The challenges of the Iranian nursing system in addressing community care needs.

BACKGROUND: The nursing system is one of the major and important fields of health and medicine in every country, responsible for providing nursing care and addressing medical and health-related community care needs. The aim of this study was to explain the challenges of the Iranian nursing system in addressing community care needs. MATERIALS AND METHODS: A conventional content analysis method was performed in this exploratory qualitative study, and 27 participants were selected through a purposive sampling method based on the inclusion criteria. In-depth semi-structured interviews were conducted with the subjects, and data saturation was achieved in the 27th interview. The main interviews with the participants were individual, in person, and face-to-face, conducted at different times (morning and evening) in a peaceful environment and at the convenience of the participants. The interviews were recorded by the researcher with the participants' consent. The duration of the interviews ranged from 50 to 70 minutes, given the participants' energy and time. Data analyses were done using Graneheim and Lundman approach. RESULTS: After conducting the interviews and the simultaneous analysis, three themes were extracted, including the challenging structure in the internal environment, the operating environment, and the social environment, with seven main categories and 26 subcategories. An inadequate number of nurses given the real needs of society, the unbalanced proportion of employed clinical nurses to the real needs of society, poor presence of nurses in community-based nursing services, insufficient attention to the optimization of the work environment, the gap between education and clinical practice in the nursing system, poor mutual accountability of the community, and policies in the health system were seven main categories in this study. CONCLUSION: In general, the results showed that the Iranian nursing system faces many micro, meso, and macroscale challenges. It is necessary to plan properly to enhance the accountability of the nursing system to the current community care needs by improving the situation.

Investigating the effect of implementing a sensory stimulation program by family members on delirium status of brain injury patients hospitalized in the intensive care unit: A randomized clinical trial.

BACKGROUND: Delirium is the most common psychological disorder in brain injury patients hospitalized in the intensive care unit (ICU), one of the leading causes of which can be sensory deprivation or sensory overload. This study aimed to determine the effect of implementing a sensory stimulation program by family members on the delirium status of ICU-hospitalized brain injury patients. MATERIALS AND METHODS: In this randomized controlled clinical trial, 66 brain injury patients hospitalized in the ICUs were assigned to intervention and control groups using stratified random sampling. For the intervention group, a sensory stimulation program was implemented by family members for 1 h a day during the ICU stay. The control group received routine care. Patients' delirium status was assessed daily using the confusion assessment method for the intensive care unit (CAM-ICU). Data were analyzed by the SPSS software version 22, using Chi-square, independent t-test, and Binary logistic regression model tests, at a significance level of 0.05. RESULTS: Odds of delirium Incidence in the intervention group was 94% lower than in the control group (OR = 0.057, 95% CI 0.017, 0.19, P = 0.001). There is a significant difference between the two groups in terms of length of delirium (P = 0.001), stay in ICU (P = 0.001) and mechanical ventilation (P = 0.001). The mean of all three variables in the intervention group was lower than the control group. CONCLUSIONS: Implementing of sensory stimulation program by the family members, as a non-pharmacological method, can reduce the incidence of delirium in brain injury patients admitted to ICU.

Exploring the social accountability challenges of nursing education system in Iran.

BACKGROUND: Nursing education in Iran is one of the disciplines of medical sciences and it needs a design tailored to the community needs in terms of theoretical and clinical approaches. This system is currently faced with various challenges. This study aims to explore the challenges of Iranian nursing education system to address community needs. METHODS: A study was carried out through an exploratory descriptive qualitative design with content analysis method. In-depth semi-structured interviews were conducted with 21 participants from the nursing society, selected through purposive sampling. The interviews were continued until data saturation. Data analysis was performed simultaneous with data collection by using Graneheim & Lundman approach. RESULTS: Based on the interviews and simultaneous analyses, a total of 471 codes, 14 subcategories, six main categories, and two themes were extracted. The first theme, "system structure," consisted of three categories: "the need for ongoing revision of curriculum," "the need to recruit qualified students," and "the need for a proportionate educational environment." The second theme was "the education process" with three categories "the need for purposive educational design," "the need for purposive monitoring and feedback," and "the need for appropriate and early interaction with the community." The participants emphasized the continuous revision of the educational curriculum based on the current needs of the community and community-based nursing education. CONCLUSIONS: In general, the results showed that Iranian nursing education system is faced with many challenges in the educational system structure and processes. It is necessary to make appropriate plans to enhance the status of the educational system structure and develop educational designs to address community needs using a hospital/community-based approach.

Barriers and facilitators of professional autonomy of clinical nurses in Iran: A qualitative study.

Religious, economic, political, social, and cultural factors influence professional autonomy in nursing, and differ from country to country. The aim of this study was to explain barriers and facilitators of professional autonomy in the experience of clinical nurses. This qualitative study was conducted on 19 clinical nurses and nursing managers selected based on purposive sampling from January 2018 to December 2019. Data were collected through semi-structured interviews, which continued until data saturation was reached. Conventional content analysis based on the Graneheim and Lundman approach was used to analyse the data. Data were categorised into 34 subcategories, 8 main categories, and two main themes, which were titled as facilitators of professional autonomy (professional, organisational, and individual factors, and effective communication) and barriers to professional autonomy (professional, organisational, and personal barriers, and inappropriate communications). The results discussed a set of facilitators and barriers faced by Iranian nurses in clinical settings. Professional organisations can play a key role by enhancing professional autonomy facilitators and increasing professional support for nurses. Another finding was the importance of training nursing staff to be competent and autonomous, beginning right from the college years.

The Lived Experiences of Iranian Patients with Rheumatoid Arthritis: A Qualitative Research.

Background: Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects various systems of the body. The present study was conducted with the aim to explain the lived experiences of Iranian patients with RA. Materials and Methods: According to the research question, the phenomenological research approach was used. The participants were selected through purposive sampling, and sampling was continued until data saturation was achieved. The data was collected by conducting unstructured interviews and using an audio recorder. To interpret the data, an interpretive/hermeneutic approach was implemented using Van Manen's method. In addition, Lincoln and Guba's criteria were used to evaluate data robustness. Results: A total of 24 participants participated in the study. Overall, 145 basic concept codes were extracted which were classified into the four main themes of self-management with the participation of the family, spiritual resilience in the face of existing problems, the tendency to hide the disease, and the fear of an uncertain future. Conclusions: It is recommended that care providers use the findings of this study to develop care plans in the various aspects of the physical, mental, social, and spiritual needs of patients with RA based on their concerns and deep experiences. It is also suggested that other qualitative research approach methodologies such as grounded theory for explaining the process of patient care and providing an appropriate model, or action research for solving the problems of hospitalized patients through suitable care at home be implemented.

Impact of a sensory stimulation program conducted by family members on the consciousness and pain levels of ICU patients: A mixed method study.

Background: The results of several studies show the different effects of a balanced sensory stimulation program (SSP) on patients with brain injury admitted to the intensive care unit (ICU), but these effects have been less studied based on mixed and comprehensive methods. Method: This mixed-method study involved 66 patients with brain injury admitted to the ICU who were allocated into intervention (n = 33) and control (n = 33) groups using random stratified sampling. Patients in the intervention group received a sensory stimulation program from family members for 1 h daily during ICU hospitalization, while the control group received only routine care. Patients' level of consciousness and pain intensity were measured immediately before and after the intervention using Glasgow Coma Scale (GCS) and Behavioral Pain Scale (BPS), respectively. In-depth unstructured interviews were conducted with the patients in the intervention group 3 months after discharge from the ICU. These interviews were analyzed following Graneheim and Lundman (2004) conventional content analysis method. Results: A significant difference was found between the study groups in terms of the mean difference of GCS (P =0.001) and BPS score (P = 0.001) before and after intervention. Patients in the intervention group had a higher mean GCS and a lower mean BPS than did patients in the control group. The main themes extracted from the qualitative analysis confirmed the results obtained from the quantitative phase of the study. Conclusion: The combination of the quantitative and qualitative findings suggested that amidst the many hardships and sufferings brain injury patients go through in the ICU, a sensory stimulation program offered by family members may have many benefits such as increased level of consciousness and reduced pain for these patients. Therefore, it is necessary to formulate a framework for this program and provide the needed facilities in order to benefit more from the capacity of such programs for ICU patients.

The effect of eye care protocol on the prevention of ocular surface disorders in patients admitted to intensive care unit.

Eye care is one of the most critical tasks of intensive care unit (ICU) nurses. Patients in this unit are exposed to potential ocular problems due to critical conditions. This study aimed to establish a new eye care protocol for preventing ocular surface disorders in patients admitted to ICU. This was a clinical trial study performed on patients admitted to ICU in 2019. The data gathering tools included the demographic questionnaire, the Schirmer test for dry eye, fluorescein staining and slit lamp manual for examining corneal ulcers, and slit lamp manual to check keratitis and conjunctivitis. A type of eye care protocol was performed on the patient's eyes. After five consecutive days of executing the protocol, the data were analyzed using SPSS software version 18. The use of eye care protocol reduced the risk of keratitis (P=0.027), conjunctivitis (P=0.012), eye dryness (P=0.001), and corneal ulcer (P=0.003) in patients admitted to ICU in the intervention group compared to the control group. Ophthalmology protocols reduced the incidence of keratitis, conjunctivitis, dry eye, and corneal ulcers in ICU patients. Therefore, using this method in ICU patients can improve nursing care.

Community Health Nursing in Iran: A Review of Challenges and Solutions (An Integrative Review).

Background and Objective: In recent decades, nursing has witnessed many changes in Iran. Despite the numerous advances in nursing, the health system faces many challenges in community health nursing. This study aims to review the challenges in community health nursing in Iran and provide an evidence-based solution as well. Materials and Methods: This article is an integrated review of the literature regarding the challenges in community health nursing published between 2000 and 2021 in the databases Scopus, Medline, Cochrane Database of Systematic Reviews, Science Direct, Google Scholar, Scientific Information Database (SID). After performing searches, 20 articles were selected and studied. Data analysis was done using Russell approach (2005). Findings: The results of this study were summarized in 6 themes consisting of challenges in community health nursing education, practical challenges in community health nursing, policy-making challenges in community health nursing, management challenges in community health nursing, and infrastructural and cultural challenges. Solutions were also proposed to address each of the above issue. Conclusions: The results of the study showed that diverse challenges exist in community health nursing in Iran, considering that community health nurses play an important role in providing primary health care and community-based care. In order to solve these challenges, the authors have some recommendations: modifying the structure of the health system with the aim of moving toward a community-oriented approach from a treatment-oriented one, developing laws to support community health nurses, creating an organizational chart for nurses at the community level, modifying nursing students' training through a community-based approach, and covering community-based services and care under insurance.

Scope of Iranian community health nurses 'services from the viewpoint of the managers and nurses: a content analysis study.

BACKGROUND: Considering the need for nurses specializing in community health and in order to define professional duties for future planning towards creating the position of community health nurses in the primary health care system of Iran, this study aims to explain the range of services which can be provided by community health nurses from the perspective of the mangers and nurses. METHODS: The present qualitative study was conducted with the approach of contract content analysis in Iran in 2020. This study was conducted through in-depth and semi-structured interviews with 22 participants, including community health nursing faculty members, health deputies and managers, community health nurses working in health centers, and the care seekers visiting comprehensive health centers. The samples were selected through purposeful sampling. The interviews continued until data saturation. Data analysis was performed simultaneously with data collection. The interviews were recorded, transcribed, and analyzed through Graneheim & Lundman's content analysis method, and data management was done using MAXQDA software. To achieve data trustworthiness, the criteria presented by Lincoln and Guba were used. RESULTS: The obtained data were classified into the two main categories of service provision settings and service provision domains. The category service provision settings covered 7 subcategories including participation in the family physician plan, activities at the centers for vulnerable groups of the community, establishing private community health clinics, leading health promotion programs in the 3rd generation hospitals, activities in comprehensive health centers, follow-ups and home visits, and activities in schools' health units. Service provision domains consisted of 6 subcategories including participation in health planning, decision-making, and policymaking, research on the health system, health promotion, monitoring and coordination, providing care for the patients with non-communicable diseases and high-risk groups, and eldercare. CONCLUSIONS: From the participants' perspective, important services that can be provided by the community health nurse are health promotion, the management of chronic patients and the elderly, follow-ups, and home visits. Therefore, it is recommended that health policy makers pay attention to the service provision areas and the services providable by the community health nurse in their macro-planning, and to provide primary health care in comprehensive health centers using inter-professional care models, integrating the community health nurse into the care team.

Experience of discomfort and its self-management strategies in ICU patients.

Introduction: Discomfort in patients admitted to the ICU occurs due to various reasons and leads to a stressful situation in these patients. Discomfort significantly affects the ability to cope psychologically, the process, and results of treatment. The aim of this study was to investigate the experiences of discomfort and its self-management strategies in patients admitted to the ICU. Methods: This qualitative study was conducted in the period of September 2019 to December 2020 through in-depth interviews with 13 patients admitted to the ICU who were selected by purposive sampling. Interviews continued until data saturation. All interviews were recorded, transcribed, and analyzed using MAXQDA18 software by the conventional Lundman and Graneheim content analysis method. Results: The two main themes including "hospitalization with anxiety" and "coping with the horror of ICU" emerged from the uncomfortable experiences of patients admitted to the intensive care unit. "Hospitalization with anxiety" included five subthemes: "fear of disability and possible death," "separation from family," "understanding ambiguity and contradiction in treatment," "environmental disruptors," and "painful and unfamiliar devices and treatments." "Coping with the horror of ICU" included three subthemes: "recourse to spirituality," "benefiting from psychosocial coping," and "information search."

The university students' viewpoints on e-learning system during COVID-19 pandemic: the case of Iran.

The outbreak of COVID-19 closed educational institutions and universities. The aim of this study was to explain the strengths and weaknesses of the e-learning system in Iranian universities of medical sciences in the COVID-19 pandemic. This is a qualitative study that was conducted with students enrolled in Iranian medical universities. Data was collected through an open-ended electronic questionnaire based on the interview guide and was analyzed through content analysis. 122 students from 46 medical universities participated in this study. 122 questionnaires from 46 universities of medical sciences were completed. From a total of 54 codes extracted from the results, seven (strengths/positive experiences) and six (weaknesses/challenges) themes were extracted, each of which had several subsets. E-learning has both visible and hidden layers in terms of advantages and disadvantages. The e-learning system is an essential tool to continue education during the COVID-19 pandemic. Most students believe that e-learning was a great complement to prevent academic failure, but it cannot replicate the same efficiency of face-to-face training.

Investigating the impact of written emotion disclosure on the level of occupational stress among intensive care nurses.

Objective: The present study was conducted with the aim of determining the impact of rewriting pleasant events on the level of occupational stress in Intensive Care Unit (ICU) nurses. Methods: This is a quasi-experimental research conducted on nurses working in the intensive care units of Imam Khomeini and Golestan hospitals in Ahvaz, from July to November 2021. Seventy-six nurses were selected based on the inclusion criteria, and were then randomly assigned to the intervention and the control groups. The nurses' demographic information form and the Expanded Nursing Stress Scale (ENSS) were used to collect data. In the intervention group, the technique of rewriting pleasant events was used for 8 weeks, at least once a week. The data was analyzed with SPSS V20. Results: No significant difference in the demographic characteristics was observed between the intervention and the control groups (p > 0.05). The pre-intervention occupational stress of the nurses in the intervention and the control groups were reported to be 173.86 ± 26.75 and 173.05 ± 24.47, respectively, showing no statistically significant difference (p = 0.89). After the intervention, the occupational stress scores were 134.21 ± 16.09 and 172.36 ± 24.33, respectively, showing a significant difference between the two groups (p < 0.001). Conclusion: Considering the impact of rewriting pleasant events on the level of occupational stress of ICU nurses, it is recommended that nursing managers and nurses plan training programs for nurses in this area, and encourage other nurses to do so, too. It is also suggested to implement this intervention on the nurses of other wards as well.

The impact of critical thinking training using critical thinking cards on clinical decision-making of CCU nurses.

INTRODUCTION: Due to the complexity of the situation and rapid changes in patients' clinical status in intensive care units, it is necessary to teach decision-making skills to nurses, alongside critical thinking. The aim of this study was to evaluate critical thinking training by using critical thinking cards on clinical decision-making of nurses in cardiac care units (CCU). METHODS: In this quasi-experimental study, 74 CCU nurses from the selected hospitals affiliated to Ahvaz and Dezful Universities of Medical Sciences were selected based on the inclusion criteria and were assigned to either the intervention or the control group by using permuted block randomization. The data were entered into SPSS V22 and analyzed. RESULTS: There was no statistically significant difference between the demographic characteristics of the two groups (P < 0.05). The mean total score of nurses' clinical decision-making before training sessions in the intervention group was calculated to be 141.59 ± 10.76, which was lower compared to a score of 148.56 ± 10.95 in the control group (P = 0.011). Therefore, covariance analysis was used to modify the results. The mean total score of nurses' clinical decision-making after the training in the intervention group was calculated as 163.82 ± 8.83, indicating a significant increase compared to a score of 154.50 ± 11.25 in the control group (P < 0.001). CONCLUSION: The findings of the present study show that the education of critical thinking by using the critical card tool leads to improved clinical decision-making in CCU nurses.

Perceived professional competence in spiritual care and predictive role of spiritual intelligence in Iranian nursing students.

AIM/OBJECTIVE: The aim of this study was to identify the relationship between perceived competence in spiritual care and spiritual intelligence among nursing students. BACKGROUND: One of the most important duties of nurses is to pay attention to the spiritual needs of patients and provide them with proper spiritual care. Therefore, professional competence in this area is essential for nurses and nursing students. Also, spiritual intelligence is a factor influencing the caring behaviors of nurses. DESIGN: A cross-sectional and correlational study SETTINGS/PARTICIPANTS: This study was included 510 undergraduate nursing students in two public faculties of nursing in Iran in the 2018-2019 academic year. METHODS: The samples were selected using a census method. A demographic information questionnaire, the valid and reliable Iranian questionnaire of nurses' competencies in spiritual care and the spiritual intelligence self-report inventory (SISRI) were used to collect data. RESULTS: A significant positive correlation was found between nursing students' competence in spiritual care and spiritual intelligence (p < 0.001, r = 0.26). No significant differences were found between the mean competence scores of spiritual care in terms of demographic characteristics. There were significant differences between the mean spiritual intelligence score in terms of age, marital status, history of clinical practice and academic year. The regression model indicated that for increased rates of spiritual intelligence, professional competence in spiritual care would rise as much as 0.39. CONCLUSION: Spiritual intelligence can affect the competence of nursing students in providing spiritual care to patients. Therefore, to promote students' spiritual intelligence, appropriate plans with the aim of promoting the level of critical thinking and spiritual self-awareness are recommended.

The Effect of Pain Self-Management Education on Pain Severity and Quality of Life in Metastatic Cancer Patients.

OBJECTIVE: Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches. METHODS: This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests. RESULTS: It was observed that after the intervention, the trend of pain severity during weeks 1-7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001). CONCLUSIONS: Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.

Perceived barriers to early mobilization of intensive care unit patients by nurses in hospitals affiliated to Jundishapur University of Medical Sciences of Ahvaz in 2019.

Early mobilization (EM) of patients in the intensive care unit (ICU) is a safe, feasible, and beneficial approach. However, the implementation of EM as a part of routine clinical care can be challenging. As a result, the present study aimed to identify the potential barriers to EM of ICU patients. The statistical population of this descriptive-analytical study included 107 critical care nurses working in hospitals affiliated with the Jundishapur University of Medical Sciences of Ahvaz. The participants were selected using the census method among the eligible critical care nurses, and the researcher-made questionnaire was used for data collection. This questionnaire included a demographic questionnaire and an inventory of barriers to EM. In total, 72% of the nurses had a highly positive attitude towards EM implementation, whereas relatively few had a slightly positive attitude. The major human-resource-related barriers included the lack of trained staff (76.6%), inadequate shift nurses (74%), and inadequate time for this procedure (57.9%). Approximately 88.9%, 82.2%, 62%, and 57.9% of the nurses reported coma or a deep degree of sedation, mobilization of obese patients, mobilization of patients with agitation, and pain, respectively, as the major patient-related barriers. The lack of EM implementation and recording according to the checklist (90.4%), the lack of an approved EM implementation protocol (88.8%), and inadequate equipment for the mobilization of mechanically ventilated patients (58%) were among the major equipment-related barriers. The participating nurses were aware of the EM advantages, and the majority of them had a highly positive attitude towards its implementation in the ICU. However, nurses believed that the actual EM implementation is associated with challenges such as human resources limitations, equipment-related barriers, and patient-related barriers.

Requirements for Creating a Position for Community Health Nursing Within the Iranian Primary Health Care System: A SWOT Analysis.

Background: Accepting community health nursing in the primary care system of each country and focusing on creating a position for community health nurses is of significant importance. The aim of this study was to examine the stakeholders' perception of the requirements for establishing a position for community health nursing in the Iranian primary health care system. Methods: This qualitative study was done using 24 semi-structured interviews conducted from May 2020 to February 2021 in Iran. The participants were selected through purposive sampling and consisted of nursing policy makers, the policy makers of the Health Deputy of Ministry of Health, the managers and the authorities of universities of medical sciences all across the country, community health nursing faculty members, and community health nurses working in health care centers. After recording and transcribing the data, data analysis was performed in MAXQDA10 software, using Elo and Kyngas's directed content analysis approach and based on WHO's community health nursing role enhancement model. The statements for each main category were summarized in SWOT classification. To examine the trustworthiness of the data, Lincoln & Guba's criteria were used. Results: By analyzing the interviews 6 main categories identified consist of creating a transparent framework for community health nursing practice, enhancing community health nursing education and training for practice in the primary health care system and community settings, seeking support, strengthening the cooperation and engagement among the key stakeholders of the primary health care system, changing the policies and the structure of the health system, and focusing on the deficiencies of the health system. Each main categories including the subcategories strengths, weaknesses, opportunities and threats (SWOT). Conclusions: Based on the participants' opinions, focusing on the aforementioned dimensions is one of the requirements of developing a position for community health nursing within the Iranian PHC system. It seems that correct and proper implementation of these strategies in regard with the cultural context of society can help policymakers manage challenges that prevent the performance of community health nursing in the health system.

Correction to: Determination of the effects of prone position on oxygenation in patients with acute respiratory failure under mechanical ventilation in ICU.

[This corrects the article on p. 274 in vol. 11, PMID: 30894882.].

Effect of Tubular Feeding with the Measurement of Gastric Residual Volume on Ventilator Associated Pneumonia.

Background: Several measures have been taken to prevent the onset of ventilator-associated pneumonia (VAP), one of which is measuring the gastric residual volume. The purpose of this study is to compare the effect of two tube feeding methods with and without gastric residual volume measurement on VAP. Materials and Methods: This clinical trial was performed on the study population of patients with endotracheal tubes hospitalized in Intensive Care Units 1 and 2 of Golestan hospital, Ahvaz, Iran. Overall, 70 patients who met the inclusion criteria were randomly divided into groups 1 and 2. Groups 1 and 2 were fed with and without measuring gastric residual volume, respectively. The incidence of pneumonia was assessed using the Modified Clinical Pulmonary Infection Score prior to the intervention and on the fifth day post- intervention. The data were analyzed by the SPSS software version 22. Results: The incidence of VAP was 9.12% in the group with gastric residual volume measurement and 7.14% in the other group. There was no significant difference between the two groups (P=0.827) regarding VAP prevalence. Conclusion: Monitoring gastric residual v olume requires aspiration and repeated measurements of gastric contents, resulting in increased nursing workload. Moreover, if the gastric residual volume is high, the patient will be deprived of calorie intake and subjected to malnutrition. As a result, removing the monitoring of gastric residual volume from the care setting and focusing on interventions proven to reduce VAP can be more helpful.

Professional Autonomy of Nurses: A Qualitative Meta-Synthesis Study.

BACKGROUND: Autonomy is the main element of professional practice in nursing. However, despite the many studies conducted on nursing autonomy, this concept is not fully understood and a comprehensive explanation of this concept in nursing is necessary. Meta-synthesis offers a way to increase the understanding of this concept using existing research findings. Thus, the present study aimed to explain the concept of professional nursing autonomy. MATERIALS AND METHODS: This qualitative meta-synthesis was conducted based on a modified version of Noblit and Hare's meta-ethnography approach and qualitative studies on the concept of nursing autonomy published in databases such as PubMed, Scopus, Web of Science, Cochrane, SID, IranMedex, Magiran, and ScienceDirect in the past 15 years (2003-2018). RESULTS: Thirteen articles that reported the experiences of nurses regarding professional autonomy were included in the research. Based on the meta-synthesis of findings, the final interpretation of the professional autonomy of clinical nurses was presented in the three themes of professional competence, professional decision making, and professional interactions. CONCLUSIONS: According to the results, the concept of professional autonomy is a developmental achievement based on patient-based professional competence along with self-reliance to provide the best care plan for the promotion of patients' health through the professional decision making and professional interactions with other professional team members.