The Experiences of Nurses in Care Provision to COVID-19 Patients: A Qualitative Study.

Introduction: Nurses are key fighters in the forefront of care provision to COVID-19 patients. Due to the diversity of nurses' experiences in different countries because of variable nursing resources, health care systems, and cultural contexts, the present study aimed to divulge a deep understanding of the essence of health system problems based on nurses' experiences of care provision to COVID-19 patients in Iran. Methods: The present study was conducted based on the conventional content analysis method and Graneheim & Lundman approach. The participants included the nurses working in the COVID-19 wards and were recruited by purposeful sampling and based on inclusion criteria. The data were collected by conducting semi-structured, one-to-one interviews, and taking field notes, until reaching data saturation. Results: In-depth interviews with 12 nurses. represented four main categories and six subcategories. Sudden exposure to an unknown threat (nurses' feelings and concerns and nurses' reactions), being involved in an unequal war (a vicious virus and weary nurses), stressful working conditions, and efforts to confine the threat (seeking for new and adequate information and gathering all forces) were among the emerged data. Conclusion: The nurses' experiences showed that despite passing a while since the coronavirus pandemic, there are still individual and professional concerns that all root in organizational and governmental factors.

The Effects of Cool Dialysate on Vital Signs, Adequacy and Complications during Hemodialysis.

BACKGROUND: Cooling the dialysate is an important factor that contributes to the hemodynamic stability in patients during hemodialysis. The aim of this study was to determine the effect of cool dialysate on vital signs, and the adequacy and common complications of hemodialysis. MATERIALS AND METHODS: The present crossover, triple-blind, clinical trial was performed on 62 dialysis patients, who were selected through stratified block randomization. First, one group underwent hemodialysis using a cool dialysate (35°C), and the other received routine hemodialysis (36.5°C). Each patient received a total of eight hemodialysis sessions. Then, treatment methods were swapped, and each group received the other group's method. The patients' blood pressure, pulse rate, and temperature were measured before dialysis, and in the first, second, third, and fourth hours of dialysis. The frequency of common complications of hemodialysis and dialysis efficacy were measured. The marginal model and Generalized Estimating Equations (GEE) were used to analyze the data. RESULTS: The participants' systolic (p = 0.01) and diastolic blood pressures significantly increased with a decrease in temperature (p = 0.005). The patients' pulse rate (p = 0.143), adequacy of dialysis (p = 0.922), and common complications of hemodialysis did not significantly differ between the two temperatures (p > 0.05). CONCLUSIONS: Reducing dialysate temperature from 36.5 to 35°C led to hemodynamic stability; the blood pressure of the patients undergoing hemodialysis was more stable with the cool dialysate method and the number of drops in the blood pressure during the hemodialysis was reduced.

Comparison of the effect of foot reflexology and body massage on physiological indicators and bilirubin levels in neonates under phototherapy.

BACKGROUND: Hyperbilirubinemia is one of the most common problems in infancy in the world. The aim of this study was to compare the effect of foot therapy and body massage on physiological indicators and bilirubin levels in infants under phototherapy. METHODS: This study was a randomized clinical trial that conducted on 51 infants with jaundice at Imam Hussein Pediatrics' Medical Center, Goldis Hospital in Isfahan (Iran). The samples randomly assigned to first intervention (reflexology), second intervention (body massage) and control groups using the block randomization. In the reflexology group, the relevant area on each foot was massaged for 15 min in a relaxed position. In the massage body group, the limbs were massaged with circular motion. The massage was performed once a day for 15 min and the control group did not receive any intervention. Physiological indicators were monitored using vital sign monitoring tools, and blood bilirubin levels were measured photo metrically (intravenous blood samples from the wrist). Finally, the data were analyzed using descriptive and inferential statistics and SPSS software version 18. RESULTS: The results showed that before the intervention there was no significant difference in the mean of physiological indicators and bilirubin level between the three groups (p > 0.05), but after the intervention the average percentage of arterial oxygen saturation and bilirubin levels were significantly improved in the intervention groups compared to the control group (p < 0.05), while the mean of heart rate and respiration rate between the three groups were not significant (p > 0.05). CONCLUSION: The results showed that reflexology and massage therapy can be effective in improving the condition of physiological indicators and blood bilirubin levels.

Randomized controlled trial of the foot reflexology on pain and anxiety severity during dressing change in burn patients.

BACKGROUND: One of the most important problems in burn patients was pain, especially in dressing changes. This pain can lead to anxiety in the patient. The aim of this study was to determine the effect of foot reflexology on pain and anxiety severity in burn patients. METHODS: This study was a randomized controlled trial, in which 66 patients with burn injuries referred to Vali-e-asr Hospital, Arak, Iran participated. After obtaining written consent, patients were enrolled to study according to inclusion criteria and then, divided into intervention (n = 33) and control (n = 33) groups using simple random allocation. In the intervention group, in addition to standard care, reflexology was performed for one week on Saturday, Monday and Wednesday (three times in a week). The intervention was done one hour before dressing change in a separate room for 30 min. The control group received only standard care during this time (both intervention and control groups were the same in the type of treatment, and reflexology was considered as an extra care in the intervention group). Severity of pain and anxiety in both groups was measured using visual analog scale twice a day (5-10 min before dressing change and 5-10 min after dressing change) for six days. SPSS software ver. 15 was used for statistical analysis. Mean and standard deviation were used for quantitative variables and qualitative variables were reported as frequency and percentage. Data were analyzed using Chi­square, Mann-Whitney, Fisher's exact tests, and paired t-test. The Kolmogorov-Smirnov test was used to check the normality of data. RESULTS: The results showed no significant difference in severity of pain (p = 0.25) and anxiety (p = 0.37) between the two groups on the first day, before the intervention. In the following days, the results showed no significant difference between the two groups in the second and third treatments after intervention . However, the mean pain scores showed a significant difference between the two groups in the forth (p = 0.005), fifth (p = 0.001), and sixth (p = 0.001) days after intervention. Anxiety scores also showed a significant difference between the two groups on the fourth (p = 0.01), fifth (p = 0.001), and sixth (p = 0.001) days. CONCLUSIONS: Our results showed foot reflexology is an appropriate and safe intervention for management of pain and anxiety of burn patients. Therefore, it can be used as a complementary method alongside other methods.

The effect of nutritional education program on quality of life and serum electrolytes levels in hemodialysis patients: A single-blind randomized controlled trial.

OBJECTIVE: To determine the effect of nutrition education program on hemodialysis patients' quality of life (QoL) and serum electrolytes levels. METHODS: This study was a randomized controlled trial in which 94 eligible hemodialysis patients were randomly assigned to intervention (n = 48) and control (n = 46) groups. In the intervention group, the patients were trained in healthy nutrition for four weeks. After two months, samples of both groups completed the Kidney Disease Quality of Life Instrument (KDQOL) and Na, K, P, Ca and Mg levels were also measured and compared. RESULTS: There were no significant differences in QoL scores and electrolytes between the two groups before intervention (p > 0.05). After intervention the QoL scores in the intervention group were significantly higher than in the control group (p < 0.05). However, after intervention the levels of Na, K, P and Mg in the intervention group were significantly lower than in the control group (p < 0.05). Calcium level was not significantly different between the two groups after intervention (p = 0.16). CONCLUSION: The results showed that e-learning is effective in improving the QoL and serum electrolytes of hemodialysis patients. PRACTICE IMPLICATIONS: This paper could serve as support for clinical healthcare professionals to improve patient knowledge and QoL through virtual education methods.

The effect of foot reflexology on constipation and quality of life in patients with multiple sclerosis. A randomized controlled trial.

BACKGROUND: Constipation is a major problem in most patients with multiple sclerosis (MS). The aim of this study was to investigate the effect of foot reflexology on constipation and quality of life in patients with MS. METHODS: This study was a randomized controlled trial, in which 63 patients with MS referred to Arak MS Society, Iran were participated (from May to Dec. 2018). In this study participants were selected according to inclusion criteria and randomly divided into intervention (n = 33) and control (n = 30) groups. In the intervention group, foot reflexology was applied twice a week for 6 weeks (each session lasted about 30-40 min). Data were collected using demographic questionnaire, Constipation Assessment Scale (CAS) and Short Form (SF) 36 Quality of Life (QOL) questionnaire. Finally, the data were analyzed using SPSS Ver. 16 and descriptive and inferential statistical tests. RESULTS: The results of the study showed that severity of constipation and QOL score were not significant between the two groups before intervention (p > 0.05), but; after intervention, severity of constipation significantly decreased in the reflexology group (p < 0.05). Nevertheless, after intervention, the QOL was improved in the reflexology group compared to the control group but was not significant (p > 0.05). CONCLUSION: The results of this study showed that foot reflexology, as an effective intervention can be useful in management of constipation in patients with MS. Therefore, this intervention can be applied as a safe method for the decrease of constipation in MS patients.

Strategies for bridging the theory-practice gap from the perspective of nursing experts.

The gap between education and the clinical practice has always been challenge for educational experts in the field. This article aims to explore the perspective of Iranian nursing experts about strategies used for coordinating education and clinical performance in nursing. This qualitative study was conducted by using a conventional content analysis approach; individual interviews were conducted at the participants' work place; while focus group discussions took place at the Nursing and Midwifery Faculty of Iran University of Medical Sciences. Participants in this study included nursing instructors, educational supervisors and nursing managers with a clinical background and teaching experience of at least five years. In addition, a graduate nursing student and a nursing PhD candidate were also interviewed to ensure data saturation. Purposive sampling was conducted between April 2016-October 2017 among scholars and nursing professional experts who were highly experienced in this field. The two focus groups, obtained the views of nursing managers and educational supervisors working in educational hospitals. Analysis involved open stepwise coding with an emphasis on continuous comparison of data, and reference to written notes of the interviews. The analysis process was carried out in three main phases of preparation, organization, and reporting. The results of this study were classified in three main categories: developing context base curriculum, interactive collaboration among nurses and faculties, the Design and Implementation of a Standard Clinical Guideline. It seems that strong intention and active participation of all beneficiaries are needed to bridge the gap between theory and practice. Creating an appropriate context for nurses and nursing trainers for mutual learning along with the use of pragmatic language in the form of clinical guidelines can help decrease this gap.

Comparing the Effect of Foot and Hand Reflexology on Pain Severity after Appendectomy: A Randomized Clinical Trial.

BACKGROUND: Appendicitis is one of the main causes of acute pain. The aim of this study was to determine the effects of foot and hand reflexology on pain severity following appendectomy. MATERIALS AND METHODS: This clinical trial was conducted on 38 patients undergoing appendectomy in Alimoradian Hospital of Nahavand, Iran, in 2016. The samples were selected using convenience sampling, and then, randomly assigned to hand and foot reflexology groups via simple random sampling. In the foot reflexology group, the dorsal and plantar surfaces of the feet were lubricated using natural olive oil for five minutes. Next, reflexology was done by applying pressure to the appendix reflex area for 20 minutes. The same intervention was applied in the hand reflexology group. The severity of pain was measured using a Visual Analog Scale (VAS) before the intervention and one, three, and 24 hours after the intervention. Data were analyzed using Chi-square, One-way Analysis Of Variance (ANOVA), and repeated measures ANOVA. RESULTS: The results of one-way ANOVA showed no significant difference in the mean pain severity between the two groups (p = 0.771), whereas pain severity in the foot reflexology group was significantly lower than that of the hand reflexology group after the intervention (t = 1.63, p = 0.001). CONCLUSIONS: The results of this study showed that foot reflexology was more effective than hand reflexology in pain alleviation.

The effect of presence of family members on the anxiety level of candidates for esophagogastroduodenoscopy: A randomized controlled trial.

Background: Anxiety and its control is a public health problem worldwide. This study was conducted to determine the effect of family members' presence on the anxiety level of patients who were candidates for esophagogastroduodenoscopy (EGD). Methods: This randomized controlled trial study was performed in Shahid Chamran hospital in city of Saveh in IR Iran. In this study, 96 patients who were candidates for EGD and met the inclusion criteria were assigned into control and intervention groups by simple random sampling method. The demographic questionnaire and Spiel Berger's State and Trait Anxiety Questionnaire (STAI) were used to measure anxiety. Results: No significant difference was found between the 2 groups in the mean level of anxiety before intervention (p= 0.13). After intervention, the level of anxiety decreased significantly in the intervention group (p= 0.001). However, the mean level of anxiety was not significant in the control group after intervention (p= 0.09). Conclusion: The results of the present study showed that the presence of family members during endoscopy may reduce the patient's anxiety level, and thus it is recommended as a non-pharmaceutical, beneficial, and safe intervention.

Reflexology as an adjunctive nursing intervention for management of nausea in hemodialysis patients: A randomized clinical trial.

INTRODUCTION: Nausea is common side effect of hemodialysis. Nonpharmacological methods such as reflexology or other branches of integrative medicine can be used to control nausea. The aim of this study was to determine the effect of reflexology on nausea in hemodialysis patients. METHODS: This study was a double-blind randomized clinical trial conducted from March 2018 to June 2018 at the Arak Dialysis Center, Iran, in which 72 eligible hemodialysis patients were randomly assigned into intervention (n = 36) and control (n = 36) groups. Reflexology was performed on the solar plexus and soles of the feet once (30 min per session) per day for twelve days, one hour after the onset of hemodialysis in the area of nausea on the solar plexus and on the soles of the feet. RESULTS: The results showed there was no significant difference in severity of nausea (P = 0.28) between the two groups before intervention. However, after intervention the severity of nausea in the 3rd, 6th, 9th, and 12th days in the intervention group was significantly lower than the control group. CONCLUSIONS: The results showed that reflexology had a positive effect on reducing the severity of nausea in hemodialysis patients. Therefore, reflexology is recommended as part of nursing care to reduce patient suffering. Universities can train students in reflexology and managers can use the protocols to apply this method to reduce patient discomfort during hemodialysis.

From Suffering to Indifference: Reaction of Novice Nurses to Ethical Challenges in First Year of Clinical Practice.

BACKGROUND: The first year of clinical practice is one of the most important steps in nursing career life. Although, studies have been conducted on ethical issues in nurses, however, few studies have been conducted on the responses of novice nurses to ethical issues. The purpose of this study was to explore the responses of novice nurses to ethical challenges in the first year of clinical practice. MATERIALS AND METHODS: This study is a qualitative study with content analysis approach was conducted with financial support of Arak University of Medical Sciences. In this study, about 11 novice nurses selected using purposive sampling from educational hospitals affiliated to Arak University of Medical Sciences. Data were collected by semi-structured interviews. The duration of the interviews was 30-110 minutes. In order to analyze the data, inductive content analysis was used. RESULTS: Data analysis revealed two important, and different responses over time in novice nurses. So that at the beginning of practice, the reaction to ethical challenges was "suffering" and after a few months it became "indifference". CONCLUSIONS: This study showed that the response of novice nurses to ethical challenges in the first year of clinical practice was a transition from suffering to indifference. These findings can be used in nursing education, research and practice. Further research is recommended in this regard.

The Effect of Oral Health Promotion Program on Early Dental Decay in Students: a Cluster Randomized Controlled Trial.

Introduction: The use of different models play a significant role in health education and its promotion. Therefore, the present study aims to investigate the effect of the Theory of Planned Behavior (TPB) on early dental decay in elementary students. Methods: This study was a single-blinded, cluster randomized controlled trial, in which 470 elementary students in the fourth, fifth and sixth grades in Saveh, Iran were participated. A demographic questionnaire and a 5-item questionnaire consisting of questions on awareness, attitude, practice, tooth brushing, diet and referring to dentist, were used to data collection. The samples of the intervention (n=234) and control (n=236) groups filled out the questionnaires before intervention (pre-test), immediately after intervention and one month after intervention. The educational intervention based on the TPB was held in three 45-minute sessions. Finally, the data were analyzed, using the SPSS version 13. For analyzing, the Independent t-test, Chi-square, and repeated measures ANOVA were used. Results: This study showed that there is a significant difference in the mean scores obtained from knowledge, attitude, subjective norm, perceived behavioral control, behavioral intention and behavior among students in the experimental group (immediately after and one month after the intervention) and students in the control group. Conclusion: The results of this study showed that using of TPB, as a framework for providing behavior-led training, can be effective in promoting oral and dental health of students. Nurses as an important member of the treatment team can use the results of this study in school health programs.

Intimate partner violence against Iranian women.

Background: . WHO has identified intimate partner violence (IPV) as a health priority as it has considerable consequences on the physical and psychological health of women. We aimed to evaluate the prevalence of IPV in women of one of the central cities of Iran in addition to examining the effect of a women's job and spousal addiction on IPV. Methods: We did a cross-sectional study on 240 homemakers and nurse women, selected by a multistage random sampling method. Data were collected by a modified version of domestic violence CTS-2 of Straus questionnaire and were analysed by chi-square test and t test. Multivariate logistic regression was used to assess the predictors of physical IPV as the most important type of violence. Results: The mean (SD) age of the women and their husbands was 33.1 (8) and 37.8 (8.7) years, respectively. Verbal (95.4%) and psychological (80.8%) violence were the most common while injury (14.6%) was the least prevalent. The prevalence of physical violence was 28.8%. Based on the regression model, economic problems, history of divorce in the woman's family and spousal addiction were the highest predictors of violence (p<0.05). Discussion: Spousal addiction was related to higher violence against women in physical, psychological and injury dimensions. Increase of family support, removal of economic disparities and tackling drug addiction could be effective in decreasing violence.

Effect of spiritual counseling on spiritual well-being in Iranian women with cancer: A randomized clinical trial.

OBJECTIVES: This study examined the effect of spiritual counseling on the spiritual well-being of Iranian women with cancer. DESIGN AND SETTING: a randomized clinical trial was conducted on 42 female cancer patients who were randomized to either an 8-week spiritual counseling intervention (n = 21) or a control group that received routine education/care (n = 21). Spiritual well-being (SWB) was assessed before and after the 8-week spiritual counseling program using Paloutzian and Ellison's (1983) Spiritual Well-Being Scale (SWBS). RESULTS: There were no significant differences on SWBS and its two subscales scores (RWB and EWB) between intervention and control groups at baseline (p > .05). After intervention, there was a significant mean difference in SWB (p = .001), RWB (p = .013) and EWB (p = .001) in two groups. CONCLUSIONS: Spiritual counseling is associated with significant improvements in SWB in Iranian women with cancer. Interventions that acknowledge the spiritual needs of these patients should be incorporated into conventional treatments.

Prevalence of Metabolic Syndrome and Associations with Lipid Profiles in Iranian Men: A Population-Based Screening Program.

PURPOSE: Metabolic syndrome (MS) is characterized by a collection of interdependent disorders, including abdominal obesity, dyslipidemia, hyperglycemia, hypertension, and diabetes. The current study aimed to estimate the prevalence of MS in Qom, Iran. MATERIALS AND METHODS: A population-based screening program was conducted in the city of Qom, in 845 urban adult men over 25 years old in 2014. Abdominal obesity, fasting blood glucose (FBG), blood pressure, and the serum lipid profile were measured in subjects after fasting for at least 8 hours. MS was defined according to the Adult Treatment Panel III criteria. Data were analyzed using the chi-square test, t-test, and multiple logistic regression. RESULTS: The overall prevalence of MS was 23.0%, and the most common prevalent metabolic abnormalities associated with MS were low high-density lipoprotein cholesterol (<40 mg/dL) in 34.3% of subjects, a waist circumference >102 cm in 33.9%, blood pressure ≥130/85 mmHg in 27.6%, fasting triglycerides (TG) ≥150 mg/dL in 25%, and FBG ≥110 mg/dL in 20.6%. A FBG level ≥110 mg/dL (odds ratio [OR]=4.85; 95% confidence interval [CI], 2.14~8.24), dyslipidemia (OR=3.51; 95% CI, 2.10~5.89), and a fasting TG ≥150 mg/dL were the most important factors contributing to MS. CONCLUSIONS: The prevalence of MS in men in Qom was higher than has been reported in other countries, but it was lower than the mean values that have been reported elsewhere in Iran. FBG was the most important factor contributing to MS, and all elements of the lipid profile showed important associations with MS.

Benson's Relaxation Effect in Comparing to Systematic Desensitization on Anxiety of Female Nurses: A Randomized Clinical Trial.

INTRODUCTION: Nursing staffs expose to a high level of anxiety. This study aimed to compare the effect of Benson's relaxation and systematic desensitization methods for decreasing the anxiety score of nurses. MATERIALS AND METHODS: In a randomized clinical trial, 72 female nurses were assigned randomly to three different groups. Benson's relaxation and systematic desensitization were used as intervention beside control group. After intervention, the Spielberger state-trait anxiety inventory was used for measuring the anxiety score. Analysis of variance (ANOVA), Tukey test, and paired t-test were applied for comparing three group scores. RESULTS: The ANOVA test showed that a significant difference among three groups regarding scores of posttrait and poststate anxiety (P < 0.05). The Tukey test showed that both Benson's relaxation and systematic desensitization methods were effective in decreasing of the anxiety score of nurses. Moreover, the mean change in trait and state anxiety scores at Benson's relaxation and systematic desensitization groups was more than control group, respectively, and was statistically significant. CONCLUSION: Both Benson's relaxation and systematic desensitization methods are effective in improvement of the state and trait dimensions of anxiety. However, these methods could be applied in stressful situation among medical staffs of students.

Mothers' Experiences about Febrile Convulsions in Their Children: A Qualitative Study.

BACKGROUND: Febrile convulsion in children is a frightening experience for the mothers. This experience may have unknown aspects, which must be investigated in order to plan better support for the mothers and children. This study is conducted with the aim of exploring the experiences of mothers whose children suffer from febrile convulsion. METHODS: This study was based on a qualitative content analysis. 12 mothers in Amir Kabir hospital of Arak city participated in the study and shared their experiences through semi-structured interviews. The gathered data were analysed using Graneheim and Lundman's (2004) method. RESULTS: Exploring the experiences of mothers whose children suffered from febrile convulsion reflected three themes: perceived threat, seeking solution, and difference in adaptation. CONCLUSION: Regarding the findings of this study, comprehensive supportive care plans can be designed for enabling the mothers to better cope with their children's febrile convulsion.

Religious Practices and Self-Care in Iranian Patients with Type 2 Diabetes.

This study aimed to examine the relationship between religious practices and self-care of patients with type 2 diabetes. A descriptive cross-sectional survey was conducted on 154 diabetic patients who were referred to two general teaching hospitals in Qom City (Iran). Data were collected using demographic questionnaire, private and public religious practices, and summary of diabetes self-care activities questionnaires. Data were analyzed using descriptive statistics and statistical tests including independent t test, and Pearson correlation coefficient. Significant positive correlations were observed between religious practices and self-care activities in diabetic patients (p < 0.05). Significant positive correlations were also found between some religious practices and self-care activities subscales (p < 0.05). Healthcare providers should be aware of the role that religion plays in the lives of diabetic patients and be able to take religious factors into account when developing care plans. Doing so will enhance a more patient-centered approach and thereby support patients in their role as self-care decision-makers.

Cold Dialysis Solution for Hemodialysis Patients With Fatigue: a Cross-over Study.

INTRODUCTION: The purpose of this study was to explore the effect of cold dialysis on fatigue in hemodialysis patients. MATERIALS AND METHODS: In a double-blinded cross-over clinical trial, 46 participants were recruited from a hemodialysis unit in Iran. The participants were allocated into 2 groups through simple random sampling method. Each group received 3 sessions of hemodialysis with a dialysis solution temperature of either 37°C 3 or 35.5°C during the first week and then with for another week with the other temperature.  The self-report Piper Fatigue Scale questionnaire was filled out by the participants. RESULTS: The Piper Fatigue Scale scores in the cold dialysis groups were significantly lower than those in the conventional dialysis solution temperature (P < .001). Reducing the temperature of hemodialysis solution brought a 31.3% reduction in the fatigue score. CONCLUSIONS: Cold dialysis can be used for all hemodialysis patients as a routine intervention, and in particular, it is recommended dialysis patients who have severe fatigue as a convenient and inexpensive therapeutic option.