Evaluation of patient satisfaction with nursing services before and after implementation of the Health System Transformation Plan in Iran: A cross-sectional study.

Background and Aims: How healthcare service delivery is achieved after implementing the Health System Transformation Plan (HSTP) is investigated in the present study by assessing the patients' satisfaction with nursing care services compared to before HSTP. Methods: This cross-sectional study was conducted in Iranian hospitals during two periods, that is, before (N = 300) and after (N = 279) HSTP, whereas the Patient Satisfaction Instrument was used to assess the satisfaction with nursing services. Results: About 57.7% and 4.7% of the patients were dissatisfied with nursing care services, whereas 34% and 77.4% for moderate satisfaction, and 8.3% and 17.9% for total satisfaction, before and after HSTP, respectively. The mean score of overall satisfaction was 57.33 (±11.17) and 70.84 (±11.99) before and after HSTP, respectively (p < 0.001), which represents there is an improvement in healthcare services delivery after HSTP. Although none of the sociodemographic factors were significantly associated with satisfaction, higher satisfaction was found among the coronary care unit (CCU) hospitalized patients. Conclusion: The patients' overall satisfaction with nursing care services after HSTP was increased, although higher satisfaction was observed in the patients of special wards such as CCU. Therefore, using more care facilities and equipment and engaging more skilled nursing staff in other wards is highly recommended.

Assessment of the Psychometric Properties of the Persian Version of the Cardiac Self-Blame Attribution (CSBA-P) Scale in Patients With Cardiovascular Disease.

According to the studies done in Iran, there has been no study investigating self-blame attributions in patients with cardiovascular disease. Moreover, there has been no standard scale for assessing self-blame attributions available in Persian. Hence, this study was conducted to determine the psychometric properties of the Persian version of Cardiac Self-Blame Attribution (CSBA-P) Scale in patients with cardiovascular disease. In this 2019 methodological study, 400 patients with cardiovascular disease completed the Persian version of the Cardiac Self-Blame Attribution scale. We evaluated the face, content, and construct validity (both exploratory and confirmatory) of the measure. The results of the confirmatory and exploratory factor analysis extracted a separate factor explained 56.249% of the variance. One factor fit model was confirmed according to standard measures such as RMSEA = 0.074, CMIN/DF = 2.454. The reliability of the scale was calculated and confirmed with a Cronbach coefficient of 0.938, construct reliability of 0.938, and ICC of 0.895. The Persian version of the Cardiac Self-Blame Attribution scale (CSBA-P) yielded acceptable validity and reliability. Thus, this scale can be used in future research to assess self-blame attributions among cardiac populations who speak Persian.

Self-blame Attributions of Patients: a Systematic Review Study.

Introduction: Psychological aspects are important issues in patients that will have significant effects on disease progression. A new and important psychological concern is self-blame. This review was performed with the aim of systematic review on studies around patient's self-blame. Methods: This is a systematic review using international databases including PubMed (since 1950), Scopus (since 2004), Web ofSciences (since 1900), and ProQuest (since 1938) and Irani an databases including SID (since 2004) and Magiran (since 2001). Mesh terms including "patient," "regret," and "guilt" and non-Mesh terms including "self-blame attribution," "characterological self-blame," "behavioral self-blame," and "blame" were used in Iranian and international databases with OR and AND operators. Results: The review yielded 59 articles; 15 articles were included in the present study. The ages of patients ranged from 29-68.4 years. Most of studies (86.6%) had cross-sectional design and use characterological self-blame and behavioral self-blame variablesfor assessing self-blame attributions. The results showed that in most studies, a significant relationship among self-blame and psychological distress, anxiety, and depression were reported. Conclusions: A significant relation was reported between self-blaming and the degree of distress, anxiety, and depression in patients in most of the studies.

The effect of education on the anxiety of a family with a patient in critical care unit: a systematic review and meta-analysis.

BACKGROUND: Studies have shown that family members of patients in intensive care units experience high levels of anxiety. Contradictions in the results of the studies conducted regarding the effect of training on the anxiety level of such families, emphasize the necessity of employing other research methods to eliminate these ambiguities. OBJECTIVE: This study applied meta-analysis to determine the effect of training on the anxiety level of families with patients in the intensive care unit. METHODS: In order to find electronically published studies from 1990 to 2016, the articles published in journals indexed in the following databases were used: Elsevier, Scopus, ProQuest, ISI, Web of Science, PubMed, Google scholar and Cochrane. For data analysis Stata Software version 11 was used and the heterogeneity index of studies was determined through Cochran (Q) and I2. Due to the heterogeneity, the random effect model was used to estimate the difference between the standardized mean of anxiety. RESULTS: In this meta-analysis and systematic review article, eight articles were found to be eligible. The number of samples in the initial studies into a meta-analysis included 387 patients in the intervention group and 393 people in the control group. Standardized difference of the mean anxiety score in the intervention group was -0.329 (CI 95%: -0.756-0.099) units less than that of the control group, indicating that this effect was not statistically significant. CONCLUSIONS: The results of this meta-analysis show that training will decline the anxiety level of a family with patients hospitalized in the intensive care unit, although the impact is not considerable.

Effects of nonpharmacological interventions on reducing fatigue after hematopoietic stem cell transplantation.

Fatigue is one of the main complaints of patients undergoing allogeneic and autologous hematopoietic stem cell transplantation (HSCT). Since nonpharmacological interventions are cost-effective and causes fewer complications, this study aimed to review the studies performed on the effects of nonpharmacological interventions on fatigue in patients undergoing HSCT during September 2016. MEDLINE, CINAHL, Scientific Information Database, IranMedex, PubMed, ScienceDirect, Scopus, Magiran, and IRANDOC databases were searched using Persian and English keywords. A total of 1217 articles were retrieved, 21 of which were used in this study. Exercise is known as an effective intervention in alleviating physical and mental problems of patients undergoing stem cell transplant. This review-based study showed that nonpharmacological methods such as exercise might be effective in decreasing fatigue in patients undergoing stem cell transplant. There is a multitude of studies on some of the complementary and alternative therapy methods, such as music therapy, yoga, relaxation, and therapeutic massage. These studies demonstrated the positive effects of the aforementioned therapies on reduction of fatigue in patients undergoing stem cell transplantation. All the investigated methods in this study were nonaggressive, safe, and cost-effective and could be used along with common treatments or even as an alternative for pharmacological treatments for the reduction, or elimination of fatigue in patients undergoing stem cell transplantation. Given the advantages of complementary and alternative medicine, conducting further studies on this issue is recommended to reduce fatigue in patients after stem cell transplantation.

Psychosocial needs of families of intensive care patients: Perceptions of nurses and families.

BACKGROUND: Admission to an intensive care unit (ICU) is not only stressful to the patients but the patients' family members. Families are believed not to receive their required attention because their needs are incorrectly and inaccurately evaluated by the health care team. Therefore, the present study aimed to examine the perceptions of ICU nurses and families regarding the psychosocial needs of families of intensive care patients. MATERIALS AND METHODS: This descriptive-analytical study was conducted on a randomly selected population of 80 nurses and 80 family members of ICU patients. Data were collected using a two-part questionnaire containing sociodemographic characteristics and the Critical Care Family Need Inventory (CCFNI). RESULTS: The rank order of the five most important CCFNI item needs identified by families were as follows: "To feel that the hospital personnel care about the patient", "to be assured that the best care possible is being given to the patient", "to have questions answered honestly", "to know specific facts concerning patient's progress", and "to be called at home about changes in the patient's condition." The top five CCFNI item needs identified by nurses were in the following order: "To be assured that the best care possible is being given to the patient", "to be told about transfer plans while they are being made", "to feel that the hospital personnel care about the patient", "to have questions answered honestly", and "to know specific facts concerning patient's progress." CONCLUSION: The present study showed there are similarities and dissimilarities between nurses and family members in their perceived importance of some family needs in the ICU. It can thus be inferred from our results that the participating nurses misestimated the needs of family members, attested by their wrong estimation of the most need statements.

Factors associated with post-surgical delirium in patients undergoing open heart surgery.

OBJECTIVE: The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. METHOD: This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression) on SPSS software version 15. RESULTS: We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. CONCLUSION: Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.

The Relationship between Marital and Sexual Satisfaction among Married Women Employees at Golestan University of Medical Sciences, Iran.

OBJECTIVE: There are various elements affecting the healthy family such as marital satisfaction. Various factors such as sexual satisfaction have an important impact on satisfaction of marital relationship. The present study aimed to determine the association of marital satisfaction with sexual satisfaction among sexually active employee women. METHODS: This analytical descriptive study was carried on 140 married women employed at educational and medical centers of Golestan University of Medical Sciences. Questionnaires for data collection included Enrich Marital Satisfaction Questionnaire and self-constructed questionnaire (demographic characteristic and sexual satisfaction). Data were analyzed using descriptive statistics, χ(2) and Spearman statistical test. Statistical significant level was set as 0.05. RESULTS: The findings showed that in marital satisfaction scale, the majority of the participants (63.6%) were very satisfied and none of them were very unsatisfied. In sexual satisfaction scale, most of the participants (56.4%) expressed extremely satisfaction rate and only 0.7% were not satisfied with their sexual relationship. Marital satisfaction was significantly associated with sexual satisfaction (p ≤ 0.001). So with the increase of sexual satisfaction, there was an increase in marital satisfaction accordingly. The findings indicated that there was a significant association between sexual satisfaction and age (p = 0.086). Level of education was associated significantly with the marital satisfaction (p = 0.038). The effects of sexual satisfaction on marital satisfaction were moderated by number of children and the level of education. CONCLUSION: The findings have implications for improving of couples' marital satisfaction by highlighting the need for awareness of sexual quality. According to the findings, it seems that development of educational programs and pre-marriage counseling is necessary. Continuous education would be helpful after marriage in addressing couples' unique transitional needs in marital life.

Substance dependence and mental health in northern Iran.

BACKGROUND: Today, substance dependence and illegal trading of narcotics is considered as a global issue. Since mental disorder has been reported in about 90% of the substance dependents, this study aimed at determining the rate of mental health in the substance dependents in Sari Township in 2011. MATERIALS AND METHODS: In this study, 500 substance-dependent patients were selected using convenience sampling method. To collect data, SCL-90-R was used for the evaluation of their mental health and a demographic questionnaire was employed for identifying their personal information. The obtained data were analyzed by descriptive and inferential statistics using the SPSS software. RESULTS: It was found that 90.4% of the participants were susceptible to mental disorder. Most of them suffered from depression, psychoticism, interpersonal sensitivity, anxiety, and paranoia. Also, there was significant relationship between the mental health of single, divorced and married addicts (P < 0.21). CONCLUSION: Due to the presence of mental disorder in the substance-dependent patients, it is recommended to help treat them by providing them with education, psychotherapy, and psychiatric medication.

Sleep quality and its correlation with serum C-reactive protein level in hemodialysis patients.

Poor sleep quality is a common problem that can potentially predict mortality risk and quality of life in hemodialysis (HD) patients. Also, inflammation is a common feature in HD patients. To determine sleep quality and its correlation with serum C-reactive protein (CRP) level in these patients, we studied 132 chronic HD patients in two university-affiliated teaching hospitals in Sari, Iran during September 2010. Pittsburgh Sleep Quality Index was employed to assess the sleep quality of the patients in addition to CRP, albumin, cholesterol, phosphorus and hemoglobin levels. There were 104 (78.7%) patients who suffered from poor sleep quality. A significant correlation was found between serum CRP level and the patients' sleep quality (P <0.05). There was also a significant correlation between sleep quality and serum phosphorus and albumin levels and body mass index (P <0.05). Furthermore, a significant positive correlation existed between the different components of sleep quality and CRP (P <0.05). We conclude that there is a correlation between decreased sleep quality in HD patients and elevated CRP levels, which may have therapeutic implications.

Developing an instrument to measure the influential factors on career choice among Iranian nursing students.

BACKGROUND: Understanding why the graduates from the high schools choose nursing is essential for the health policy makers in each country and Iran is not an exception. The aim of this study was to develop an instrument measuring the influential factors on career choice among Iranian nursing students. MATERIALS AND METHODS: This methodological study employed both qualitative and quantitative approaches. In the first phase of the study, the items were generated for the instrument. These items were drawn from a relevant literature review along with taking a poll of experts' opinions. Then the psychometric properties of instrument were measured using content validity, face validity, and construct (exploratory factor analysis) validity as well as its reliability. RESULTS: Initially, a 35-item instrument was developed. In the second phase, a scale-level content validity index of 0.90 was obtained for the instrument. The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 139 nursing students. Three factors were extracted with a total variance account of 42.03%. Reliability was demonstrated with Cronbach's alpha coefficient of 0.77 for the entire scale. Consistency of the instrument was established with test - retest reliability with an interval of 2 weeks (intra-cluster correlation = 0.94, P < 0.001). Wilcoxon signed-rank test demonstrated no significant differences between the test - retest scores (P > 0.05). CONCLUSION: It seems a culturally sensitive instrument with a satisfactory level of validity and reliability has some implications for policy makers in nursing education.

The effect of supportive counseling program on the academic performance of nursing and midwifery students.

INTRODUCTION: Poor academic performance in universities is a worrying issue, imposing extra finance on the government. This study was conducted to discover if supportive counseling program (SCP) has any effects on the academic performance of students. METHODS: Sixty nursing and midwifery Iranian students with poor academic performance participated in this quasi-experimental semester-long study. They were balanced by gender, major, years of study, and grade average. They were divided into intervention and control groups, the former attended the SCP. Finally the grade averages of the groups before and after the intervention were calculated. RESULTS: An independent t-test revealed a significant difference between the grade averages of the two groups (p = 0.01); similar results were obtained for theoretical courses' grade averages (p = 0.03). Also, a paired t-test indicated a significant difference between the grade averages of the intervention group pre and post-intervention (p < 0.0001). CONCLUSION: Findings favored designing and carrying out SCP for students, especially for those with poor academic performance. The effect of SCP on the academic performance of nursing and midwifery students.

Iranian clinical nurses' coping strategies for job stress.

OBJECTIVES: Since the existence of work-related stressors is inevitable in nurses' workplace, nurses usually use a variety of coping strategies which can be called cognitive, affective, and behavioral techniques. In this study, we aimed to explore the coping strategies employed by the Iranian clinical nurses in depth. METHODS: This work was a qualitative study using Straus and Corbin's grounded theory approach focusing on the process of coping with job stress used by Iranian clinical nurses. RESULTS: The results of the present qualitative study indicate that the core category was "on the route to coping" which contained six categories comprising work management, self-control, emotional, spiritual, cognitive, and interactional strategies. CONCLUSIONS: We conclude that in nursing it is inevitable that different kinds of strategies are used to cope with the many stressors. The conceptual model emerging from the data indicate that nurses are engaged in a dynamic process of struggling to cope with job stressors. In fact, they are "on the route to coping" with the job stressors. Considering the high level of stress in the nursing profession, the findings of this study have implications for both hospital managers and Iranian clinical nurses.