People's attitudes towards the use of quarantine in the Covid-19 pandemic in Iran: Validity and reliability study.

BACKGROUND: The purpose of this study was first to translate (into Persian) and evaluate the psychometric properties of the attitudes towards the use of quarantine questionnaires (PAQ). METHODS: This methodological study was conducted on 1000 adults' participants in Iran, using convenience sampling. Based on permission from the developer of the scale, it was back-translated. Content validity, exploratory and confirmatory factor analyses were tested. Reliability of the questionnaire was evaluated with test-retest and internal consistency. RESULTS: The adequacy of the sample was acceptable because of the results of the Kaiser-Meyer-Olkin test (0.788), and Bartlett's test of sphericity revealed statistically significant results (P < .001). Exploratory factor analysis showed the 4-factor structure of the instrument. The reliability of the scale was 0.77 based on internal consistency. Also, the intra-class reliability of the scale was 0.9. The attitude of the maximum number of respondents towards quarantine is positive and they support a quarantine in the pandemic of COVID-19 in Iran. CONCLUSIONS: Current study showed that the Persian version of attitudes towards the use of quarantine (PAQ) in the Iranian population including 17 items could be used as a valid and reliable instrument.

Is there a relationship between moral competencies and the formation of professional identity among nursing students?

BACKGROUND: Moral competencies are essential for nursing work. Professional identity is a set of values and beliefs that a person has about her/his job, which includes moral values as well. The development of moral competencies and formation of professional identity in nursing students occurs mainly during their college years. The aim of this study was to investigate the relationship between moral competencies and the formation of professional identity among nursing students. METHODS: This study was designed as a descriptive-correlational study. The study population was consisted of nursing students who were enrolled in nursing schools at the time of the study. Two hundred and twenty-one nursing students completed the study tools. The research tools were a demographic questionnaire, Moral Development Scale for Professionals (MDSP), and Professional Identity Scale for Nursing Students (PISNS). RESULTS: The mean (SD) of MDSP and PISNS scores was 45.69 ± 5.90 and 55.61 ± 12.75, respectively. There was a significant statistical relationship between MSDP and PISNS scores (p < 0.05). A significant equation was found (f (2, 218) = 16.68, p < 0.001) with an R2 of 0.113. The MSDP scores increased 0.136 for each score of PISNS, and married students had 2.452 scores higher than single students. CONCLUSIONS: The positive correlation between the formation of professional identity and development of morality in nursing students indicates that by strengthening students' professional values, their moral competencies may develop positively.

Provider Experiences with a Payer-Based PCMH Program.

BACKGROUND: The patient-centered medical home (PCMH) is an enhanced primary care model that aims to improve quality of care. Over the past several years, the PCMH model has been adopted by Medicare and private payers, which offer financial resources and technical assistance to participating practices. However, few studies have examined provider experiences and perspectives on the adoption of payer-based PCMH models in different practice settings. OBJECTIVE: The goal of this qualitative study was to analyze how providers experienced specific elements of a payer-based PCMH model and identify cross-cutting themes that can be applied to other payer-based PCMH initiatives. DESIGN: Observational qualitative study. PARTICIPANTS: A total of 65 individuals (which includes 57 primary care physicians) participated in focus group sessions. Telephone interviews were conducted with an additional 14 physicians and 2 practice administrators. APPROACH: Interviews and focus groups were recorded after obtaining the informed consent of participants. Written transcripts from the recordings were then imported into NVivo 11 for subsequent coding and qualitative analysis of themes. KEY RESULTS: We found that nurse care coordinators (NCCs) were the single most valuable and visible program element. Individual care plans served as effective tools of communication between the NCC and physician on patient care management goals and issues. The online data portal was viewed as the least valuable element. With regard to cross-cutting themes, some providers expressed a strained relationship with CareFirst due to communication challenges, a lack of trust, and differing priorities in selecting patients for care plans. CONCLUSION: Nurse care coordinators and the targeted use of individualized care plans are essential components in a payer-based PCMH program. Improving communication and trust in data reports are critical for effective implementation. Future research should examine provider experiences in other payer-based PCMH programs to see how interactions with payers affect program implementation.

The challenges of nursing care for patients with lumbar discectomy: A qualitative study.

AIM: Patients with lumbar disc surgery experience many different problems during their hospital stay. Nurses also face different challenges in providing care to them. Nonetheless, no study has yet specifically addressed these challenges to the best of our knowledge. This study aimed at exploring the challenges of nursing care for patients with lumbar discectomy. DESIGN: This qualitative study was conducted in 2022 using content analysis. METHODS: Eight nurses, three patients with lumbar discectomy, and one physician were purposively selected from the neurosurgery wards of the hospitals affiliated to Golestan University of Medical Sciences, Gorgan, Iran. Semi-structured interviews were conducted for data analysis and the content analysis method recommended by Elo and Kyngas was used for data analysis. The main phases of this method are open coding, grouping, categorization, and abstraction. The MAXQDA 10 software was employed to facilitate data management. Data collection continued to reach data saturation. RESULTS: The challenges of nursing care for patients with lumbar discectomy were categorized into eleven subcategories and three main categories, namely dominant routine-based practice in the healthcare system, futile attempt for team-based care, and shortages as a major barrier to quality care. There are different personal, professional, financial, structural, and organizational challenges in nursing care for patients with lumbar discectomy which can negatively affect postoperative patient recovery.

Implementation strategies for large scale quality improvement initiatives in primary care settings: a qualitative assessment.

BACKGROUND AND OBJECTIVES: The EvidenceNOW: Advancing Heart Health in Primary Care was designed to assist primary care practices in the US in implementing evidence-based practices in cardiovascular care and building capacity for quality improvement. EvidenceNOW, NCT03054090, was registered with ClinicalTrials.gov on 15/02/2017. The goals of this study were to gain a comprehensive understanding of perspectives from research participants and research team members on the value of implementation strategies and factors that influenced the EvidenceNOW initiative in Virginia. METHODS: In 2018, we conducted 25 focus groups with clinicians and staff at participating practices, including 80 physicians, advanced practice clinicians, practice managers and other practice staff. We also conducted face-to-face and telephone interviews with 22 research team members, including lead investigators, practice facilitators, physician expert consultants, and evaluators. We used the integrated-Promoting Action on Research Implementation in the Health Services (i-PARIHS) framework in our qualitative data analysis and organization of themes. RESULTS: Implementation strategies valued by both practice representatives and research team members included the kick-off event, on-site practice facilitation, and interaction with physician expert consultants. Remote practice facilitation and web-based tools were used less frequently. Contextual factors that influence quality improvement efforts include leadership support, access to resources, previous quality improvement experience, and practice ownership type (independent compared to health system owned). Many clinicians and staff were overwhelmed by day-to-day activities and experience initiative fatigue, which hindered their ability to fully participate in the EvidenceNOW initiative. CONCLUSIONS: This study provides details on how the practice environment plays an essential role in the implementation of evidence-based practices in primary care. Future efforts to improve quality in primary care practices should consider the context and environment of individual practices, with targeted implementation strategies to meet the needs of independent and health system owned practices. Future efforts to improve quality in primary care practices require strategies to address initiative fatigue among clinicians and practice staff. External support for building capacity for quality improvement could help primary care practices implement and sustain evidence-based practices and improve quality of care. TRIAL REGISTRATION: This project was registered with ClinicalTrials.gov on 15/02/2017 and the identifier is NCT03054090.

The Effect of Acupressure on Preventing Constipation in Patients with Acute Myocardial Infarction under Primary Percutaneous Coronary Intervention.

Background: Cardiac patients are prone to experiencing constipation. The main purpose of the present study was to assess the effect of acupressure on preventing constipation in patients with acute myocardial infarction (AMI) under primary percutaneous coronary intervention. Methods: The present randomized clinical trial was conducted on 90 patients with AMI (30 patients in each group) who were randomly allocated based on inclusion criteria. The intervention was carried out among the patients with AMI on the acupressure points SJ6, LI4, ST25, and SP6 two times a day (10 am and 6 pm) for three sequential days. Results: On the first and second days of the study, all of the patients had no defecation, and the first defecation occurred on the third day of the study. In the intervention, sham, and control groups, 93.3%, 46.7%, and 50.0% had normal defecation on the third day of the study, respectively. The results of the Chi-square test revealed significant differences among the three groups (P<0.001). Conclusion: The results of the present study showed that patients with AMI in the intervention group had significant improvement in terms of stool consistency based on the Bristol stool scale. So, acupressure can be used as a nursing intervention in critical care units.

Motor Exercises Effect on Improving Shoulders Functioning, Functional Ability, Quality of Life, Depression and Anxiety For Women With Breast Cancer.

PURPOSE: This research aimed to study the effects of motor exercises on improving shoulder functioning, functional ability, quality of life, depression, and anxiety in patients. PATIENTS AND METHODS: A randomized clinical trial in which 70 eligible patients referred to the oncology ward participated in two intervention and control groups. The intervention group (N=35) had been doing motor exercises for five weeks. Before the surgery, two days, and five weeks after surgery, shoulder Range Of Motion (ROM) was measured with a goniometer, and the functional capacity level was measured by the 6-Minute-Walk-Test. Quality of life, depression, and anxiety were measured using the EORTC QLQ-C30 and QLQ-BR23; and HADS questionnaires, respectively, at baseline and five weeks after surgery. Descriptive statistics, the T-test, and the Chi-Square t-hotelling model were used to analyze the data. RESULTS: The results showed that motor exercises had a significant statistical increase in the distance of 6MWT (P<.001) and ROM (P≤.001) compared to the control group. Moreover, there were significant differences in dimensions of patients' quality of life, depression, and anxiety in the intervention group, compared to the control group (P<.05). CONCLUSION: Motor exercises had positive effects on improving physical functioning, shoulder ROM, and decreasing patients' anxiety and depression symptoms, consequently enhancing the quality of life.

A Qualitative Analysis of Implementing EvidenceNOW to Improve Cardiovascular Care.

PURPOSE: The Heart of Virginia Health care (HVH) was a regional cooperative under the EvidenceNOW initiative to assist primary care practices in implementing evidence-based cardiovascular care and building capacity for quality improvement. The HVH implementation team included individuals from multiple universities, quality improvement organizations, and consulting firms. The goal of this study was to understand HVH team member viewpoints on the challenges, strengths, and lessons learned in each phase of the project. METHODS: Qualitative methods were used to facilitate reflection on the implementation and dissemination of the EvidenceNOW initiative in Virginia. In-depth interviews were conducted at the end of the project with 22 HVH team members. A nonparticipant, multidisciplinary research team completed thematic analysis of interview transcripts. RESULTS: Positive attributes of the HVH initiative included diverse team member skills and areas of expertise, a well-received kick-off event, and a comprehensive set of practice improvement resources. Major challenges included recruiting primary care practices, varying types and capabilities of electronic health records, and working with practices at different transformation stages, with different objectives for participating and involvement in other government initiatives. CONCLUSIONS: Study findings provide insights for future dissemination research and implementation of evidence-based practices in primary care. Challenges experienced in project development can result in a domino effect that could change the project timeline, type of practices recruited for study participation, resource allocation, and planned activities for quality improvement. Effectiveness of external quality improvement support may depend on practice engagement, preexisting organizational structures and processes, availability of resources, and length and continuity of practice facilitation.