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.

Predictors of emotional intelligence among family caregivers of cancer patients: A cross-sectional study.

BACKGROUND: Family caregivers of cancer patients must have strong emotional intelligence skills essential for understanding one's and others' feelings and learning how to cope. OBJECTIVES: The present study aims to determine the predictive factors of emotional intelligence and its relationship with spiritual intelligence, coping, and knowledge and experience about pain among family caregivers of cancer patients in Iran. METHODS: A cross-sectional, descriptive study was conducted in 2020-2021. Two hundred twenty-six family caregivers of cancer patients participated in this study. The data collection tools were Wong and Law's emotional intelligence, King's spiritual intelligence, Brief Cope, and the family pain questionnaire. Following determining the variables' correlation, linear regression was carried out. RESULTS: Emotional intelligence had a significant correlation with age (r = 0.20, p = .003), academic degree (r = 0.15, p = .032), duration of care (r = 0.15, p = .032), and spiritual intelligence (r = 0.30, p < .001). The regression model accounted for 12.4% of the variance in emotional intelligence; age (ß = 0.16, p < .021) and spiritual intelligence (ß = 0.26, p < .001) were significant explanatory variables. CONCLUSIONS: Emotional intelligence is correlated with age, academic degree, duration of care, and spiritual intelligence, but only age and spiritual intelligence were found to be predictive factors for emotional intelligence in the family caregivers of cancer patients.

Academic resilience, moral perfectionism, and self-compassion among undergraduate nursing students: A cross-sectional, multi-center study.

BACKGROUND: Academic resilience has been identified as a coping method for nursing students' educational and practice challenges. Despite the importance of academic resilience, knowledge on how to enhance academic resilience is under-researched. To suggest suitable approaches, relationships between academic resilience and other constructs need to be appraised. OBJECTIVES: This study aims to evaluate predictors of academic resilience, examining its relationships with other essential constructs: self-compassion and moral perfectionism, in undergraduate nursing students in Iran. DESIGN: This descriptive cross-sectional study was conducted in 2022. PARTICIPANTS: A convenience sample of 250 undergraduate nursing students at three universities in Iran participated in this study by completing self-report measures. METHODS: Data collection tools were Nursing Student Academic Resilience Inventory, Moral Perfectionism scale, and Self-Compassion Scale-Short Form. Correlation and regression analyses were conducted. RESULTS: The mean and standard deviation of academic resilience were 57.57 ± 23.69; moral perfectionism 50.24 ± 9.97, and self-compassion 37.19 ± 5.02. Self-compassion had significantly related to moral perfectionism (r = 0.23, p < 0.001). Academic resilience had no statistically significant relationship with moral perfectionism (r = -0.05, p = 0.41) and self-compassion (r = -0.06, p = 0.35), but significantly affect age (r = 0.14, p = 0.03), Grade point average (r = 0.18, p < 0.001) and university of study (r = 0.56, p < 0.001). The grade point average and the university of the study predicted 33 % of the changes in academic resilience, and the greatest impact was related to the university (r = 0.56, p < 0.001). CONCLUSION: Adopting appropriate educational strategies and supporting the students will help improve nursing students' academic resilience and performance. Promoting self-compassion will lead to the development of nursing students' moral perfectionism.

Cultural competence in critical care nurses and its relationships with empathy, job conflict, and work engagement: a cross-sectional descriptive study.

BACKGROUND: Cultural competence is more important than ever for nurses today; therefore, it may be helpful to learn more about it and examine how it relates to empathy, job conflict, and work engagement. The purpose of this study was to determine (a) the level of cultural competence, empathy, job conflict, and work engagement; (b) the relationship between cultural competence, demographic information, and main variables; (c) the predictors of cultural competence among critical care nurses. METHODS: A multicenter, descriptive cross-sectional study was conducted in Iran from August to October 2022. Through convenience sampling, 153 critical care nurses from three hospitals participated. The research tool consisted of five parts: Demographic information questionnaire, Cultural Competence Questionnaire, Jefferson Scale Empathy, Dobrin Job Conflict, and Utrecht Work Engagement, which were collected by paper self-report. Descriptive statistics, the correlation between variables, and linear regression were used to analyze the data. RESULTS: Among critical care nurses (response rate 79.27%), the mean (SD) scores for cultural competence, empathy, job conflict, and work engagement were 74.05 (7.96), 83.44 (29.17), 11.00 (2.38), and 43.69 (16.33), respectively. There was a significant correlation between cultural competence and age (r = 0.46, p = 0.001), marital status (r = 0.27, p = 0.004), academic degree (r = 0.44, p = 0.001), work experiences (r = 0.43, p = 0.001), empathy (r = 0.50, p = 0.001), and job conflict (r=-0.16, p = 0.049). Academic degree (ß = 0.36, p < 0.001) and empathy (ß = 0.26, p < 0.001) were significant explanatory variables that predict cultural competence. CONCLUSION: In Iranian critical care nurses, cultural competence and job conflict were moderate, empathy was good, and work engagement was poor. There was a significant relationship between cultural competence, age, marital status, academic degree, work experiences, empathy, and job conflict. Academic degree and empathy predict cultural competence.

Effect of prone position on clinical outcomes of nonintubated patients with COVID-19: A randomised clinical trial.

Background: Prone positioning (PP) is a well-known respiratory support approach. Limited data are available for the use of PP in nonintubated patients with COVID-19. Aim: This study aims to investigate the effect of PP on the clinical outcomes of patients with COVID-19 pneumonia. Methods: In this clinical trial, the participants in the PP group (n = 41) were asked to lie comfortably in a PP for 90 min. In the supine position (SP) group (n = 41), the participants were asked to lie comfortably in a SP for 90 min. Clinical data such as oxygen saturation, respiratory rate (RR), the severity of dyspnoea, mean arterial pressure (MAP), and pulse rate were assessed at 0 (immediately before), 30, 60, and 90 min after the start of the intervention, and 30 min after resuming the SP. The participants in the PP group were then asked to intermittently stay in a PP for a total of 8 h per 24 h of hospitalisation. The participants in the control group were asked to remain in their usual positions during the hospital stay. Finally, the length of hospital stay, intubation rate, and survival were assessed. Findings: PP was associated with significant improvement in oxygen saturation (P = 0.001), RR (P = 0.004), the severity of dyspnoea (P = 0.014), and MAP (P = 0.027). There was no significant difference between the two groups in terms of pulse rate (P = 0.890), hospital stay (P = 0.994), intubation rate (P = 0.324), and survival (P = 0.091). Discussion: Our results demonstrated that PP showed marked improvement in some short-term clinical outcomes in nonintubated patients with COVID-19. Conclusion: PP can be considered an inexpensive, accessible, and simple measure in awake nonintubated patients with COVID-19.

Efficacy of olive leaves extract on the outcomes of hospitalized covid-19 patients: A randomized, triple-blinded clinical trial.

INTRODUCTION: Since the emergence of the novel coronavirus, herbal medicine has been considered a treatment for COVID-19 patients. This study was done to determine the efficacy of olive leaf extract on the outcomes of COVID-19 patients. MATERIALS AND METHODS: This randomized, triple-blinded clinical trial was conducted on hospitalized COVID-19 patients. Using block randomization, eligible patients were allocated to the following groups: intervention A received olive leaf extract (250 mg every 12 hours for five days), intervention B received olive leaf extract (500 mg every 12 hours for five days), and the control group received placebo (every 12 hours for five days). The outcomes (vital signs, laboratory tests, and length of hospitalization) were compared by group. RESULTS: Of the 150 patients randomized into groups, 141 completed the follow-up and were analyzed. On the fifth day of hospitalization, body temperature (MD=0.34, P<0.001), pulse rate (MD=5.42, P=0.016), respiratory rate (MD=1.66, P=0.001), ESR (MD=13.55, P<0.001), and CRP (MD=15.68, P<0.001) of intervention A were significantly lower than the control group, while oxygen saturation (MD= -1.81, P=0.001) of intervention A was significantly higher than the control group. Furthermore, body temperature (MD=0.30, P=0.001), pulse rate (MD=5.29, P=0.022), respiratory rate (MD=1.41, P=0.006), ESR (MD=14.79, P<0.001), and CRP (MD=16.28, P<0.001) of intervention B were significantly lower than the control group, while oxygen saturation (MD= -2.38, P<0.001) of intervention B was significantly higher than the control group. CONCLUSION: Olive leaf extract can improve the clinical status of the patients and decrease the length of hospitalization.

Predicting moral intelligence in nursing students and its relationships with self-compassion, and cultural competence: a cross-sectional study.

BACKGROUND: In the recent era, nursing needs employees with moral intelligence, cultural competence, and self-compassion skills more than ever. This study aimed to determine the predictors of moral intelligence and its relationship with self-compassion and cultural competence in nursing students. METHODS: This cross-sectional and multi-center descriptive study was conducted in 2022. With convenience sampling, 250 nursing students from three Iranian universities participated in this study. Data gathering included the Moral Intelligence Questionnaire, Self-Compassion Scale (short form), and Cultural Competency Questionnaire. The data were analyzed using descriptive statistics, the correlation between variables, and hierarchical regression. RESULTS: The results showed that nursing students had good moral intelligence (72.63 ± 11.38), moderate self-compassion (37.19 ± 5.02), and poor cultural competence (50.06 ± 13.15). No statistically significant relationship was observed between self-compassion and cultural competence (r = 0.11, p = 0.07). Moral intelligence with marital status (r = 0.16, p = 0.01), academic year (r = 0.14, p = 0.03) and self-compassion (r = 0.33, p < 0.001) had a significant relationship in such a way that these variables explained 15% of moral intelligence and self-compassion had the highest impact (p < 0.001). CONCLUSION: Considering the moderate level of self-compassion and the poor level of cultural competence reported in the undergraduate nursing students, and also that self-compassion was known to be a predictive factor for moral intelligence, planners and educators must pay more attention to promoting self-compassion and cultural competency in the curriculum and conduct studies to find ways to improve them.

The efficacy of olive leaf extract on healing herpes simplex virus labialis: A randomized double-blind study.

OBJECTIVE: Herpes simplex virus (HSV), as a common infection in healthy individuals, is treated symptomatically, but drug resistance and the side effects of drugs have drawn the attention of researchers to complementary medicine. Olive Leaf Extract (OLE) has antiviral effects that may treat HSV. The current study aimed to compare the clinical effects of OLE and Acyclovir on HSV-1. METHODS: This randomized double-blind clinical trial was conducted on 66 patients who had already been diagnosed with HSV-1. The participants were randomized into two groups, receiving 2% OLE cream or 5% acyclovir cream five times a day for six days. The symptoms were evaluated before, and three and six days after the interventions. Data were analyzed using the SPSS software through the Kolmogorov-Smirnov test, chi-squared, t-test, and repeated measures ANOVA. RESULTS: The results showed clinical symptoms decreased in both groups during the study and both medications were effective in the treatment of HSV-1. However, the OLE group experienced less bleeding (P = 0.038), itching (P = 0.002), and pain (P = 0.001) on the third day as well as less irritation (P = 0.012), itching (P = 0.003) and color change (P = 0.001) on the sixth day compared to the acyclovir group. The treatment course for participants in the OLE group was shorter than in the acyclovir group (P = 0.001). CONCLUSION: The evidence from these trials suggests the OLE cream is superior in the healing of episodes of HSV-1 over the acyclovir cream. Future studies are recommended to investigate if OLE could be an adjunct to acyclovir treatment.

Effects of flaxseed on blood pressure, body mass index, and total cholesterol in hypertensive patients: A randomized clinical trial.

OBJECTIVES: Given the antioxidant properties of flaxseed and its biologically active ingredients, this study was conducted to determine the effects of flaxseed supplementation on body mass index (BMI), blood pressure, and total cholesterol levels in patients with hypertension. METHODS: In this triple-blind clinical trial, 112 patients, with an age range of 35 to 70 years, were randomized to 2 groups receiving 10 g (n = 45) and 30 g (n = 45) of flaxseed supplementation and 1 group receiving placebo (n = 45) for 12 weeks by stratified block randomization. They were evaluated in terms of systolic (SBP) and diastolic blood pressure (DBP), BMI, and total serum cholesterol. Physical activity was measured using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and food intake was assessed using the Food Frequency Questionnaire (FFQ). The data were analyzed with SPSS, version 22, using the chi-square, Kruskal-Wallis, repeated measures analysis, ANOVA, and ANCOVA tests. RESULTS: The interaction effects among the study groups and time on the mean SBP (p = 0.001), DBP (p = 0.001), total cholesterol level (p = 0.032), and BMI (p < 0.001) were significant. During the study, the 30-g group achieved the best results, so that a 13.38-unit decrease in SBP was observed compared to a 1.72 unit increase in the placebo group and a 5.6-unit decrease in DBP was measured compared to a 2.39 unit increase in the placebo group. BMI decreased by 0.86 units compared to 0.06 units in the placebo group. Total cholesterol also decreased by 20.4 units compared to 11.86 units in the placebo group. CONCLUSION: The results of this study showed that flaxseed can be effective in reducing blood pressure, total cholesterol, and body mass index in hypertensive patients in a twelve-week period.

Development and psychometric properties of health care workers' concerns in infectious outbreaks scale.

Introduction: Healthcare workers are a crucial workforce; from a moral perspective, understanding their concerns and how to support them is crucial and makes it possible for health services to keep functioning. This study aimed to develop and validate Health Care Workers' Concerns in Infectious Outbreaks Scale (HCWCIOS). Methods: This exploratory sequential mix-method study was employed to design and validate the HCWCIOS. The initial tool was designed after searching similar studies and performing a qualitative phase under the semi-structured approach. Both qualitative and quantitative methods were used to evaluate the face and content validity. The content validity ratio, content validity index, and item-level content validity index were also calculated. Exploratory factor analysis was employed to evaluate the construct validity. Using a convenient sampling method, 354 Iranian healthcare workers participated in the study. Computing Cronbach's alpha coefficient estimated the internal consistency for HCWCIOS and its subscales. Furthermore assessed was test-retest reliability. Results: The preliminary scale was designed with 57 items. By eliminating nine items in the content validity phase and 12 items during factor analysis, the final 36-item scale was developed on six factors: inadequate preparedness, lack of knowledge, risk perception, affected social relations, work pressure, and absenteeism. These six factors accounted for 46.507% of the total variance. The whole scale's Cronbach's alpha coefficient was 0.912, and the intra-class correlation coefficient was 0.88. Conclusion: A 36-item HCWCIOS has good psychometric properties and is suitable for measuring healthcare workers' concerns during a pandemic.

Effect of aromatherapy with Melissa essential oil on stress and hemodynamic parameters in acute coronary syndrome patients: A clinical trial in the emergency department.

Stress and hemodynamic changes are among the most significant symptoms and signs that could be observed in patients with acute coronary syndrome (ACS) upon admission to the emergency department. The present study was conducted to determine the effect of the fragrance of lemon balm (Melissa Officinalis) essential oil on stress level and hemodynamic parameters in patients with ACS in the emergency department. METHODS: In this double-blind clinical trial, 72 patients were allocated to two groups of Melissa and placebo based on stratified block random sampling. The Melissa group inhaled two drops of Melissa essential oil, whereas the placebo group inhaled two drops of sunflower oil in two aromatherapy phases for 10 min with 90-min intervals. Stress level was measured using the depression, anxiety and stress scale (DASS-21), and hemodynamic parameters were measured and recorded in six time points by a cardiac monitoring system. Data analysis was carried out using descriptive statistics and ANOVA statistical tests, Chi-square test, independent t-test, and post-hoc Tukey's test. RESULTS: Interaction between the time and group indicated the significant decrease in the mean score of stress and heart rate in the time points 2 and 5 (5 min after every occasion of aromatherapy) (p < 0.001) and also the remarkable decrease in the mean arterial pressure (MAP) in the time point 2 in the Melissa group in comparison with the placebo group (p < 0.001). There were no significant differences between the mean changes in stress, heart rate and MAP in the two group (P > 0.05). CONCLUSION: Aromatherapy via the inhalation of Melissa essential oil with temporary impacts on certain time points could relieve stress and regulate hemodynamic changes in patients with ACS in emergent and acute conditions.

The Efficacy of Topical Basil Essential Oil on Relieving Migraine Headaches: A Randomized Triple-Blind Study.

OBJECTIVE: Complementary therapies have been increasingly used for the prevention and treatment of migraine so that there is a need for studies in this setting. This study sought to determine the effects of basil essential oil on the severity and frequency of migraine attack headaches. METHODS: A triple-blind clinical trial study was performed on 144 patients diagnosed with migraine. Patients were randomly allocated by a stratified method to four groups of 36 titled basil essential oil 2, 4, 6%, and placebo groups. Medications were used topically every 8 h for 3 successive months. In addition, each individual received 325 mg of acetaminophen every 12 h. The severity and frequency of migraine attacks were measured prior to the study, at weeks 2, 4, 8, and 12. The visual analog scale was used to measure pain intensity. The marginal model and generalized estimation equations were used to compare changes in the intensity and frequency of pain over time. RESULTS: The interaction of the dose and time factors was significant on both pain intensity (p < 0.001) and frequency of attack (p < 0.001). The odds ratio of higher pain intensity and rate ratio of higher frequency of attack in the intervention groups compared to the placebo group were decreased over the study time. CONCLUSION: Time lapse and higher doses of basil essential oil would reduce both the intensity and frequency of migraine attacks.

Promoting the Quality of Ventilator-Associated Pneumonia Control in Intensive Care Units: an Action Research.

BACKGROUND: Ventilator-associated pneumonia (VAP) is the most common infection in intensive care units (ICUs), with the highest mortality rate of all hospital-acquired infections. This study aimed to improve the quality of VAP control in the ICU of a university-affiliated teaching hospital in Kouhdasht, Iran. MATERIALS AND METHODS: This action research was conducted during 2016-2018. The survey data of 18 participants, who were included in the study using the non-probability sampling method, were evaluated. Qualitative data were analyzed using Graneheim and Lundman's qualitative content analysis, and descriptive indices and t-test were measured to analyze quantitative data. Finally, the qualitative and quantitative data were integrated.This research was developed and implemented in four stages, including assessment and identification of priorities for improvement, design of action plans, implementation of action plans, and reassessment. Data were collected by analyzing 540 performance observations, 55 interviews, six focused group discussions, and two steering group discussions. RESULTS: The mean scores of VAP control before and after implementing the action plans were 259.33±21.64 and 395.16±13.90, respectively (P<0.001). The qualitative findings indicated that the low quality of the personnel's working life and poor organizational culture were the main barriers to the quality improvement of VAP control. Improvement was achieved after implementing the action plans for enhancing the nurses' quality of working life and realization of their professional identity. CONCLUSION: The results of this study suggested that effective approaches, such as personnel empowerment, improvement of environmental conditions, and provision of facilities and equipment can improve the quality of VAP control in ICUs.

Effects of Cold Application on Chest Tube Removal Pain in Heart Surgery Patients.

BACKGROUND: Chest tube removal is considered a painful technique, which may not respond well to palliative therapies. There are no standard procedures or guidelines to manage the pain associated with chest tube removal. This study aimed to examine the effects of cold application on pain reduction during and after chest tube removal. MATERIALS AND METHODS: This randomized controlled trial was conducted on 90 hospitalized patients, undergoing heart bypass surgery at the intensive care units where at least a pleural chest tube was inserted. The patients were randomly divided into two groups (45 samples per group). In the cold application group, an ice bag was placed at the designated point for 20 minutes before chest tube removal, while only routine interventions were applied for chest tube removal in the control group. Pain severity was measured in the groups before, during, and 15 minutes after chest tube removal, using the visual analogue scale. Repeated measures ANOVA test was applied for data analysis. RESULTS: There was no significant difference in the baseline pain score between the groups (P= 0.18). However, there was a significant difference in terms of pain severity score between the cold application (3.58±1.09) and control (4.73±0.86) groups during chest tube removal (P< 0.001). On the other hand, there was no significant difference between the groups regarding the score of pain severity at 15 minutes after chest tube removal (P= 0.38). CONCLUSION: Cold application, as a nonpharmacological intervention, may contribute to the alleviation of cryotherapy-related pain.

The combined effects of cold therapy and music therapy on pain following chest tube removal among patients with cardiac bypass surgery.

BACKGROUND: Chest tube removal is an extremely painful procedure and patients may not respond well to palliative therapies. This study aimed to examine the effect of cold and music therapy individually, as well as a combination of these interventions on reducing pain following chest tube removal. METHODS: A factorial randomized-controlled clinical trial was performed on 180 patients who underwent cardiac surgery. Patients were randomized into four groups of 45. Group A used ice packs for 20 minutes prior to chest tube removal. Group B was assigned to listen to music for a total length of 30 minutes which started 15 minutes prior to chest tube removal. Group C received a combination of both interventions; and Group D received no interventions. Pain intensity was measured in each group every 15 minutes for a total of 3 readings. Analysis of variance, Tukey and Bonferroni post hoc tests, as well as repeated measures ANOVA were employed for data analysis. RESULTS: Cold therapy and combined method intervention effectively reduced the pain caused by chest tube removal (P < 0.001). Additionally, there were no statistically significant difference in pain intensity scores between groups at 15 minutes following chest tube removal (P = 0.07). CONCLUSION: Cold and music therapy can be used by nursing staff in clinical practice as a combined approach to provide effective pain control following chest tube removal.