Concept analysis of conscience-based nursing care: a hybrid approach of Schwartz-Barcott and Kim's hybrid model.

BACKGROUND: The nursing profession considers conscience as the foundation and cornerstone of clinical practice, which significantly influences professional decision-making and elevates the level of patient care. However, a precise definition of conscience in the nursing field is lacking, making it challenging to measure. To address this issue, this study employed the hybrid approach of Schwartz Barcott and Kim to analyze the concept of conscience-based nursing care. METHODS: This approach involves a three-phase process; theoretical, fieldwork, and analytical. A systematic literature review was conducted using electronic databases during the first phase to find relevant papers. The content of 42 articles that met the inclusion criteria was extracted to determine the attributes, antecedents, and consequences of consciousness care using thematic analysis. Based on the working definition as a product of this phase, the plan of doing the fieldwork phase was designed. During this phase, data were collected through interviews with nurses all of whom were responsible for patient care in hospitals. In this phase, 5 participants were chosen for in-depth interviewing by purposeful sampling. Data were analyzed using directed content analysis. The findings of the theoretical and fieldwork phases were integrated and the final definition was derived. RESULTS: The integration of the theoretical and fieldwork phases resulted in identifying four key characteristics of conscience-based nursing care. Firstly, it involves providing professional care with a conscientious approach. Secondly, ethics is at the core of conscience-based care. Thirdly, external spirituality plays a significant role in shaping one's conscience in this context. Finally, conscience-based nursing care is both endogenous and exogenous, with professional commitment being the central focus of care. CONCLUSION: Conscience-based nursing care is an essential component of ethical care, which elevates clinical practice to professional care. It requires the integration of individual and social values, influenced by personal beliefs and cultural backgrounds, and supported by professional competence, resources, and a conducive organizational atmosphere in the healthcare field. This approach leads to the provision of responsive care, moral integrity, and individual excellence, ultimately culminating in the development of professionalism in nursing.

From pervasive chaos to evolutionary transition: The experience of healthcare providers during the COVID-19 pandemic.

AIM: The outbreak of the COVID-19 pandemic confronted healthcare providers, especially physicians and nurses, with many unprecedented changes and physical and psychological pressures. This study aimed to explore the healthcare providers' experiences providing healthcare services for patients during the COVID-19 pandemic in "Golestan, Northeast Iran". DESIGN: Qualitative, conventional content analysis. METHODS: A total of 13 eligible participants were recruited through the purposeful sampling method. Data were gathered using semi-structured in-depth individual interviews. Transcripts were analysed using an inductive content analysis based on the Elo and Kyngas model. The COREQ checklist was used to prepare the manuscript. RESULTS: The analysis of the data in this study led to the development of 16 subthemes and 5 themes emerged as follows pervasive chaos, imposed difficulties, paradoxical perceptions, committed efforts, and constructive transition. CONCLUSION: The experience of HCPs during the COVID pandemic in "Iran" showed that despite the physical, mental, emotional, and social consequences, a kind of constructive evolution and transition has also taken place in personal, professional, and organizational dimensions. It is suggested that managers while strengthening and protecting the capabilities and skills that have emerged, to reduce the tensions of HCPs, have developed programs for comprehensive support from them in physical, psychological, social, and financial dimensions. RELEVANCE TO CLINICAL PRACTICE: It is necessary to improve inter-professional cooperation, empathy, teamwork, professional commitment, and continuous learning in crises.

Nurses' experience of integrating evidence-based changes into their practice: A qualitative study.

AIM: To explore the experiences of neonatal and NICU nurses on participating in evidence-based changes in their neonatal pain management practice. DESIGN: It is a qualitative conventional content analysis. METHODS: A purposive sample with nurses working in neonatal and NICUs was used. The data were collected through 11 semi-structured in-depth individual interviews, five focused group discussions, and observations and analyzed using the conventional content analysis method based on the Elo and Kyngäs model. The COREQ checklist was used for writing the report. RESULTS: Analysis of gathered data led to the emergence of four themes, including 'being in a supportive and encouraging atmosphere', 'a journey from resistance to adherence', 'achieving multi-dimensional improvements', and 'facing obstructive challenges'.

Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran.

Background/aim: Patients in the intensive care units (ICUs) are at high risk of developing delirium and agitation. Physical restraint (PR) has increased to control these patients which accompanies by adverse consequences. The aim was to determine the PR use and associated factors in patients hospitalized at the ICUs in the North of Iran. Materials and methods: In this cross-sectional study, a total of 272 patients in 3 ICUs of 5 Azar referral hospital affiliated to Golestan University of Medical Sciences (Gorgan, Iran) in 2018 were included. Confusion assessment method for the ICU (CAM-ICU), Richmond Agitation-Sedation Scale (RASS), acute physiology and chronic health evaluation II (APACHE II), and Glasgow Coma Scale (GCS) were used to evaluate delirium, sedation level, disease severity, and level of consciousness, respectively. Analysis was done by STATA version 14.2 (StataCorp LP, College Station, Texas), univariate and multiple analyses. Results: Data from 272 patients were analyzed (mean age of 45.8 ± 21.3 years). PR was used for 74.5% of patients. Restrained patients had more severe disease [mean of APACHE II score, 20.20 (7.5) vs 11.6 (7.1)], longer length of stay [mean of 10 (5.5) vs 5.5 (4.6) days], and lower level of consciousness [mean of GCS score, 8.7 (3.5) vs 13.5 (3.3)] than patients without it. CAM-ICU was positive in majority of patients (79.5 vs 10.4%) and agitation level of RASS score was higher in restrained patients (31.7 vs 3.0%). Associated factors in multiple analysis were use of sedative and psychoactive drugs [odds ratio (OR), 2.85; 95% confidence interval (CI): 1.04-7.82], presence of delirium (OR, 15.13; 95% CI: 4.61-49.65), deep sedation (OR, 0.04; 95% CI: 0.00-0.45), and GCS score (OR, 0.69; 95% CI: 0.53-0.9). Conclusion: This study revealed the high use of PR in the ICUs, and use of sedative and psychoactive drugs, presence of delirium, deep sedation, and GCS score were such associated factors. How to cite this article: Nomali M, Ayati A, Yadegari M, Nomali M, Modanloo M. Physical Restraint and Associated Factors in Adult Patients in Intensive Care Units: A Cross-sectional Study in North of Iran. Indian J Crit Care Med 2022;26(2):192-198.

Knowledge and Attitude of Iranian Medical University Students about Organ Donation and Transplantation: A Cross-Sectional Study.

BACKGROUND: Medical professionals' knowledge of and attitudes toward organ donation and transplantation have positive impact on donation rates. The aim of this study was to determine the knowledge and attitude of medical university students in Iran about organ donation and transplantation. METHODS: This cross-sectional study was carried out on 1078 undergraduate students in Golestan University of Medical Sciences, Gorgan, Iran, from January to June 2019. All eligible students were recruited using convenient sampling. Data were gathered using knowledge and attitude toward organ donation and transplantation questionnaire. The higher scores of both subscales, the knowledge subscale (range from 0 to 13) and the attitude subscale (range from 13 to 65), indicate the better knowledge and attitude toward organ donation and transplantation. RESULTS: The mean age of students was 22.24±5.16 years. Finding showed that the mean score of students' knowledge and attitude toward organ donation and organ transplantation were 8.48±1.71 and 48.55±8.11 respectively. Also, the mean score of students' knowledges in females (P<0.001), married (P=0.001) and who had organ donation card (P<0.001) was significantly higher. Nearly all of the students had heard about organ donation (98.3%) and organ transplantation (98.4%). Majority of them pointed that their source of information about organ donation and transplantation was television (TV) program (47.1%). Most of the students (73.8%) reported that they agree to donate their organs but most of them (67.5%) did not know how to obtain organ donation card and only 9.6% of them had the organ donor card as a volunteer donor. CONCLUSION: According to finding, despite the awareness and favorable attitude about organ donation and transplantation among medical students, the number of registered donors was low. In addition to promoting college students' awareness about organ donation for increasing registered donors, it is needed to aware and pursue lay people through social media.

Concept development of "Aging in place": Application of hybrid model.

There are various methods and services which help elders protect their independency and ability and take care. Like aging in place (AIP), that is a home and community-based model. Despite its importance, this concept is still ambiguous and there is no comprehensive definition for it. This study aims to clarify and conceptualize the meaning of AIP and to develop a context-based definition. In this qualitative study, the concept was developed using a hybrid model during three theoretical phases, fieldwork and final analysis. In the theoretical phase, 30 selected articles, following a systematic search in Web of sciences-Scopus-PubMed databases using the keywords "Aging in place", "Aging at home" and "Aging in community", during 2000-2019 were screened and analyzed. After providing the working definition, the fieldwork phase directed qualitative content analysis was performed on interviews conducted with seven eligible elderly. Finally, in the final phase, after comparing the findings of the previous two phases, the final definition was presented. The results of the hybrid model extracted and identified various definitions of AIP and attributes, antecedent and consequences of AIP. attributes included; independency, belonging to the place, maintaining network, living in one's own home and community, safety, comfort, non-institutionalization, first preference, and life routines continuity. Antecedents included; health, physical environment, financial ability, socialization, information support, technology, AIP antecedent prediction, community services and transportation. Finally, Consequences included; Individual acceptability and community acceptability. Also final definition was provided. If the AIP and its related factors are known and provided so that elders can stay in their homes, then they do not have to choose a nursing home and thus stay out of the community. As a result, following the AIP, both the elderly and community will be satisfied.

The effects of earplugs and eye masks on sleep quality of patients admitted to coronary care units: A randomised clinical trial.

Sleep is an essential need for patients admitted to coronary care units. The present clinical trial aimed to determine the effect of using eye masks and earplugs on the sleep quality of patients with coronary heart disease (CHD). A total of 68 eligible patients with CHD were randomly allocated into four groups of 17 (control, eye masks, earplugs, and eye masks with earplugs). All three interventions were performed during the night from 10:00 p.m. to 7:00 a.m. the next day. The outcomes were the quality of sleep, measured by the Verran and Snyder-Halpern (VSH) Sleep Scale, and the urinary levels of nocturnal melatonin and cortisol, measured by urine samples taken during the night (from 10:00 p.m. to 7:00 a.m.). The study outcomes were measured on the third and fourth days. Sleep disturbance was statistically significantly lower in patients with earplugs (visual analogue scale mean difference [MD]: 74.31 mm, SE: 11.34, p = 0.001). Sleep effectiveness was statistically significantly higher in patients with eye mask (MD: 36.88 mm, SE: 8.75, p = 0.001). The need for sleep supplementation was statistically significantly lower in patients with eye masks (MD: 39.79 mm, SE: 7.23, p = 0.001). There was a significant difference in melatonin levels between eye masks and the control group (p = 0.03). For urinary cortisol levels, there were significant differences between eye masks and the control group (p = 0.007), earplugs and the control group (p = 0.001), and eye masks with earplugs and the control group (p = 0.006). The mean scores for comfort, effectiveness, and ease of use were highest for the group that used eye masks (2.88, 2.94, and 3.18, respectively). As a result, all three interventions improved the sleep quality of patients. However, the interventions had different effects on the three dimensions of the VSH Sleep Scale, as well as the urinary levels of cortisol and melatonin.

Development and implementation of anxiety management program for women under gynecological surgery with spinal anesthesia: Protocol of action research study.

BACKGROUND: Anxiety is the most common health problem and the second leading cause of disability worldwide. Patients undergoing surgery often experience anxiety. It is necessary to use appropriate interventions to achieve the best results. The aim of this study is to develop, implement, and evaluate of anxiety management program for gynecological surgery patients under spinal anesthesia. MATERIALS AND METHODS: This participatory action research will be conducted through four phases; problem identification, planning, action, and evaluation phases in the Gonbad-e-Kavous Shahada, hospital in northeastern of Iran. These phases will be guided based on the Promoting Action on Research Implementation in Health Services framework. Participants will be included using purposive sampling method. We will use both of qualitative (semi-structured interview, observation) and quantitative (questionnaire) approaches for data collection through the study. CONCLUSION: For anxiety management of patients, context-based interventions should be performed. Combination of multidimension approach based on health-care providers, patients, and environment will have an effect to solve the problem in the clinical setting.

Comparison of Prevalence and Risk Factors of Acute Coronary Syndrome in Patients with Different Ethnicity: A Cross-sectional Study.

BACKGROUND: Although the main risk factors of acute coronary syndrome (ACS) have been previously identified, there is not yet strong and consistent evidence about the ethnical differences of these risk factors. The aim of this study was to identify and compare the distribution of risk factors of ACS among two ethnic groups in northern Iran. METHODS: This cross-sectional study was done on a total of 250 patients (100 Fars and 150 Turkmen ethnics) with ACS admitted in coronary care units (CCU) of medical centers in Gonbad-e Kavus, a city in the Northeast of Iran. The demographic characteristics, clinical parameters and anthropometric indices of patients in two ethnic groups were recorded. In addition, Beacke's questionnaire and Cohen's scale were used to evaluate and compare the patients' level of physical activity and perceived stress, respectively. RESULTS: The mean age of the patients was 60.9±11.9 years and they were mostly males (54.8%) and married (84.8%). Findings showed that the prevalence of myocardial infarction in Fars patients was significantly higher than Turkmens (24% versus 15.3%; P=0.04). In addition, there was a significant difference in terms of the history of using opium (P=0.07) and opium sap (P=0.03), socioeconomic status (P=0.009), the place of residence (P=0.001) and type of health insurance services (P=0.001) between two groups. However, the clinical parameters and anthropometric indices and the level of physical activity and perceived stress were not significantly different between two groups (P>0.05). CONCLUSION: This study showed a significant difference in the prevalence and risk factor of ACS in patients with different ethnicity in northern Iran. This finding points to the importance of paying attention to the ethnicity-based difference in ACS prevalence and risk factors, especially in patients who are at high to intermediate risk for ACS, such as Turkmens.

The effect of melatonin on quality of sleep in patients with sleep disturbance admitted to post coronary care units: A randomized controlled trial.

BACKGROUND AND OBJECTIVES: Patients with cardiovascular disease who required to be admitted in coronary care units (CCU) would have sleep deprivation. During the admission some factors such as continuous ambient light exposure can suppress melatonin release, in consequence sleep deprivation will be occurred and hinder the progress of patients' treatment. The aim of study was to evaluate the effect of melatonin on the sleep quality of patients admitted to post-CCU. MATERIALS AND METHODS: This randomized clinical trial was carried out on 110 patients admitted to post-CCU at SayyadeShirazi Hospital, Gorgan, Iran. Patients with a poor sleep quality (Pittsburgh sleep quality index (PSQI) global score>5) were randomly allocated into two intervention and placebo groups. Patients in the intervention group received melatonin (3 mg; 30 minutes before bedtime), and the placebo group received placebo for 2 weeks, and their sleep quality was re-evaluated after the end of intervention. Data were analyzed using paired t test, Wilcoxon, and Chi-square tests by SPSS version 21. RESULTS: The results showed that mean of the patients' PSQI scores decreased significantly in intervention group (from 14.95 ± 1.48 to 11.65 ± 1.50, P < 0.001), while in placebo group the difference was not significant (from 15.48 ± 1.47 to 15.24 ± 1.71, P = 0.129). Post-intervention score of patients in intervention group was also lower than the placebo group (P < 0.001). CONCLUSION: The melatonin can improve the sleep quality of the patients admitted to post-CCU who suffer from sleep disturbance.

Factors affecting supportive needs in hemodialysis patients: A literature review.

BACKGROUND: Explaining the factors affecting supportive needs of patients under hemodialysis seems to be essential to supply their needs. Also, it can help healthcare providers to make favorite decisions about care planning to improve the patients' quality of life. OBJECTIVE: This study was conducted to determine the factors affecting supportive needs in hemodialysis patients using a literature review. METHODS: This literature review was carried out in PubMed, MEDLINE, SCOPUS, SID, Magiran, and Iranmedex. Data based were searched from 2000 to 2018 using the keywords of "Need", "Supportive Need", and "Hemodialysis". In a total of 239 full texts of published articles, 12 such relevant articles were selected. RESULTS: The finding showed that the factors affecting the supportive need of patients can be categorised into two: internal and external factors. Internal factors consist of patient-related factors, disease-related factors, and treatment-related factors. External factors consist of personal living circumstances, health system-related factors and socioeconomic factors. CONCLUSION: By explaining the factors affecting supportive need in hemodialysis patients, it may help clinicians and researchers to identify the patients' need, developing an appropriate questionnaire, and implementing suitable intervention. As a result, it can improve their quality of life.

Effects of Pilates Exercises on Professional Self-concept in Nurses Working in Intensive Care Units and Emergency Departments.

BACKGROUND: Professional Self-Concept (PSC) affects one's way of thinking, role evolution, professional behavior, and performance. The present study aimed to determine the effect of Pilates exercises on PSC in nurses working in Intensive Care Units (ICU) and emergency departments. MATERIALS AND METHODS: This quantitative study was a randomized controlled field trial. The study population consisted of all nurses working in ICUs and emergency departments from 2016 to 2017. Based on the inclusion and exclusion criteria, 110 nurses were assigned to intervention and control groups using a permuted block randomization method. The Nurses' Self-Concept Questionnaire (NSCQ) was completed by both groups. The intervention group performed Pilates 30 min each session at home for 8 weeks. The Chi-squared test, Mann-Whitney U, Kruskal-Wallis test, and t-test were employed to analyze the collected data. RESULTS: Mean and standard deviation of the PSC score was 223.73 (23.35) in the intervention group and 215.75 (34.54) in the control group at baseline; it reached 229.17 (23.36) in the intervention group and 217.77 (34.44) in the control group at the end of the study. The difference was not significant. The paired-samples t-test showed that the score of PSC was increased by 5.45 points on average in the intervention group after the Pilates exercises, which was statistically significant (t54= 25.80, p < 0.001). CONCLUSIONS: Pilates enhances the score of PSC in nurses working in ICUs and emergency departments. The designing and implementation of these easy and safe exercises may prove beneficial for nurses.

The age-friendly cities characteristics from the viewpoint of elderly.

BACKGROUND: Elderly population is rising due to advancement of health care, medical services, and increasing life expectancy. World Health Organization (WHO) has initiated a global project to define "age-friendly city for improving the elderly's quality of life". OBJECTIVES: The purpose of the study was to determine the age-friendly cities characteristics from the elderly's point of view in Gorgan, Iran. METHODS: This cross-sectional study was conducted in 2019 on elderly people who referred to the health centers of Gorgan, Iran. 160 eligible elderly people were recruited through multi-stage random sampling. The viewpoint of participants about the characteristics of Gorgan in the four age-friendly city indicators; urban and outdoor buildings, transport and transportation systems, information and communication services, and social support and health services was compared with the standard of WHO. Data were collected using the age-friendly city questionnaire and analyzed in SPSS-18 using Chi-square and one-sample t-tests. RESULTS: From the elderly viewpoint, the mean score of 4 indicators; urban buildings and outdoor (58.50 ± 31.2), Transport and transportation system (43.3 ± 82.00), access to Information communication services (46.75 ± 15.1) and the level of access to social support and health services (81.43 ± 21.10). Considering age-friendly city indicators, the characteristics of Gorgan City were significantly lower than the WHO recommended standard (P < 0.001). The "Information and Communication" and "buildings and outdoor space" indicators had the highest and lowest differences from the standard, respectively. CONCLUSION: According to the present results it is recommended that managers and policymakers of urban planning and healthcare providers in their programs consider the elderly viewpoint to improve the urban characteristics as an age-friendly city.

Adherence to Treatment in Patients with Chronic Diseases: From Alertness to Persistence.

BACKGROUND: Adherence to treatment is a process that begins with alertness about the disease and has to end with staying in treatment. It is a concern to all health care disciplines. The aim of this study was to explore the experience of adherence to treatment patients with chronic diseases. METHODS: This qualitative study was conducted during a period of 6 months in Golestan province in Iran in 2017. In-depth semi-structured interviews were done with a purposive sample of 15 patients with chronic disease (i.e. Chronic renal failure (CRF), Hypertension (HTN), Multiple sclerosis (MS) and Diabetes). Data were analyzed using qualitative content analysis in MAXQDA Software. RESULTS: The analysis of the data in this study led to the development of ten subthemes and four themes emerged as follows: motivation, cohesion, commitment and empowerment which are necessary components for adherence to treatment in patients. "Moving from alertness to persistence" emerged as the main theme. CONCLUSION: The findings of the study offer helpful insights into the concept of adherence to treatment and its components for health care providers, which can be used to develop the best possible care plan and may help health care providers to support the patients to have an active role for following treatment rather than just doing it.

Prevalence of Malnutrition Among Elderly People in Iran: Protocol for a Systematic Review and Meta-Analysis.

BACKGROUND: Malnutrition occurs following a decrease or an imbalance in the absorption of energy, protein, vitamins, and minerals because of numerous factors. Thus, it has serious and life-threatening consequences. To plan for this issue, we need information on the burden of this problem. OBJECTIVE: The aim of this study is to determine the prevalence of malnutrition among elderly people in Iran. METHODS: For the purpose of this study, papers, including original articles, theses, and conference proceedings on the prevalence of malnutrition among people aged 60 years and above, and have been published in national and international journals until September 2018 will be included without any language limitation. The following keywords along with their synonyms in Persian will be used in the literature search: malnutrition, elderly, and Iran. At first, the screening process will be conducted based on our inclusion and exclusion criteria. Then, the full text of the remaining articles will be read carefully, and eligible articles will be selected according to the objectives of the study. Next, the methodological quality of the selected papers will be reviewed, and the required information will be extracted from those with acceptable quality. Finally, a meta-analysis will be performed using the Stata software (version 14) when optimum criteria are met. It should be noted that all stages of screening, selection, quality assessment of primary studies, and data extraction will be performed by two reviewers independently. RESULTS: This review is ongoing and will be completed at the end of 2019. CONCLUSIONS: This review aims to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran. This can help Iranian health managers and policy makers make informed decisions for preventing malnutrition and promoting the health status of elderly people. TRIAL REGISTRATION: PROSPERO CRD42018115358; https://tinyurl.com/y28su47m. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15334.

Impact of Implementing the Critical Care Pain Observation Tool on Nurses' Performance in Assessing and Managing Pain in the Critically Ill Patients.

BACKGROUND AND AIMS: Pain management is one of the most important responsibilities of nurses in an intensive care unit (ICU). It is difficult to perform pain assessment appropriately in patients who are unable to report their pain. This study is aimed to determine the impact of implementing the critical care pain observation tool (CPOT) on the amount and frequency of analgesics' administration in ICUs. MATERIALS AND METHODS: This interventional study was conducted in 2014. Sixty nurses and 240 patients were studied. This study was carried out in three phases: first the data about amount and frequency of analgesic administration were extracted from patients' medical files. Then the CPOT was implemented into the nursing assessment process and finally, nurses' performance regarding the amount and frequency of analgesic administration was recorded. This data obtained before and after intervention were analyzed using chi-square and independent t-test p values less than 0.05 were considered significant. RESULTS: In this interventional study, we found that there was no difference in the demography and cause of ICU admission before and after implementation of CPOT (age p = 0.937, gender p = 0.996, and the cause of admission p = 0.996). We found that after implementing the CPOT into the nursing assessment process, the amount of analgesics administered (7.95 ± 8.77 mg vs. 11.01 ± 11.04 mg, p = 0.018) and the frequency of administration (2.91 ± 1.38 vs. 4.16 ± 0.99, p <0.001) increased significantly. Moreover, there was a significant increase in the frequency of pain assessment per patient per day in nursing practice after implementation of CPOT as compared to the practice before (7.2 ± 2.48 vs. 1.03 ± 1.63, p <0.001). The mean pain scores before and after the intervention (5.5 ± 1.08 vs.2.2 ± 0.48) were also significantly different. CONCLUSION: Applying CPOT, as an objective mean of pain assessment, was effective in improving the performance of ICU nurses in assessment and management of patients' pain. It increased the amount and frequency of analgesic administration. We can recommend that COPT is a useful tool for assessment and management of pain in ICU patients and should be implemented in all ICUs. HOW TO CITE THIS ARTICLE: Modanloo M, Mohsenpour A, et al. Impact of Implementing the Critical Care Pain Observation Tool on Nurses' Performance in Assessing and Managing Pain in the Critically Ill Patients. Indian J Crit Care Med 2019;23(4):165-169.

The Effect of Computer-based Tests on Nursing Students' Test Anxiety: a Quasi-experimental Study.

BACKGROUND: Test anxiety often leads to poor academic performance. This study aimed to determine the effect of computer-based tests on nursing students' test anxiety. METHODS: This quasi-experimental study was conducted in 2016 on 39 nursing student with anxiety score under 128 on Spielberger's State-Trait Inventory (STAI). They were randomly allocated to computer-based tests (CBT) and paper-based test (PBT) group. Prior to exam, all students completed Sarason's Test Anxiety Scale (TAS). We administered CBT for students in experimental group. Data were analyzed using independent t-test and one-way ANOVA. RESULTS: Students mean test anxiety score was 11.94 and 11.32 in CBT and PBT groups, respectively. 47.4% of students in CBT group and 29.4% of those in PBT group experienced higher test anxiety, while the difference was not significant (p=0.56). CONCLUSIONS: Despite, there was no significant difference between anxiety score of two groups; but students' test anxiety score was higher in CBT group. With the current increase in computer-based assessment, educational administrators must be aware of and plan for the possible unfavorable effects of computer assisted testing, such an anxiety. Future studies are needed to evaluate and compare the effect of different type of student testing such as distance testing or CBTs using new information technologies such as laptop, tablet or mobile phone on students' test anxiety and performance.

A Cross-Sectional Study Examining the Correlation between Nocturnal Melatonin Level and Sleep Quality in Patients Admitted To the Cardiac Care Unit.

BACKGROUND: Quality of sleep, as a basic need, is an important factor for surviving patients in hospitals. Many factors may contribute to disturbing patients sleep, such as continuous ambient light, is required for healthcare providers to monitor patients. Ambient light can influence patients' quality of sleep due to melatonin secretion. AIM: Study aimed to determine the correlation between nocturnal melatonin levels and sleep quality in patients admitted to the Cardiac Care Units (CCU). MATERIAL AND METHODS: This cross-sectional study was done on inpatients of CCUs at Amir-Almomenin Hospital in Kordkoy city, a cardiac referral hospital in the northeastern of Iran in 2015. Sixty-eight inpatients were selected through convenience sampling. Before data gathering light level of CCUs was measured every one hour in 2 days, the quality of nocturnal sleep was investigated through Verran and Snyder-Halpern (VSH) Sleep Scale at the second night of admission urinary melatonin level was measured at the same night in all urine excreted between 22:00 pm and 07:00 am. RESULTS: The mean and standard deviation (SD) score of sleep quality in three dimensions of sleep disturbance, sleep effectiveness and sleep supplementation were 336.6 ± 149.9, 269.0 ± 82.2, and 175.2 ± 30.7, respectively. Also, the mean and SD of nocturnal urinary melatonin levels was 323.02 ± 136.21 pg/ml. There was not a significant correlation between level of nocturnal melatonin and three domains of sleep quality; sleep disturbance (r = 0.005, P = 0.968), sleep effectiveness (r = 0.090, P = 0.464), and sleep supplementation (r = -0.037, P = 0.763). CONCLUSION: According to the result, most CCUs patients suffer from sleep disturbance. However, there was no correlation between the level of melatonin and sleep quality. There is a need for recognising the reasons for sleep disturbances in Cardiac Care Units. It is imperative for care providers to be able to recognise the causes of sleep disturbances and to modify environmental factors such as ambient light to improve sleep quality in hospitalised patients.