Factors associated with the quality of dying and death and missed nursing care.

BACKGROUND: Patients in intensive care units need full nursing care due to the high mortality rate. However, some aspects of nursing care can be forgotten. AIMS: To investigate the quality of death and dying and its association with aspects of missed nursing care, alongside the overall perception of nurses in intensive care units about factors associated with missed nursing care. METHODS: This cross-sectional study used a census sampling method of 105 nurses working in intensive care units. In order to collect data, the Quality of Dying and Death Questionnaire (QODD), missed nursing care (MISSCARE survey) and factors associated with missed nursing care questionnaire were used. Data analysis was performed by using SPSS 16. FINDINGS: The quality of death and dying, as perceived by nurses, was found to be lower than the average (Range score: 0 to 100). The range of missed nursing care was average (Range of score: 24 to 96) and the most noticeable reason for this missed nursing care was the shortage of nursing staff. CONCLUSION: Managers should ensure that nurses provide complete nursing care for terminally ill patients in intensive care units and eliminate factors that lead to aspects of nursing care being missed, such as staffing levels, material resources and communication between staff members.

COVID-19 stress and coping strategies among older adults: a systematic review of qualitative evidences.

BACKGROUND: The COVID-19 pandemic has brought about far more stressful conditions for people worldwide. As a vulnerable group, older adults have suffered various psychological problems, such as stress, because of this pandemic and have applied various strategies to cope with the dire consequences. This study aimed to synthesize qualitative evidence regarding coping strategies for stressful situations among older adults throughout the COVID-19 pandemic. METHODS: We searched electronic databases, including Scopus, Embase, PubMed, ProQuest, and the Cochrane Library, based on PRISMA standards. The protocol of this systematic review was registered on the PROSPERO (registration code: CRD42022364831). All relevant English-language articles published between 2019 and November 10, 2022, were searched. We reviewed the reference lists for all the included studies and key references. Two reviewers conducted screening, data extraction, and quality appraisal independently, with disagreements resolved by consensus with all team members. The Joanna Briggs Institute (JBI) checklist was used to assess the quality of studies. A thematic synthesis of the selected studies was conducted. RESULTS: We included 13 studies in our review. Most studies were conducted in the early months of the COVID-19 pandemic. The stress caused by the COVID-19 pandemic was classified into six categories: health management challenges, stress caused by quarantine, economic challenges, media and bad news stress, virus threats, and challenges related to the use of communication technologies. The strategies used by older adults to cope with these challenges were categorized into five categories: protective strategies, avoidance strategies, maintaining social connections, meaning-based strategies, and fun strategies. This research showed that depending on the situation and conditions, older adults use various strategies to cope with COVID-19. CONCLUSION: Older adults experience much stress during the COVID-19 pandemic. In most cases, older adults can cope with these challenges with simple strategies from previous experiences and learnings. Older people require educational interventions in some cases, such as those involving communication skills. A better understanding of older adults coping strategies may enable policymakers to develop more effective policies and manage the problems of older adults in post-COVID situations.

Comparing the Performance of Emergency Department Personnel and Patients' Preferences in Breaking Bad News.

Objective: Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significant implications for patients' outcomes. Inadequate and inappropriate delivery of bad news can result in detrimental psychological and emotional effects. This study aimed to compare the performance of emergency department (ED) personnel and patients' preferences in BBN. Methods: This descriptive-analytical study was conducted in 2022, and 135 patients who were admitted to the ED were included using quota sampling. Data were collected using a demographic questionnaire, a researcher-made questionnaire, and a standard questionnaire on attitudes toward the methods of BBN in the ED. The data were analyzed using SPSS software (version 16), and a p-value<0.05 was considered statistically significant. Results: The results showed that the majority of patients (69.6%) received bad news from nurses. Based on the conditions mentioned in the standard questionnaire, the overall performance of personnel was 6.08±4.22 out of 19, while the overall attitude score (59.66±7.66 out of 76) revealed patients' high tendency to receive bad news. There was a statistically significant difference between the total score of personnel performances and the total score of patients' attitudes (p=0.001). Conclusion: The performance of ED personnel concerning patients' attitudes toward the method of BBN in the emergency department was not optimal. Therefore, it is recommended to implement appropriate training programs for medical professionals, especially physicians, and nurses, to enhance their communication skills and reduce the detrimental effects of inappropriate delivery of bad news in medical settings.

Factors Affecting the Use of Physical Restraints by Nurses for Patients in Intensive Care Units.

How to cite this article: Shakeri B, Vatandost S, Nouri B, Valiee S. Factors Affecting the Use of Physical Restraints by Nurses for Patients in Intensive Care Units. Indian J Crit Care Med 2023;27(5):372-373.

Level of Self-Care and Patient Care Against COVID-19 Among Emergency Medical Services Personnel; a Cross-sectional Study.

Introduction: Provision of pre-hospital care by emergency medical services (EMS) requires paying attention to self-care and patient care against possible infections. The present study was conducted with the aim of determining the level of self-care and patient care against COVID-19. Methods: The present correlational, descriptive, analytical study was carried out on 301 EMS personnel in Iran. Data were collected using a demographic information form and questionnaires made by the researcher on the level of self-care and patient care against COVID-19. Results: The results showed that more than half of the participants (55%) were aged 27 to 34 years. The majority of the participants had an experience of participating in self-care (88.7%) and patient care (83.7%) training courses against COVID-19. The overall score of self-care was 55.96 ± 6.97 out of 72 and that of patient care was 26.86± 3.39 out of 32, both of which revealed a favorable level. However, in some questions, the mean score was lower than the optimal level. The lowest mean score among items related to self-care against COVID-19 was allocated to wearing protective clothing (1.77±1.19). Among items related to patient care against COVID-19, the lowest mean score was related to training the patient about hand hygine after touching contaminated equipment (2.83±1.08 out of 4). There was a positive (r=0.491) and significant correlation between self-care and patient care against COVID-19 (p=0.001) based on our findings. Conclusion: Although the general level of self-care and patient care against COVID-19 was favorable, due to the undesired level of some domains, it seems necessary to implement corrective planning through periodical training and monitoring the performance of the personnel.

Exploring the Experience of Nurses in Providing Care to Patients With COVID-19: A Qualitative Study.

BACKGROUND: The COVID-19 pandemic has caused conflicts in the world health system. The role of nurses is prominent because of their close contact with patients. PURPOSE: The aim of this study was to explore the experiences of nurses in providing care to patients with COVID-19. METHODS: This phenomenological study was conducted in 2020. Purposive sampling was used and continued until data saturation. Semistructured interviews were conducted with 14 nurses at Tohid Hospital, Sanandaj, Iran, all of whom had experience providing care to patients with COVID-19. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method. RESULTS: The participants included four men and 10 women. Data analysis revealed four main themes (14 subthemes) related to the experience of the participants in providing care to patients with COVID-19. These themes included (a) fear (fear of being infected, fear of being a carrier, fear of the disease, and high mortality of patients), (b) compulsion (compulsion to care, being under pressure), (c) distinct experience (need for self-care, working with personal protective equipment, and ambiguity in care/treatment), and (d) sacrifice (altruism, compassion, self-sacrifice, and being proud of yourself). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The experience of participants in caring for patients with COVID-19, in addition to the unique experience of care, was associated with fear, compulsion, and sacrifice. Because of the ongoing COVID-19 pandemic and the unique experience of nurses serving in COVID-19 units, it is necessary to educate and support nurses to deal effectively with this situation.

Effect of Multimodal Intervention on Nursing Students' Adherence to Hand Hygiene: An Experimental Study.

BACKGROUND: Hand hygiene adherence is highly important in clinical practice and is influenced by various factors. AIMS: This study investigated the effect of multimodal intervention on nursing students' adherence to hand hygiene in clinical practice. METHODS: Internship nursing students were randomized into control (n = 20) and intervention (n = 26) groups. Adherence to hand hygiene was measured by self-report questionnaire and by observation. The intervention group received multimodal interventions for 1 week. FINDINGS: Results showed significant effects of multimodal intervention on adherence to hand hygiene in "before contact with the patient," "before and after contact with the patient" situations, and at the beginning of medication administration, catheterization, vital sign measurement, and blood sugar testing. CONCLUSION: The multimodal intervention improved adherence to hand hygiene in the intervention group. Given the importance of hand hygiene adherence by nursing students in all situations, designing and implementing context-based multimodal interventions are recommended as part of nursing students' educational programs.

Development and preliminary psychometric evaluation of a nursing error tool in critical care units.

OBJECTIVE: This study was conducted to address the importance of identifying nursing errors in critical care units and the lack of appropriate tools for measuring them. This study aimed to develop and psychometrically evaluate a nursing error tool in critical care units. DESIGN: This was a psychometric validity study. SETTING: The study involved eight critical care units affiliated with Kurdistan University of Medical Sciences. METHODS: The research was conducted in two phases. In the first phase, data were gathered via interviews with nurses, and analyzed with conventional content analysis. The primary codes and subcategories were identified as tool items. In the second phase, the psychometric properties of the instrument, including face validity, content validity, construct validity, internal consistency, and reliability were investigated. RESULTS: In the first phase, 142 items were extracted; this number was reduced to 40 items after assessing qualitative content validity. Exploratory factor analysis identified five factors: medication error, task description error, executive error, procedural error, and safety error, which made up 88% of the total variance. The Cronbach's alpha was 0.97. CONCLUSIONS: The development of a validated nursing error tool is helpful in identifying the extent and typologies of nursing errors, and could aid in designing better prevention strategies in critical care units.

Investigating patients' attitudes toward receiving care from an opposite-gender nurse.

BACKGROUND: The imbalance in nurse-to-patient ratio and limited physical space may lead to care provision by a nurse of the opposite gender. On the other hand, the relationship with the opposite gender in Iran is limited due to cultural and religious beliefs. The aim of this study was to investigate patients' attitudes toward receiving care from the opposite gender nurse. MATERIAL AND METHOD: This descriptive cross-sectional study was carried out on 200 patients admitted to different hospital wards. The patients were recruited using convenience sampling. Data collection tools comprised of a demographic questionnaire and a researcher-made questionnaire. Data were analyzed using SPSS (version 16) and running descriptive statistics (i.e., χ2 , independent t test, and linear regression analysis). RESULTS: Male and female patients had 31.8% and 42.6% negative attitudes toward receiving care from the opposite gender, respectively, indicating a statistically significant difference (p = .05). Patients' attitudes had a significant and positive relationship with age, level of education, and experience of receiving care from a nurse of the opposite gender. CONCLUSION: A significant percentage of patients had a negative attitude toward receiving care from the opposite-gender nurse. Since people's attitudes affect their relationships, it is necessary to provide conditions for assigning the same gender nurse for patients and improving patients' attitudes toward nurses of the opposite gender.

Nursing faculty's point of view regarding noncompliance with ethics in academic environments: a qualitative study.

BACKGROUND: An academic environment is the first place that nursing students are introduced to ethics related to nursing and healthcare. In this study, we explored the nursing faculty members' point of view regarding noncompliance with these academic ethics. METHODS: This study was a qualitative descriptive study conducted in 2018. Faculty members at a nursing school were selected through purposeful sampling. Data was collected using semi-structured interviews. The interviews were digitally recorded and transcribed verbatim. Data collection and data analysis were conducted simultaneously. Data saturation was ensured with 11 interviews. The interview transcripts were analyzed using a qualitative content analysis method introduced by Elo and Kyngäs. RESULTS: The participants were six women and five men with 12.72 ± 6.64 years of experience as nursing instructors. After data analysis, seven categories were identified: discrimination, violence, misuse, out-of-date instruction and knowledge, conflicts of evaluation, hypocrisy, and disorganization. CONCLUSION: The findings of this study indicated the existence of noncompliance regarding academic ethics. It is recommended that faculty members be informed about possible instances of ethical noncompliance in academia. There is a need to develop strategies to promote a faculty's compliance with academic ethics. Academic administrators need to emphasize the importance of ethics in academia and use further methods to enhance academic ethics.

Exploration of service recipients' image of a perfect nurse: A qualitative descriptive study.

AIM: The aim of this study was to explore the image of the perfect nurse from service recipients' perspective. BACKGROUND: The public image of nursing is one of the long-term challenges of this profession. Specific cultures affect the views and satisfaction of nursing service recipients. METHODS: This study was a qualitative descriptive study conducted in 2018. Purposive sampling was used and continued until saturation. Twelve semi-structured interviews were conducted with service recipients who had experience in using nursing services in the past six months. Participants were 5 men and 7 women. Interviews transcript verbatim and analyzed by qualitative content analysis. RESULTS: Four themes emerged from the perspective and experience of the participants concerning perfect nurse including the followings: affable (compassionate, sympathetic and good-tempered), responsive (answering questions, answering requests), tower of strength (listener, being patient, understanding and attention) and efficient (providing careful care, providing timely care, providing proper care). CONCLUSION: From the participants' perspective, a perfect nurse should be responsive to the patient and be well-mannered and patient with them in addition to providing expert care. Therefore, nurses should not only improve their skills in providing care but also focus on the communication dimension and respond to the patients. Identifying communication barriers with the clients in the context of the study is also suggested.

Experience of Workplace Violence Toward Nursing Students in Iran: A Qualitative Study.

BACKGROUND AND AIMS: This study explored the dimensions of violence experienced by Iranian nursing students, during their nursing education. Violence toward students has become a major concern in recent years, and strategies are needed to reduce the incidence. METHODS: A qualitative study was conducted. Participants were seven male and nine female third-year undergraduate nursing students. Purposive sampling was used, and qualitative data from semistructured interviews were analyzed using thematic content analysis. RESULTS: From the qualitative data, five categories emerged: instances of violence, causes of violence, emotions after experiencing violence, reactions after violence, and violence prevention strategies. CONCLUSION: To reduce the incidence of violence and provide safer learning environments, nursing students need to be taught preventive measures, but moreover, they need to receive appropriate support from nurses, instructors, and educational managers, Forensic nurses should be active stakeholders in monitoring, supporting, and referring nursing students who experience workplace violence.

Nurses' experience of providing ethical care following an earthquake: A phenomenological study.

BACKGROUND: Ethical care provided by nurses to earthquake victims is one of the main subjects in nursing profession. OBJECTIVES: Given the information gap in this field, the present study is an attempt to explore the nurses' experience of ethical care provided to victims of an earthquake. RESEARCH DESIGN AND METHOD: A hermeneutic phenomenological study was performed. The participants were 16 nurses involved in providing care to the injured in Kermanshah earthquake, Iran. They were selected using purposeful sampling, and in-depth and semi-structured interviews were carried out. The transcribed interviews were analyzed based on the hermeneutic approach using the analysis method proposed by Diekelmann et al. ETHICAL CONSIDERATIONS: The study was approved by the Research Council and Ethics Committee of Urmia University of Medical Sciences, Iran. FINDINGS: Data analyses revealed four themes and 10 sub-themes that illustrated nurses' experience of ethical care during earthquake. The themes were (1) Respecting humanistic values (sacrifice, stepping beyond task description, and voluntary work), (2) Commitment to ethics (honesty, confidentiality, and trustworthiness), (3) Respecting dignity of victims (respecting cultural values, maintaining privacy, having humanistic perspective, and effective communication), and (4) Spiritual support (helping patients to do religious rituals Psychological support). CONCLUSION: The results showed the nurses' experience with providing care to earthquake victims. The findings underlined ethics and ethical values in providing nursing care during disasters. It is suggested that special courses on the importance of nursing ethics in critical situations be incorporated into nursing curriculums and in-service educations.

Effect of an education program, risk assessment checklist and prevention protocol on violence against emergency department nurses: A single center before and after study.

AIM: The purpose of this study was to evaluate the effects of an education program, risk assessment checklist and preventive protocol on violence against emergency department nurses. METHODS: The design was a quasi-experimental before and after study of a group. A hospital emergency department's nurses participated in a workshop in which they were taught a method of using a risk assessment checklist and preventive protocol. The intervention lasted six weeks. The mean score and type of violence was measured before and after the intervention. The data were analyzed by SPSS. RESULTS: The mean score of violence before the intervention was 8.4 and after the intervention it was 2.7, which was statistically a significant difference (p < 0.0001). In addition, there were significant differences in the mean frequency of verbal abuse (p < 0.0001), assessment of workplace security (p = 0.006), fear of injury (p < 0.02) and type of reaction to violence (p < 0.01) before and after the intervention among the nurses. CONCLUSIONS: Using the BVC risk assessment checklist and preventive protocol can reduce the experience of violence and verbal abuse, which is the most common form of violence for emergency department nurses. Using this checklist and preventive protocol when patients arrive in emergency departments is recommended.

Barriers to and Facilitators of Nurses' Adherence to Clinical Practice Guidelines: A Qualitative Study.

BACKGROUND: Guidelines for clinical practice are needed in order for nurses to provide consistent, standardized care and avoid preventable harm. AIMS: The present study aims to explore the barriers to and facilitators of nurses' adherence to clinical practice guidelines. METHODS: Detailed semistructured interviews were conducted with 14 nurses from two educational hospitals in Kurdistan University of Medical Sciences, Sanandaj, Iran, about their involvement with clinical practice guidelines. The text of the interviews was analyzed by qualitative content analysis. FINDINGS: Identified barriers to full adherence to clinical practice guidelines were work pressure, lack of facilities, paperwork, lack of motivational environment, and nonapplicability of guidelines. Facilitators identified were encouragement, improving working conditions, conscientiousness, training, and supervision. CONCLUSION: Interventions to remove barriers to and provide facilitators of adherence to clinical practice guidelines should be designed and implemented. Removing organizational barriers is the responsibility of nursing managers.

Risky Behaviors and Sensation-Seeking in Adolescence: A Descriptive Correlational Study.

Risky behaviors are common in developing countries, especially in adolescence. Moreover, sensation seeking is an important factor in personality. This study was conducted to evaluate the relationship between risky behaviors and sensation-seeking in a sample of Iranian adolescents. This study used a cross-sectional method with 400 high school adolescents (age between 15 and 21 years old) in Kashan city from multistage random sampling. The research instrument consisted of three parts: a socio-demographic questionnaire, the Youth Risk Behavior Surveillance System (YRBSS) and the Zuckerman Sensation-Seeking Scale-V (SSS-V). Data analysis was performed using the t-test, ANOVA, chi-square, regression and Spearman correlation coefficient in SPSS v 11.5. Risky behaviors were found in 51.2% of students, and a significant difference was found between the male and female students in this regard (p < .021). The overall sensation-seeking score and the scores in the dimensions of experience seeking, disinhibition, and boredom susceptibility were higher in males than females (p < .0001). All dimensions of sensation-seeking other than disinhibition dimension could significantly predict risky behavior. Sensation seeking can be used as an indicator for screening risky behaviors. Detailed planning on the part of the health care system and public authorities is recommended for appropriate screening and counseling adolescents with risky behaviors.

Barriers of medication adherence in patients with type-2 diabetes: a pilot qualitative study.

Background: Patients with type-2 diabetes have poor adherence to the therapeutic regime. It can result in various complications in body systems associated with undesirable metabolic control. Purpose: The present study aimed to explore the inhibitors of medication adherence in patients with type-2 diabetes. Patients and methods: This was a qualitative study using a conventional content analysis method. Participants were 12 patients with type-2 diabetes referred to the diabetes unit in Saghez, Kurdistan Province in 2015. The purposive sampling method was used with a maximum variation in sampling, and data collection was continued until data saturation was achieved. Semi-structured interviews were used for data collection. Interviews were recorded and immediately transcribed verbatim. Results: Data analysis led to the development of four main categories including disbelief in medical explanatory/prescriptive knowledge, lived experiences of the disease, challenges of everyday life, and interactive/economic challenges. The main inhibitors were the patient's understanding of his/her own physical status and strategies used for maintaining the internal balance. Healthcare providers need to take patients' perceptions into account when they are prescribing medicinal diets. Another inhibitor was the incidents of everyday life, including economic and social challenges, and interactions to receive education and skills for living with the disease. Conclusion: Beliefs of the medical team and patients should be brought closer to each other, and patients' trust in the medical team should be increased. Nurses should consider the unique experience of every patient when giving healthcare recommendations, and try to limit the existing challenges as much as possible.

Clinical Instructors' Experience of Managing Students' Errors: A Qualitative Study.

Given the importance of patient safety, this study aimed to explore clinical instructors' experience of managing students' errors. A qualitative approach was adopted to conduct semistructured interviews with 12 clinical nursing and midwifery instructors. Three main categories emerged: prevention (orienting, review of the knowledge, repeating procedure by instructor, checking steps prior to performing procedure, and reminding), action (correcting, monitoring and follow-up, and informing), and feedback (cause analysis, notifying, and affecting assessment). Patient safety and error management programs should be included in the nursing curriculum and nursing education.

Effect of Interventional Educational Programs on Intensive Care Nurses' Perception, Knowledge, Attitude, and Practice About Physical Restraints: A Pre-/Postclinical Trial.

The article reports results of an educational program designed to modify negative attitudes of intensive care nurses regarding the use of physical restraints. Findings revealed that increased knowledge about appropriate utilization of various types of restraints positively impacted perceptions, attitudes, and patient care practices. Authors also explore restraint use in several countries and identify variations in use of restraining methods.

A Clinical Trial of the Effect of Warm Intravenous Fluids on Core Temperature and Shivering in Patients Undergoing Abdominal Surgery.

PURPOSE: This study was conducted to investigate the effect of warm intravenous fluids on shivering and core temperature of patients undergoing abdominal surgery. DESIGN: This study was a two-group clinical-control trial. METHODS: Ringer's solution at normal room temperature and serum at 38°C were infused in the control and intervention groups, respectively. Shivering, core temperature, SpO2, and vital signs were measured at admission to the operating room and postanesthesia care unit (PACU) and 30 minutes after the admission to the PACU. FINDINGS: There was a significant difference between the two groups in terms of shivering, core temperature, and pulse rate at the time of admission to the PACU and 30 minutes after. CONCLUSIONS: Ringer's solution at 38°C instead of room temperature can be used to reduce the incidence of postanesthetic hypothermia and shivering in patients undergoing abdominal surgery. Using this method in addition to other nursing care is recommended preoperatively.