A5 genetic polymorphism before transplantation.

Effect of moral empowerment program on moral distress in intensive care unit nurses.

BACKGROUND: Moral distress has been experienced by about 67% of critical care nurses which causes many complications such as job dissatisfaction, loss of capacity for caring, and turnover for nurses and poor quality of care for patients as well as health system. OBJECTIVE: The purpose of this research was to provide a moral empowerment program to nursing directors, school of nursing, and the heads of hospitals to reduce moral distress in nurses and improve the quality of care. METHODS: This research was a randomized clinical trial conducted in two groups and three stages before, after 2 weeks, and 1 month after the intervention in order to evaluate the changes in moral distress of 60 nurses working in adults' intensive care unit wards of Al-Zahra teaching hospital of Isfahan University of Medical Sciences. Data were collected using the standard Hamric's Moral Distress Scale (2012) and analyzed using SPSS software version 22. ETHICAL CONSIDERATIONS: This study was approved by the Ethics Committee of Isfahan University of Medical Sciences, Isfahan, Iran. RESULTS: Results showed that in the three stages, there was no significant difference between the mean score of moral distress before (4.12 ± 2.70), 2 weeks after (4.23 ± 2.70), and 1 month after the intervention (4.04 ± 2.54) in the control group (p > 0.05), while in the experimental group, there was a significant difference between the three stages (p < 0.05). The mean score of moral distress in the experimental group before intervention (4.05 ± 2.26) and 2 weeks after the intervention (3.38 ± 2.11) was not significant (p > 0.05). However, this score significantly decreased 1 month after the intervention (2.64 ± 2.23; p < 0.05). CONCLUSION: In this research, it was observed that moral empowerment program has been effective in reducing the mean score of moral distress. Therefore, it is recommended that nursing managers and hospital directors implement empowerment program, in order to reduce the moral distress of nurses and improve the quality of care.

The Effects of Aloe vera-Peppermint (Veramin) Moisturizing Gel on Mouth Dryness and Oral Health among Patients Hospitalized in Intensive Care Units: A Triple-Blind Randomized Placebo-Controlled Trial.

OBJECTIVE: Mouth dryness is one of the most prevalent problems in Intensive Care Units (ICUs). It facilitates dental plaque formation. The aim of this study was to analyze the effects of Aloe vera-Peppermint (Veramin) moisturizing gel on mouth dryness and oral health among patients hospitalized in ICUs. METHODS: This triple-blind two-group randomized placebo-controlled clinical trial was undertaken in 2016-2017 on a convenient sample of 80 patients. Patients were randomly allocated to an intervention and a placebo group. Oral care for patients in the intervention and the placebo groups was provided for 5 successive days using Veramin moisturizing gel and a placebo gel, respectively. Data were collected at the 1st, 3rd, and 5th days of the study using a demographic and clinical characteristics questionnaire, the Challacombe scale (for mouth dryness assessment), and the Mucosal-Plaque Index (for oral health assessment). The Chi-square, Fisher Exact, Mann-Whitney U, and Friedman tests were used for data analysis. FINDINGS: In the 5th day, the mean score of mouth dryness in the intervention group was significantly lower than the placebo group (P = 0.0001). On the other hand, in the third and the 5th days, the oral health mean score in the intervention group was significantly lower than the placebo group (P = 0.0001). CONCLUSION: Veramin moisturizing gel is effective in significantly relieving mouth dryness, preventing dental plaque formation, and improving oral health. Thus, it can be used for improving oral care outcomes in ICUs.

Performance of ICU Nurses in Providing Respiratory Care.

BACKGROUND: Failure to provide proper respiratory care leads to incidence of certain complications such as ventilator-associated pneumonia. Nurses have a crucial role in providing this care. The aim of this study is to assess the performance of ICU (Intensive Care Unit) nurses in providing respiratory care. MATERIALS AND METHODS: The present descriptive cross-sectional study recruited 120 nurses working in selected hospitals affiliated to Isfahan University of Medical Sciences from March to August 2016. The questionnaire used included demographic and employment details and performance observation checklist (containing 39 items in four care domains) based on recommendations in clinical guidelines. The performance of each nurse during a working shift was observed. Data were analyzed by SPSS 18, using tables of frequency, mean, and standard deviation. RESULTS: According to the results obtained, mean (SD) total performance score of nurses in providing respiratory care was 15.46 (2.16). The highest score was obtained in preventing contamination of respiratory equipment 5 (0), and the lowest score was in oral care 0.68 (0.73). CONCLUSIONS: Considering that respiratory care is one of the main pillars of patient care in ICU and that nurses scored poorly in this area, it is imperative to pay greater attention to this area. It is essential to provide necessary training to nurses and adequate facilities for improving the quality of clinical care.

The Effects of Acupressure on Pain Severity in Female Nurses with Chronic Low Back Pain.

BACKGROUND: Low back pain causes physical and psychological impacts among nurses. This study aimed to investigate the effects of acupressure on the severity of pain in chronic low back pain in female nurses. MATERIALS AND METHODS: This study is a single-blinded randomized clinical trial conducted among 50 nurses suffering from chronic low back pain. After simple sampling, participants were randomly assigned into acupressure and sham groups using lottery method (25 patients in each group). In the experimental group, the intervention was performed by the researcher three times a week throughout a 3-week period. The sham group received placebo interventions. Data was collected through VAS questionnaire before, immediately after, 2 weeks, and 4 weeks after performing intervention. Data analysis was conducted using SPSS version 18 using descriptive and inferential statistical methods. RESULTS: There was no significant difference in the mean pain severity scores in the pre-interventions phase between the groups (P = 0.63), however, a significant difference was observed Immediately, 2 weeks, and 4 weeks after performing intervention. Further, the mean pain severity scores in intervention group significantly decreased compared to the sham group (P = 0.000). CONCLUSIONS: Acupressure on specific points was proved to reduce pain. Thus, acupressure can be used as nonmedicament, inexpensive, and without side effects treatment in reducing pain.

The effect of acupressure on fatigue among female nurses with chronic back pain.

AIM: To investigate the effect of acupressure on fatigue among female nurses with chronic back pain. BACKGROUND: Chronic back pain is one of the most common problems among nurses and has numerous physical and psychological effects. One of these effects is fatigue that impairs an individual's life. MATERIALS AND METHODS: This randomized single-blind clinical trial was conducted on 50 nurses with chronic back pain working at the selected hospitals in Isfahan, Iran. After convenient sampling, the subjects were randomly allocated, through lottery, to the two groups of experimental (n=25) and sham (n=25). In the experimental group, acupressure techniques were performed during 9 sessions, 3 times a week for 14min for each patient. In the sham group, points within 1cm of the main points were only touched. Data were collected using the Fatigue Severity Scale (FSS), before, and immediately, 2weeks, and 4weeks after the intervention. Data analysis was performed using SPSS software. RESULTS: The mean score of fatigue severity before the intervention was not significantly different between the two groups (P=0.990). However, it was significantly lower in the experimental group than the sham group immediately (P<0.001), 2weeks (P=0.005), and 1month after the intervention (P<0.001). CONCLUSIONS: Acupressure on specific points of the foot and back improves back pain so, reduces fatigue. Therefore, acupressure can be used as a drug-free and low-cost approach without side effects to improve fatigue in nurses with chronic back pain.

Patients' experiences of adapting to multiple sclerosis: a qualitative study.

Unpleasant, unpredictable symptoms, difficult treatment regimes, and uncertainty about the future of Multiple Sclerosis require the patients to adapt to new life changes and restrictions. This study aimed to explore patients' experiences of adapting to Multiple Sclerosis. A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with Multiple Sclerosis, chosen through purposeful sampling. Data were analyzed by using content analysis. The analysis resulted in the emergence of seven themes and eighteen subthemes. The main themes were: religiosity, information seeking, seeking support, hope rearing, emotional reactions, concealing the disease, fighting the disease and disability. These themes can represent the perceived characteristics and difficulties of adaptation to Multiple Sclerosis by patients. These findings can help nurses and families to aid patients in increasing their abilities to adapt to the disease and enhance their quality of life.

Confronting the diagnosis of multiple sclerosis: a qualitative study of patient experiences.

BACKGROUND: Multiple sclerosis (MS) involves complex physical and mental disabilities and often results in family, occupational, and social problems that cause difficulties in confronting the diagnosis of MS, which may delay or deny acceptance of the disease. Therefore, it is important to understand the experiences of patients in facing this disease to help and support families, communities, and healthcare teams more effectively. PURPOSE: This study explores the experiences of patients in confronting their diagnosis of MS. METHODS: A qualitative content analysis method was used in this study. The study participants were 25 people with MS chosen via purposeful sampling from the MS associations in Isfahan and Tehran (Iran). Data were collected using unstructured interviews and analyzed using content analysis. RESULTS: The analysis resulted in the emergence of four themes and 11 subthemes. The main themes were knowledge deficit, concealing the disease, religiosity, and emotional reactions. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The findings highlight the principal means by which patients confront a diagnosis of MS and the needs and challenges involved in transiting successfully to acceptance and treatment. The authors hope the findings of this study will increase the information available to families and nurses regarding the reaction of patients to an MS diagnosis and have a positive impact on support programs designed to help patients confront and adapt to MS. Furthermore, these findings may serve to create a framework for developing related nursing care processes and establishing counseling and support programs that are sensitive to the religious, ideological, and cultural backgrounds of patients.

Spousal support as experienced by people with multiple sclerosis: a qualitative study.

About 30% of people with multiple sclerosis require some form of supportive assistance at home, and 80% of that assistance is usually provided by spouses or partners. So, the explanation and understanding of patients' experiences of support received from their spouses enable spouses and healthcare professionals to reform their actions toward positive support. This study aimed to explore the experiences of people with multiple sclerosis regarding support from their spouses. A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with multiple sclerosis who were chosen through purposeful sampling from multiple sclerosis associations of Isfahan and Tehran (Iran). Data were collected through nonstructured interviews from September 2011 to August 2012. Four themes and nine subthemes emerged through data analysis. The main themes were play a supportive role, establish a friendly and comfortable relationship, help patient to fight the disease, and help to maintain and to improve patients' functional ability. The results could help in improving the quality of spouses' support in people with multiple sclerosis. Moreover, it could aid in determining the educational needs of patients as supported persons and spouses as supporters. The results could lead to increased knowledge of healthcare experts about the issue of how Iranian people with multiple sclerosis are being supported by their wives/husbands. Furthermore, it would help them to design caring models to promote successful supporting strategies for patients.

Experiences of hospitalization in patients with multiple sclerosis: A qualitative study.

BACKGROUND: Patients with multiple sclerosis experience hospitalization several times in their lives. Certainly, providing efficient and high-quality care by healthcare professionals is not possible unless the experiences of patients' hospitalization are taken into consideration. This qualitative study was aimed to identify experiences of patients with multiple sclerosis in their hospitalization. MATERIALS AND METHODS: A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with multiple sclerosis, who were chosen by purposeful sampling. Data were collected through non-structured interviews. RESULTS: The analysis resulted in the emergence of 4 themes and 11 subthemes. The main themes were: Religiosity, emotional reactions, seeking support, and feeling of being in a cage. CONCLUSIONS: Awareness of families and healthcare providers of the reactions of patients with multiple sclerosis to hospitalization will help them to deal effectively with patients and to improve relationships with them. However, by understanding the patients' experiences, the practitioners gain expertise and can join in the patients' health journey in a therapeutic way during the hospitalization period. In addition, the findings can serve to create a framework for developing nursing care processes including informational and supporting programs for multiple sclerosis patients during hospitalization while taking into consideration patients' needs and cultural backgrounds.

Continuous versus intermittent administration of piperacillin-tazobactam in intensive care unit patients with ventilator-associated pneumonia.

BACKGROUND AND AIMS: Ventilator-associated pneumonia (VAP) is one of the most common Intensive Care Unit (ICU)-acquired infection. The aim of this study was to compare the clinical outcome of continuous and intermittent administration of piperacillin-tazobactam by serial measurements of the Clinical Pulmonary Infection Score (CPIS). SUBJECTS AND METHODS: Groups were designed as parallel and the study was designed as quasi-experimental and conducted at a semi-closed ICU between September 2008 and May 2010. Patients received 3.375 g (piperacillin 3 g/tazobactam 0.375 g) either through intermittent infusion every 6 h for 30 min [Intermittent Infusion (II) group; n = 30] or through continuous infusion every 8 h for 4 h [Continuous Infusion (CI) group; n = 31]. CPIS was used to assess the clinical diagnosis and outcome of VAP patients. RESULTS: Sex, age, Acute Physiology and Chronic Health Evaluation II II score on ICU admission, diagnosis and underlying disease of VAP patients were not significantly different in the CI (n = 31) and II (n = 30) groups. Duration of mechanical ventilation, length of stay, total number of antibiotics used per patient and duration of piperacillin/tazobactam treatment were similar in both groups. Mortality rates of VAP patients were similar between both groups during hospitalization. CONCLUSION: There was no significant difference in clinical outcomes of patients receiving piperacillin-tazobactam via CI or II when measured by serial CPIS score.

Effectiveness of applying progressive muscle relaxation technique on quality of life of patients with multiple sclerosis.

AIMS AND OBJECTIVES: To identify the effects of applying Progressive Muscle Relaxation Technique on Quality of Life of patients with multiple Sclerosis. BACKGROUND: In view of the growing caring options in Multiple Sclerosis, improvement of quality of life has become increasingly relevant as a caring intervention. Complementary therapies are widely used by multiple sclerosis patients and Progressive Muscle Relaxation Technique is a form of complementary therapies. DESIGN: Quasi-experimental study. METHOD: Multiple Sclerosis patients (n = 66) were selected with no probability sampling then assigned to experimental and control groups (33 patients in each group). Means of data collection included: Individual Information Questionnaire, SF-8 Health Survey, Self-reported checklist. PMRT performed for 63 sessions by experimental group during two months but no intervention was done for control group. Statistical analysis was done by SPSS software. RESULTS: Student t-test showed that there was no significant difference between two groups in mean scores of health-related quality of life before the study but this test showed a significant difference between two groups, one and two months after intervention (p < 0.05). anova test with repeated measurements showed that there is a significant difference in mean score of whole and dimensions of health-related quality of life between two groups in three times (p < 0.05). CONCLUSIONS: Although this study provides modest support for the effectiveness of Progressive Muscle Relaxation Technique on quality of life of multiple sclerosis patients, further research is required to determine better methods to promote quality of life of patients suffer multiple sclerosis and other chronic disease. RELEVANCE TO CLINICAL PRACTICE: Progressive Muscle Relaxation Technique is practically feasible and is associated with increase of life quality of multiple sclerosis patients; so that health professionals need to update their knowledge about complementary therapies.