The Effect of Simulation-Based Education on Patient Training Correct Inhaler Technique of Nursing Students: A Randomized Controlled Trial.

Introduction: Teaching inhaler techniques to nursing students is crucial. Objective: This study aimed to investigate the effect of simulation-based education on patient training correct inhaler technique in nursing students. Methods: This is a single-blind, randomized controlled trial in which nursing students are randomly allocated into two groups of control (n = 41) and intervention (n = 40). The students' mean score of correct inhaler technique was measured before and one week after intervention, using checklists of inhaler techniques. Results: The mean score of control group was significantly lower than the intervention group (p < .001). The results also revealed that there was no significant difference in students' level of confidence regarding the ability to educate patients on inhaler techniques before the intervention, while all students were shown to have higher levels of confidence in this term after the intervention. Conclusions: Simulation is an effective way to train nursing students in the correct inhaler techniques.

Strategies for Improving Nurses' Performance Regarding Cardiovascular Patient's Adherence to Treatment Regimen: Content Analysis.

Background: Patient adherence to the treatment regimen is an important goal of treatment; finding appropriate strategies to improve treatment adherence is a nursing challenge. This study aimed to explore strategies to improve nurses' performance to enhance cardiovascular patients' adherence to treatment regimens. Materials and Methods: This is a qualitative content analysis study that was performed in an educational hospital of the Urmia University of Medical Science. Data were collected through semi-structured individual and group interviews. Sixteen individual interviews were conducted with nurses, patients, and physicians. A focus group was conducted with the presence of six nurses and nursing managers. Data were analyzed by conventional content analysis using MAXQDA 2020. Results: After analyzing the interviews, five strategies were explored; these strategies include: follow-up of the patient after discharge (systemic and organizational follow-up, educational follow-up, counseling follow-up, and motivational follow-up), sending reminders for necessary cases to the patients (risk reminders, care reminders); improving patient education methods (modern and up-to-date education, conventional and routine education), improving support services (home care services, social support, Psychological support), and optimizing the structure and processes of the hospital (making structural changes, making process changes). Conclusions: Much needs to be done to improve patient's adherence to treatment. Nurses are at the forefront of this work. In this study, we introduced ways to improve nurses' performance in order to increase patient adherence.

The perceived social support by Iranian women with breast cancer: a qualitative study.

BACKGROUND: Social support has an important role in improving health outcomes and is considered as one of the crucial aspects of the modern care in cancer patients. Therefore, this article aims to explain the perceived experiences of women suffering from breast cancer towards social support. METHODS: In this qualitative study, 22 women with breast cancer were selected through purposive sampling from 5 hospitals affiliated to Urmia University of Medical Sciences. The data were collected through semi-structured interviews and were analyzed by the Conventional Qualitative Content Analysis and Graneheim's and Lundman's approach, using MAXQDA software, version 10. RESULTS: After completion of the analyzing process, 6 categories were appeared including "creating an empathic atmosphere by family and community," "being in relationship with others," "adaption to disease," "giving meaning to life," "satisfaction with the role of healthcare providers," and "the impact of others support in fighting with the disease." CONCLUSION: According to the findings, good social support during the illness can result in the spiritual, mental, and physical well-being of the patients and is one of the most effective factors in fighting the disease and feeling of recovery. The findings of this study can be used to develop plans to help the patients to achieve more support from the family, healthcare providers, and the community and even providing the required supportive care for this group of women.

Causes of nonadherence to treatment in people with myocardial infarction: Content analysis.

BACKGROUND: Nonadherence with the medication regimen in patients with heart disease can lead to treatment failure. The purpose of this study was to identify the causes of nonadherence in people with myocardial infarction. MATERIALS AND METHODS: This study is a qualitative conventional content analysis. Data were collected through semistructured interviews. Thirteen individual interviews and a focus group were conducted with nurses, patients, and doctors. Data were analyzed using conventional content analysis. RESULTS: Four main themes were identified, which are organizational-managerial causes and factors (drug-related problems, educational system-related problems, weak performance of hospitals, and problems related to insurance companies); sociocultural causes and factors (factors related to cultural problems and factors related to social problems); causes and factors related to care providers (skill problems of care providers and functional problems of care providers); and causes and factors associated with caregivers (factors related to social characteristics of the patient, factors related to patient characteristics, and factors related to the patient's belief). CONCLUSIONS: Many individual and organizational factors affect nonadherence, which can be reduced by fundamental changes.

Evaluation of blended medical education from lecturers' and students' viewpoint: a qualitative study in a developing country.

BACKGROUND: To improve the quality of education, many academic medical institutions are investing in the application of blended education to support new teaching and learning methods. To take necessary measures to implement the blended learning smoothly, and to achieve its goals, we aimed to identify its strengths, weaknesses, opportunities, and threats (SWOT) from its key users' viewpoints. METHODS: A qualitative study consisting of 24 interviews with lecturers and students and document analysis was conducted at Urmia University of Medical Sciences, in Iran, in 2018. The SWOT framework was used to analyze the data. RESULTS: The most important strengths were the promotion of lecturer-student interactions, the focus on students' learning needs and self-learning, and problem-solving skills. The supports of university executives, alignment with the national health education transformation plan, and access to the shared infrastructures of the national virtual medical science university were opportunities to facilitate its implementation. However, this endeavor had weaknesses such as bottlenecks in technical, organizational, and human resource infrastructures and lack of culture readiness. The threats envisioned for its maintenance were its dependency on the education transformation plan and the lack of an independent e-learning center for better planning and support services, lack of proper evaluation and supervision of virtual activities, and insufficiency of the privileges considered for users. CONCLUSIONS: One of the important implications of this study is that different aspects surrounding blended learning might work as a double-edge sword from time to time, which requires a thorough overview. While retaining the strengths and enjoying the opportunities in such interventions, the weaknesses should be recognized and threats are faced and addressed. Therefore, if the SWOT items are considered mindfully, they can help to adopt the right implementation strategies to reap full benefits.

How do parents deal with their children's chronic kidney disease? A qualitative study for identifying factors related to parent's adaptation.

BACKGROUND: Parents' adaptation affects the health outcomes of children with chronic kidney diseases (CKD). Identifying factors that affect parents' adaptation is necessary to understand their adaptation status. This study aims to explore factors related to the adaptation of parents who have children with CKD. METHODS: This was a qualitative study with a content analysis approach. Seventeen parents of children with CKD were selected by using purposive sampling. The leading researcher performed semi-structured, in-depth, face-to-face interviews to collect data. Conventional content analysis was used to analyze data. RESULTS: Two main categories extracted from the data were "adaptation facilitators" and "adaptation barriers." Adaptation facilitators were supported by three sub-categories: "social support", "family capability" and "spiritual beliefs". Four sub-categories of "adaptation barriers" were revealed as: "family-related barriers," "mental stress by others," "the chronic nature of the disease," and "unfavorable treatment conditions." CONCLUSIONS: Identifying the factors influencing parental adaptation helps the medical staff to make the necessary interventions to support the parents. According to this study, increasing parent access to the required information, supporting them financially and emotionally, and helping them identify support resources can facilitate their adaptation to their child's chronic illness. Also, identifying and eliminating adaptation barriers can help parents deal better with their child's chronic disease.

The Effect of Using Communication Boards on Ease of Communication and Anxiety in Mechanically Ventilated Conscious Patients Admitted to Intensive Care Units.

BACKGROUND: Using mechanical ventilation devices has unique advantages for the patient; however, it can also cause various problems. This study aimed to determine the effect of using communication boards on the ease of communication and anxiety in mechanically ventilated conscious patients admitted to intensive care units (ICUs). MATERIALS AND METHODS: In this quasi-experimental study, 30 conscious patients undergoing mechanical ventilation were enrolled using consecutive sampling method and assigned to experimental (n = 15) and control (n = 15) groups. The control group included patients receiving primary communication methods, whereas the experimental group included patients who used the communication board for communication. The Hospital Anxiety and Depression Scale (HADS) and Ease of Communication Scale (ECS) were completed for both groups. Data were analyzed using descriptive-inferential statistics. RESULTS: Communication scores of the patients indicated that there was no significant difference between the control and experimental groups before the intervention (z = -1.77; p = 0.070). However, after the intervention, there was a significant difference in communication scores between the two groups (z = -4.69; p = 0.001). The anxiety scale scores showed a significant difference between the control and experimental groups after the intervention, and patients' anxiety had significantly decreased in the experimental group (z = -2.98; p = 0.003). CONCLUSIONS: The results showed that the use of the communication board is possible in mechanically ventilated conscious patients and may contribute to ease of communication and decrease patients' anxiety during mechanical ventilation.

Challenges of PhD Graduated Nurses for Role Acceptance as a Clinical Educator: A Qualitative Study.

Introduction: Clinical education is the core component of nursing education. PhD graduated nurses who are faculty members can play a main role in clinical instruction. However, there is not clear understanding about the challenges which they may encounter for accepting their role as clinical educator. The aim of this study was to explore the challenges of role acceptance by PhD aduated nurses who are faculty members. Methods: In this qualitative exploratory study a total of 13 participants (8 PhD graduated in nursing, 3 head of departments of nursing, one educational vice chancellor of nursing school, and one nurse) were selected by purposive sampling method. Data were collected by semi-structured, face to face interview and analyzed by conventional content analysis approach developed by Graneheim and Lundman. Results: The main theme emerged from data analysis was "identity threat". This theme had five categories including expectations beyond ability, lack of staff's rely on the performance of PhD graduated nurses, poor clinical competencies, doubtfulness, and obligation. Conclusion: PhD graduated nurses experienced some worries about their role as clinical educators and argued that they have not been prepared for their role. Therefore, policy makers and authorities of nursing schools should support PhD graduated nurses for accepting their new roles as clinical educators. Moreover, some changes in nursing PhD curriculum is needed to improve the clinical competencies of PhD graduated and prepare them for their role as a clinical educator.

Comparative Analysis of the Perception of Family Functioning by Heads of Families with and without Cancer Members During Illness.

BACKGROUND: Cancer is a major health problem due to the aging population with increasing deaths. Family functioning is affected by cancer diagnosis and treatment. The aim of this study was to comparative analysis of the perception of family functioning by heads of families with and without cancer members during illness, focusing on changes or probable changes. MATERIALS AND METHODS: This comparative study was conducted on two groups (families with a member of the cancer and controls without a family member with cancer). The families were of patients referred to the clinics and hospitals of Imam Khomeini, Taleghani and Omid of Urmia city, the number of samples being 148 for cases and 176for the control group. To collect the data, valid and reliable family functioning (FAD) was applied, a 60-item questionnaire with seven dimensions, with heads of families. To analyze the data SPSS- 23 Software was used for descriptive and analytical statistics. Significance level was defined p<0.05. RESULTS: Among the seven items : problem solving, communication, roles, emotional response, emotional involvement, behavior control and overall functioning, only differences for average scores of problem-solving were statistically significant. DISCUSSION: Contrary to common perception of severe damage for family functioning in families with cancer members, results of this study indicate that functioning in terms of family caregivers is more or less similar to that of the families with other diseases. Only in problem-solving item do these families experience more difficulty. CONCLUSION: According to the research findings, in nursing from families with cancer patient, it is recommended to focus more on the problem-solving item of the families.

Patient Safety in Medical Education: Students' Perceptions, Knowledge and Attitudes.

Patient safety is a new and challenging discipline in the Iranian health care industry. Among the challenges for patient safety improvement, education of medical and paramedical students is intimidating. The present study was designed to assess students' perceptions of patient safety, and their knowledge and attitudes to patient safety education. This cross-sectional analytical study was conducted in 2012 at Urmia University of Medical Sciences, West Azerbaijan province, Iran. 134 students studying medicine, nursing, and midwifery were recruited through census for the study. A questionnaire was used for collecting data, which were then analyzed through SPSS statistical software (version 16.0), using Chi-square test, Spearman correlation coefficient, F and LSD tests. A total of 121 questionnaires were completed, and 50% of the students demonstrated good knowledge about patient safety. The relationships between students' attitudes to patient safety and years of study, sex and course were significant (0.003, 0.001 and 0.017, respectively). F and LSD tests indicated that regarding the difference between the mean scores of perceptions of patient safety and attitudes to patient safety education, there was a significant difference among medical and nursing/midwifery students. Little knowledge of students regarding patient safety indicates the inefficiency of informal education to fill the gap; therefore, it is recommended to consider patient safety in the curriculums of all medical and paramedical sciences and formulate better policies for patient safety.

Effect of applying cold gel pack on the pain associated with deep breathing and coughing after open heart surgery.

BACKGROUND: Coughing and deep breathing after sternotomy causes severe pain. This study was conducted to assess the effect of cold therapy on the pain in patients undergoing open heart surgery. MATERIALS AND METHODS: In a randomized controlled trial (RCT) with crossover design, 50 eligible and consenting patients were recruited and randomly allocated to gel pack and non-gel pack groups on the first postoperative day. All patients performed four episodes of deep breathing and coughing (DB and C) every 2 h. Pain intesity was measured and compared at rest and after DB and C in both groups. At the end of the study, all patients were asked about their preferences for the cold gel pack application prior to DB and C. The study hypotheses were analyzed using repeated measures analysis of variance (RM-ANOVA). RESULTS: Data analysis showed significant reduction in pain scores (P < 0.001) after cold gel application. Forty-five (90%) patients were inclined to reapply the gel pack in the future. CONCLUSION: Cold gel pack can reduce the pain associated with DB and C in cardiac surgery patients.

Effect of self-efficacy enhancement program on self-care behaviors in chronic obstructive pulmonary disease.

BACKGROUND: Given the importance of the chronic obstructive pulmonary disease (COPD) and role of different factors in self-care behaviors of COPD patients, this study was conducted to determine the effect of self-efficacy program on self-care behaviors of COPD patients. MATERIALS AND METHODS: In this semi-experimental study, 62 COPD patients were recruited in which 31 subjects were in control group and 31 were in experimental group. Subjects were selected based on purposive sampling from Imam Hospital affiliated to the Urmia University of Medical Sciences, Iran, in 2011. Two valid and reliable questionnaires were filled after completing informed consent form. A month later, and after implementing the planned intervention, the questionnaires were completed by the subjects again. RESULTS: The mean standard deviation of age were 64.1 (9.1) years in the control group and 65.2 (8.0) years in the experimental group. There was a statistically significant difference between self-efficacy state before and after intervention. Self-care scores in the experimental group were significantly higher after intervention (t = 25.18, P < 0.0001). CONCLUSIONS: Given the high potency of self-efficacy factors on self-care behaviors of the COPD patients, enhancement of self-efficacy in these patients can be very effective in disease control, prevention of complications, reduction of hospitalization costs, and improve their quality of life. Hence, it is suggested that in empowerment programs of these patients, special emphasis will put on the strengthening of their self-efficacy.

Effect of phase III cardiac rehabilitation and relaxation on the quality of life in patients with cardiac syndrome X.

BACKGROUND: Cardiac syndrome X is a relatively common disorder, and still not much is known about the causative factors or its pathophysiology, which makes it difficult to cure. Due to its chronic nature and debilitating symptoms, many patients have significantly reduced quality of life (QOL).The purpose of this study was to assess the impact of phase III cardiac rehabilitation (CR) and relaxation on the QOL of patients. MATERIALS AND METHODS: This research is a randomized clinical trial study. Forty eligible and consenting women (age 30-65 years) were randomly assigned to four groups. In the first group (n = 11), progressive muscle relaxation (PMR); in the second group (n = 11), phase III CR; and in the third group (n = 11), PMR along with phase III CR were performed for 8 weeks at home. The fourth group (n = 7) was used as the control group. Short form of QOL questionnaire (SF-36) was used for data gathering. Data analysis was performed using χ(2), Kruskal-Wallis, and rank sum difference tests. RESULTS: After phase III CR, relaxation, and combination of CR and relaxation, patients demonstrated improved QOL (P < 0.001). The results of post-test multiple comparisons showed that there were statistically significant differences between control and all intervention groups (P < 0.05). There was also statistically significant difference between relaxation and combination of phase III CR and relaxation groups (P < 0.5). CONCLUSIONS: An 8-week phase III CR program together with relaxation improved QOL of patients with cardiac syndrome X. We suggest phase III CR program together with relaxation as an effective treatment in these patients.