Puzzle game-based learning: a new approach to promote learning of principles of coronary artery bypass graft surgery.

INTRODUCTION: Since learning with high educational quality requires an advanced intervention. This study seeks to answer how many puzzles game-based training can improve knowledge and cognitive function of surgical technology students in CABG surgery and its sequence, as well as the tools and equipment used in each stage of surgery and the sequence of their preparation. MATERIALS AND METHODS: This study was carried out as a quasi-experimental single-group pre-test-post-test, during which, after designing a puzzle game including various stages of surgery (from the preparation of the patient for surgical sutures and the necessary equipment to perform each stage), 18 people from third-year surgical technology students who met the inclusion criteria were entered in the study by convenience sampling method and based on the sample size determined using a similar study and they participated in the test of knowledge and cognitive function, that the validity and reliability were measured, before the intervention and 14 days after the intervention (using a puzzle game). Data were analyzed using descriptive and Wilcoxon statistical tests. RESULTS: After the withdrawal of 2 people, 15 person (93.80 per cent) of the students were female, the average age of students was 21.87 ± 0.71 years, and 50% (8 people) of them were 22 years old. Also, the average score of the end-of-semester exam of the heart surgery technology course was 15.19 ± 2.30 (the lowest score was 11.25, and the highest score was 18.63), and the score of 43.80% (7 people) of them were in the range of 15.01-17.70, and their average of grade point average was 17.31 ± 1.10 (the lowest grade point average is 15 and the highest grade point average is 19.36) and grade point average 75% (11 people) of students were 16-18. The average scores of knowledge(5.75 ± 1.65 vs. 2.68 ± 0.79) and cognitive performance(6.31 ± 2.57 vs. 2.00 ± 1.09) of students in the post-intervention phase were significantly higher than the pre-intervention phase (P < 0.0001). CONCLUSION: The results of the present study showed that the use of puzzle games in CABG surgery training led to a significant improvement in the knowledge and cognitive performance of surgical technology students regarding the stages of CABG surgery and its sequence, as well as the tools and equipment used in each stage of surgery and the sequence of their preparation.

Evaluation of Warming Effectiveness on Physiological Indices of Patients Undergoing Laparoscopic Cholecystectomy Surgery: A Randomized Controlled Clinical Trial.

PURPOSE: The present study aimed to evaluate the impact of warming on physiological indices of patients undergoing laparoscopic cholecystectomy. DESIGN: The study was a three-group randomized controlled clinical trial. METHODS: In the present study, 96 patients were assigned to three groups: forced-air warming system group; warmed intravenous fluid group; and control group. The intervention was performed immediately after the anesthesia induction. Physiological indices (core body temperature, blood pressure, and heart rate) were evaluated at 15-minute intervals, and postoperative shivering was also recorded. FINDINGS: The mean systolic blood pressure and the mean heart rate were significantly different in each warming group before, during, and after surgery, but the three groups had no significant differences in terms of physiological indices at any time (P > .05). Postoperative shivering was not seen in any group. CONCLUSIONS: Both interventions had similar effects on physiological indices. Therefore, the recommendation is to use the warming method according to patient's other conditions.

A survey on the effects of patient safety training programs based on SBAR and FMEA techniques on the level of self-efficacy and observance of patient safety culture in Iran hospital, Shiraz in 2022-2023.

BACKGROUND AND OBJECTIVE: Patient safety and medical personnel self-efficacy are among the main factors involved in providing quality health services. Moreover, safety culture in an organization is considered one of the most critical factors regarding patients' safety. Therefore, the present study aimed to determine the effects of patient safety programs based on Situation, Background, Assessment, Recommendation (SBAR) and Failure Model Effects Analysis (FMEA) techniques on self-efficacy and patient safety culture in Iran Hospital of Shiraz in 2022-2023. MATERIALS AND METHODS: This two-stage quasi-experimental study was conducted in 2022-2033. Considering inclusion criteria, the present study included 80 nurses working in Iran Hospital. The participants were divided into groups of SBAR (40 participants) and FMEA (40 participants). All the data were collected using a Hospital Survey on Patient Safety Culture questionnaire and Sherer General Self-Efficacy Scale. Then, the collected data were analyzed using SPSS 13, Fisher's exact test, paired t-test, and independent t-test with a significant level of P < 0.05. RESULTS: The mean score of total patient safety culture between the two groups was insignificant before the intervention (P = 0.58). However, it was more significant in the FMEA group than the SBAR group after the intervention (P < 0/05). In addition, the mean self-efficacy score between the two groups was insignificant before the intervention (P = 0.80). However, after the intervention, the mean score of the FMEA group was significantly higher than the SBAR group (P < 0.05). CONCLUSION: According to the findings of this study, there is a meaningful relationship between patient safety training programs based on SBAR and FMEA techniques on patient safety and self-efficacy of nurses; however, FMEA training has more positive effects on self-efficacy and patient safety compared to other techniques. As a result, these techniques, along with other plans, are recommended to authorities in order to help improve patient safety.

Safety and Health Management System, Safety Climate, and Accident Occurrences in Hospitals: The Study of Needlestick, Sharp Injuries and Recidivism Rates.

Background: Hospital Safety and Health Management System (HSH-MS) and Hospital Safety Climate (HSC) are the significant elements to develop safe work practices. The current study aimed to examine the dimensions of HSH-MS and HSC and the association with the prevalence of Needlestick and Sharp Injury (NSI) and NSI recidivism. Materials and Methods: A cross-sectional study was conducted among 1070 nurses in Iranian hospitals (89% response rate). Results: More than 54% (n = 579) had sustained at least 1 NSI in the previous year. The NSI recidivism rate was 8.6% and recidivists were more likely to be younger, female, married, with higher Body Mass Index (BMI), and on night shift. Two aspects of HSH-MS including management leadership and employee participation were associated with the incidence of NSIs Odds Ratio (OR): 1.91 and 95% Confidence Interval (CI): 0.69-1.21; OR: 1.29 and 95% CI: 0.92-1.82) and NSI recidivism rate (OR: 1.98 and 95% CI: 0.55-1.74; OR: 1.12 and 95% CI: 0.83-1.49). Furthermore, three dimensions of HSC comprising management support (OR: 1.02 and 95% CI: 0.93-1.11 for NSIs; OR: 1.21 and 95% CI: 0.77-1.22 for NSI recidivism), absence of job hindrances (OR: 1.06 and 95% CI: 0.98-1.16 for NSIs; OR: 1.11 and 95% CI: 0.96-1.30 for NSI recidivism) and cleanliness/orderliness (OR: 1.07 and 95% CI: 0.98-1.08 for NSIs; OR: 0.84 and 95% CI: 0.87-0.97 for NSI recidivism) were correlated with reduced NSIs risk. Conclusions: This study suggests that HSH-MSs and employees' safety climate are significant factors, which are correlated with not only the prevalence of recurrent NSIs but also the single NSI in hospitals.

Effects of virtual and lecture-based instruction on learning, content retention, and satisfaction from these instruction methods among surgical technology students: A comparative study.

BACKGROUND: There are various instructional methods worldwide and virtual instruction is one of them. This widely used method involves online instruction and e-learning. The present study compares the effects of lecture-based and virtual instruction on student learning, satisfaction, and content retention among surgical technology students at Isfahan University of Medical Sciences. MATERIALS AND METHODS: The population of this two-stage, quasi-experimental study consisted of 40 surgical technology students at the School of Nursing and Midwifery. After fulfilling inclusion criteria, they were randomly assigned to the virtual instruction group (VG, n = 20) and the traditional, lecture-based instruction group (TG, n = 20). Data were collected via a researcher-made student satisfaction questionnaire and two learning examinations. Their validity and reliability had been confirmed. The data were analyzed using SPSS 13 and analytical and descriptive tests (P < 0.05). RESULTS: There was no statistically significant difference between the TG and the VG with respect to the mean score in the first examination (P = 0.89). However, the two groups were significantly different in terms of the mean score in the second examination (P = 0.03). Regarding content retention and recall performance, the VG outperformed the TG. Furthermore, the mean satisfaction score of the VG (132.24 ± 17.92) was higher than that of the TG (115.56 ± 17.57) (P < 0.05). CONCLUSION: Virtual instruction and lecture-based instruction had comparable short-term learning outcomes. Nevertheless, with the passage of time, it was revealed that virtual instruction could result in better learning performance and higher content retention and satisfaction.

Effects of an orientation tour on preoperative anxiety in candidates for coronary artery bypass grafting: A randomized clinical trial.

BACKGROUND: Candidates for cardiac surgery usually suffer from preoperative anxiety. Although there are various anxiety reduction techniques, it is unclear which one is the most effective. Therefore, the present study was conducted to explore the effects of an orientation tour on preoperative anxiety in candidates for coronary artery bypass grafting (CABG). METHODS: In this randomized clinical trial study, 70 patients who were candidate for CABG were recruited from February 2016 to May 2017. They were randomly assigned to two groups of 35. The intervention group members were taken on an orientation tour and the control group received routine care. Data were collected using the State-Trait Anxiety Inventory (STAI). RESULTS: The statistical tests revealed that there was no significant difference between the intervention group (42.43 ± 13.24) and the control group (45.11 ± 10.19) with respect to the pre-intervention state anxiety level (P = 0.340); however, before surgery, the state anxiety level was significantly lower in the intervention group (34.83 ± 11.15) than in the control group (47.69 ± 11.30) (P < 0.001). Moreover, the independent t-test showed that there was no significant difference between the intervention (43.71 ± 12.04) and control (45.03 ± 8.76) groups with respect to the pre-intervention trait anxiety level (P = 0.600). Nevertheless, before surgery, the trait anxiety level was significantly lower in the intervention group (35.40 ± 10.24) than in the control group (46.91 ± 9.51) (P < 0.001). CONCLUSION: The preoperative orientation tour had a positive impact on the anxiety level in the candidates for CABG. Hence, the tour can be used as a remarkably effective technique for reducing anxiety.

Sharing the power through promoting heart health literacy: A participatory action research in Iran.

BACKGROUND: Low health literacy can act as a barrier to effective disease self-management. The study aimed to promote heart health literacy in Iranian society. METHODS: This study was conducted as a participatory action research (PAR) based on Zuber-Skerritt Model to design and implement a program for promoting heart health literacy in Iranian society. Participants were selected among adults with heart diseases and their family members, as well as their health care providers in Chamran Hospital, Isfahan Heart Friends association and researchers, and Isfahan Cardiovascular Research Institute, Isfahan, Iran. Data collection was conducted using interviews. Content analysis was used to analyze the data to promote heart health literacy. Promoting of heart health literacy was implemented in different levels in Isfahan from March 2017 to October 2017. The effect of the program was evaluated based on interviews, feedback, and focus groups at the individual level. RESULTS: Finally, at the World Heart Week, a healthy heart campaign was formed with the slogan "Share the power". At the end of this program, participants experienced significant empowerment during the project to promote heart health literacy. The three main themes indicating this feeling of empowerment were "Being worried about the hearts of others", "Sensitization to the care of the heart", and "General understanding of heart health". CONCLUSION: PAR can be an effective way to promote heart health literacy in Iranian society. It integrates the voices of the marginalized group promoting heart health literacy in Iranian society.

Nonadherence Behaviors and Some Related Factors in Kidney Transplant Recipients.

BACKGROUND: Kidney transplantation is the renal replacement therapy of choice for most patients with end-stage renal disease (ESRD), however, adherence to the recommended lifestyle is critical for a positive prognosis. The purpose of this study was to assess adherence to immunosuppressive therapy and lifestyle recommendations along with some related factors among kidney transplant patients. MATERIALS AND METHODS: In this descriptive analytical study, all patients completed a questionnaire regarding medication intake and lifestyle recommendations (preventing of infection, self-monitoring, prevention of cardiovascular disease (CVD), and sun protection). The participants were divided into 4 groups according to the level of adherence (good, partial, poor, and nonadherent) indicated in their responses. RESULTS: Most kidney recipients were adherent to their drug prescriptions, but were partial, poor, or nonadherent regarding lifestyle recommendations. Increased passage of time since transplantation and low family support and educational level resulted in nonadherence. Men showed greater adherence to medication intake than women. Patients with lower number of drugs and reported drug side-effects illustrated better adherence to medication intake. Women adhered to infection protection recommendations more than men, and older and married patients adhered to cardiovascular prevention recommendations more than others. However, younger patients showed greater adherence to self-monitoring recommendations, and singles, young individuals, and women were adherent to sun protection recommendations. CONCLUSIONS: Nonadherence is common among kidney transplant recipients. Thus, it is necessary to determine patients who are at risk of nonadherence and to introduce more educational programs to improve their adherence and their quality of life (QOL).

Validation of critical care pain observation tool in patients hospitalized in surgical wards.

BACKGROUND: Application of a reliable and authentic behavioral tool for measuring patients' pain, hospitalized in intensive care units who are not able to establish relationship, is needed severely. Therefore, this study is conducted with the aim of validating Critical Care Pain Observation Tool (CPOT) in patients hospitalized in surgical wards. MATERIALS AND METHODS: CPOT was first translated into Persian and was psychometrically measured in terms of content. RESULTS: It should be noted that the content validity of CPOT was approved by panel of specialists. In addition, validity of this tool was confirmed with high internal cluster correlation (nonpainful procedure (0.997) and painful procedure (0.726). The diagnostic validity was supported with the increased CPOT score during position change and its constancy during the measurement of blood pressure (P < 0.001). Despite higher NRS scores than CPOT, CPOT criterion validity was confirmed due to the correlation between the scores obtained by these two tools (P < 0.001). CONCLUSIONS: CPOT is a valid and reliable tool to study pain in patients hospitalized in intensive care units.

Patients' experiences from their received education about the process of kidney transplant: A qualitative study.

BACKGROUND: Kidney transplant needs long term treatment, care and a follow up. Patients with kidney transplant need support in fields of knowledge, skills and motivations. Several researches showed existing challenges regarding education of these patients. A qualitative study was conducted to define patients' experiences from their received education about the process of kidney transplant. MATERIALS AND METHODS: This was a qualitative study with a content analysis approach. Sampling was purposive up to data saturation. The participants aged 18-60 years, had experienced transplantation. The data were collected by semi-structural individual in-depth interviews with 18 participants. The interviews were analyzed by Graneheim and Lundman content analysis method. FINDINGS: Three general themes of "educational experiences at the beginning of transplantation", "educational experiences in post transplantation care", and "patients' struggle to enhance their awareness in order to preserve their transplanted kidney" were emerged. CONCLUSIONS: The findings showed that patients' did not receive adequate knowledge about kidney transplant process. This issue reveals an unstructured and uncoordinated education given to kidney transplant patients by health team members during kidney transplant process. With regard to high motivation of the patients, designing such educational program based on self-management in the process of kidney transplant for these recipients is essential. Nurses in their educational role can enable the patients through educating them about problem solving methods and selection of the best solution to preserve their transplanted kidney and consider renal transplant recipient self-management as their first priority toward these patients.