The Effect of Training the Nonverbal Pain Scale (NVPS) on the Ability of Nurses to Monitor the Pain of Patients in the Intensive Care Unit.

Introduction: Pain in the intensive care unit is a silent fact. Considering the positive features of the nonverbal pain scale (NVPS) in assessing the pain of non-verbal patients, this study investigates the effect of training the NVPS on the ability of nurses to monitor the pain of patients in the intensive care unit. Materials and methods: In this semi-experimental study, the effect of the NVPS training on the ability of 50 intensive care unit (ICU) nurses of Imam Khomeini Hospital affiliated to Ahvaz University of Medical Sciences was investigated. At first, the ability to diagnose the presence and intensity of pain was checked by a checklist. Then the nurses were taught how to use the scale correctly. After 2 weeks of training completion, the ability to correctly use the scale was measured again. Data analysis was performed using descriptive statistics (mean and standard deviation) and inferential statistics (McNemar, Chi-squared, paired t-test, and Fisher's exact test) in SPSS software version 16. Results: After the training on the non-verbal pain scale, there was a significant difference between the intervention and control groups in diagnosing the presence of pain related to changing the patient's position (p = 0.023). Also, nurses ability to diagnose pain intensity during airway suction increased fourfold and for physiotherapy procedures twice as much as before training. Conclusion: Nonverbal pain scale training improves ICU nurses ability in diagnosing the presence and severity of pain in nonverbal patients. How to cite this article: Ghayem H, Heidari MR, Aghaei B, Norouzadeh R. The Effect of Training the Nonverbal Pain Scale (NVPS) on the Ability of Nurses to Monitor the Pain of Patients in the Intensive Care Unit. Indian J Crit Care Med 2023;27(3):195-200.

Nurses' Communication With the Families of Patients at the End-of-Life.

BACKGROUND: Effective communication is important in providing quality care to families at the end-of-life. In the end-of-life situations, the nurses' views on how to communicate with the family are not well understood. AIM: This study was conducted to explore the nurses' experiences of their communication with families of patients at the end-of-life situations. METHODS: The authors used standards for reporting qualitative research. The data were analyzed by conventional content analysis. Semi-structured interviews were conducted with 24 Iranian nurses who had the experiences of dealing with patients' families at the end-of-life. RESULTS: Nurses' perceptions of communication with families emerged base on the main theme: "Disrupted communication" consisting of two categories: "restricted communication" and "abortive communication." CONCLUSION: The results of this study highlight the need to increase the professional and ethical sensitivity of nurses in dealing with patients' families at the end-of-life.

Contingency Help: The Main Strategy of Iranian Nurses in Dealing With the Family of the End-of-Life Patients.

Families are struggling with many challenges in the final stages of patient life. It is important to understand what actions nurses do for the family of the end-of-life (EOL) patients. This study aimed to explain the main strategy of nurses' dealing with the family of the EOL patients. Data were analyzed using conventional content analysis. Semistructured interviews were conducted on 32 nurses from hospitals in Tehran. Nurses used six measures of explaining the bitter reality, effective communication, management of violence, referral, consolation, and reinforcement. "Contingency help" was conceptualized as the main strategy. Nurses through "contingency help" were involved in solving the emotional, physical, financial, and spiritual needs of the family. Nurses will be able to apply the results of this study to the development of care policies for the family of the EOL patients.

A review of 17 years of application of partnership care model on the consequences of chronic diseases: Describing and assessing the quality of the methodology of papers.

Background : Regarding the widespread prevalence of chronic diseases, nurses need to understand the choices, priorities, and abilities of patients in reality, their communication, and the social context in order to play their professional role and responsibility. This review study was conducted with two purposes: determining the effect of partnership-care-model (PCM) on the outcomes of chronic diseases, and describing and assessing the quality of methodology of published papers in the field. Methods : The systematic review was conducted from inception to the year 2019. A systematic search was conducted using PRISMA guidelines to retrieve all national and international PCM studies. To assess the quality of the methodology of studies, four instruments were used, including JADAD, Consort, New Castle-Ottawa, and Cochrane. Results : In the initial search, 11509 papers were retrieved, which according to the PRISMA guidelines, 23 relevant papers remained. The results of the reviewed papers indicated the effectiveness of the PCM. Describing and assessing the quality of the methodology of published papers of PCM was at an acceptable level. The final papers were classified and reviewed according to the authors, year, sampling characteristics, data collection methods, and final PCM conclusion. Conclusion : According to the review of the studies and their effectiveness in the different outcomes, also, the acceptable quality of the methodology of published papers, it can be concluded that the PCM is an effective, context-based, simple, efficient, and reliable model and has the ability to be used in promoting and improving the various dimensions of chronic diseases.

Supporting families of dying patients in the intensive care units.

Family support in the intensive care units is a challenge for nurses who take care of dying patients. This article aimed to determine the Iranian nurses' experience of supporting families in end-of-life care. Using grounded theory methodology, 23 critical care nurses were interviewed. The theme of family support was extracted and divided into 5 categories: death with dignity; facilitate visitation; value orientation; preparing; and distress. With implementation of family support approaches, family-centered care plans will be realized in the standard framework.

Health literacy and self-efficacy of the elderly with diabetes.

Aim: This study aimed to investigate the relationship between health literacy and self-efficacy in the elderly with diabetes. Method: This cross-sectional study was conducted on 375 diabetic elderly members from a diabetes association, in Iran. Self-efficacy and health literacy questionnaires were used. The Pearson test was used to determine the relationship between self-efficacy and health literacy and linear regression was used to predict self-efficacy by health literacy. Results: Elderly men and women with diabetes showed a significant difference in terms of health literacy (P = 0.003). People over the age of 70 had a lower level of literacy (P < 0.05). The highest and lowest self-efficacy in the elderly patients were related to taking medications (89.75 ± 17.56) and physical activity (71.38 ± 24.40), respectively. The results of stepwise linear regression showed that health literacy is a predictor of self-efficacy in the diabetic elderly (r2 = 0.55, P < 0.001). Conclusion: Health literacy is directly related to self-efficacy in older people with diabetes. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-023-01181-w.

The Challenges of Nursing Presence at the Patient's Bedside from the Perspective of Nurses: A Qualitative Study.

Background: Presence is one of the vital aspects of nursing care that improves the outcome of treatment, self-care, satisfaction, loneliness, and anxiety of patients. The literature review shows that most of the studies have been conducted on the conceptual analysis of the presence of nurses, while there are many challenges for the presence of nurses at the bedside. Therefore, this study aimed to determine the perceived challenges of nurses from being at the bedside of patients. Methods: This is a qualitative descriptive study. Conventional inductive content analysis was used. Field notes and in-depth semi-structured interviews were conducted with nineteen clinical nurses. Participants were selected from general and intensive care units. Data analysis was performed using Zhang and Wildemuth approach. Results: Three categories emerged: (1) professional challenges with subcategories: Supervision of novice nurses, insufficient skills and cultural unfamiliarity, (2) Management challenges with subcategories: managers' negligence toward nurse's needs, Strategies of nursing managers, lack of medical staff, inadequate medical facilities, inappropriate planned visits and appointments, (3) work environment challenges with sub-categories: ward overcrowding and non-standard hospital environment. Conclusions: This study identified the challenges and obstacles of nurses' presence at the bedside in different dimensions from the perspective of clinical nurses. To increase the presence of nurses at the bedside, nursing managers should create a standardized work environment.

Psychometric Properties of the Intensive Care Unit Nurses' Perceptions Questionnaire of Self-Performance With Families of Critically Ill Patients (Persian Version).

BACKGROUND AND PURPOSE: Nurses' self-perception of their performance toward family members of patients is one of the most important issues in predicting family adaptive behaviors. This study analyzed the psychometric properties of the Persian version of intensive care unit (ICU) nurses' perceptions questionnaire of self-performance with families of critically ill patients. METHODS: Among 135 intensive care nurses, to determine face validity, 10 nurses were asked to comment on, comprehensibility, grammar, and writing of items. Exploratory factor analysis was used to assess construct validity. RESULTS: The intra-cluster correlation coefficient (ICC) was 0.82 and Cronbach's alpha was 0.74. Exploratory factor analysis showed the first nine related factors have 65.22% variance. CONCLUSION: Persian version of ICU nurses' perceptions of self-performance with families of critically ill patients had good reliability and validity.

Study of outcomes of delay in referral of patients with acute myocardial infarction.

BACKGROUND: Delay in seeking medical help in patients with acute myocardial infarction (AMI) challenges the patients in terms of diagnosis and treatment. This study aimed to evaluate the outcomes of delay referral (≥12 h) in patients with AMI. MATERIALS AND METHODS: In this retrospective cohort study, the medical records of 252 patients with AMI (2017-2019) admitted to Shahid Beheshti Hospital, Qom, Iran, was reviewed. Data collection tool was a researcher-made data sheet that included demographic characteristics, times, hospitalization costs, risk factors, history of heart disease, results of paraclinical tests, clinical information at the time of admission, and outcomes of delayed referral. Data were analyzed using t-test, Chi-square, Kaplan-Meier estimator, log-rank test, Cox regression by STATA, and SPSS (version 25). RESULTS: The levels of troponin, creatine phosphokinase, lactate dehydrogenase were significantly higher in the delayed referral group (P < 0.05). After treatment, the cardiac ejection fraction was significantly different in the nondelayed referral (41.56 ± 9.16) and the delayed referral group (38.39 ± 11.01) (P < 0.001). There was no significant difference in the percentage of hospital deaths in the groups (P = 0.078). CONCLUSION: Delayed referral of patients with AMI is associated with decreased physiological cardiac function, which complicates recovery for these patients.

The effect of family-centered empowerment model on the quality of life of adults with chronic diseases: An updated systematic review and meta-analysis.

BACKGROUND: Family-centered empowerment model (FCEM) is a concept that strengthens the family to help a chronic patient to obtain a better quality of life (QoL). The effects of FCEM on QoL of chronic patients are still inconclusive. Therefore, this meta-analysis was conducted to evaluate the effect of FCEM on QoL of adult patients with chronic diseases. METHODS: Following an online search PubMed/MEDLINE, Scopus, Web of Science, ProQuest, OVID, EMBASE, EBSCO, PsycINFO and Persian databases (Irandoc, IranMedex, SID and MagIran), all studies that tested the impact of FCEM on QoL of patients with chronic diseases were included. Cochrane Risk of Bias Tool was used to assessment the quality of included randomized clinical trials (RCTs) and before/after studies. Analyses were conducted by STATA16. RESULTS: Six hundred and ninety-seven studies were identified for screening. After screening process, 11 eligible studies were included in this meta-analysis. There were significant intervention effects in all QoL dimensions, physical and mental subscales and QoL total score (All P < 0.05). The minimum lower bound for SMD was 0.61 (95%CI: 0.96 to 1.66), indicating an increasing effect of the intervention on all QOL dimensions. The results showed substantial heterogeneity between the studies for all QoL dimensions, physical and mental subscales and QoL total scores (P < 0.001). CONCLUSION: FCEM is an appropriate model with a simple and effective application for families with a patient suffering from a chronic illness. Nursing education planners and healthcare providers could benefit from this model for improving the nursing education curriculum and accrediting programs.

Challenges of postgraduate emergency nursing program in Iran: A qualitative study.

BACKGROUND: Some nursing schools in Iran with the aim of training qualified nurses have set up master's degrees in emergency nursing. In any case, there are challenges in the implementation of this discipline in academic nursing centers which prevent the fulfillment of goals and missions in the curriculum. MATERIALS AND METHODS: In this qualitative study, four graduates of the master of emergency nursing and 13 undergraduate students were purposively recruited from the Nursing and Midwifery Faculty in Qom, Iran. Data were collected through semi-structured interviews and analyzed through conventional content analysis. RESULTS: Emergency nursing master's program challenges consist of two categories: nonproductive course design and unresolved infrastructure. The extracted subcategories were unfit curriculum, inappropriate content, nonspecialized program, unclear roles, improper course planning, unskilled human resources, and poor educational facilities. CONCLUSION: Based on the experiences of nursing graduates, the curriculum of master of emergency nursing in Iran needs to be substantially revised in terms of content and structure.

The Experiences of Intensive Care Nurses in Advocacy of COVID-19 Patients.

The lack of face-to-face interactions with families, the increase in the number of patients admitted to the ICU, nursing staff shortages, and inadequate personal protective equipment has created many challenges for nurses in advocacy of the COVID-19 patient with life-threatening conditions. This study aimed to explore the experiences of intensive care nurses in the advocacy of COVID-19 patients. This study was performed using a qualitative content analysis method with Graneheim and Lundman approach, Iran, 2020. Data were collected through semi-structured interviews with eighteen clinical nurses from the intensive care units of three hospitals. Themes extracted from the nurses' statements were promoting patient safety (informing physicians about the complications and consequences of treatment, preventing medical errors, protecting patients from threats), respecting the patients' values (providing comfort at the end of life, providing a comfortable environment, commitment to confidentiality, cultural observance, respect for individualism, fair care), and informing (clarifying clinical conditions, describing available services, and being the patients' voice). ICU nurses in health crises such as COVID-19 as patient advocates should promote patient safety, respect patients' values, and inform them. The results of this study could help enhance the active role of intensive care nurses in the advocacy of COVID-19 patients.

Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study.

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.

Teamwork competence and readiness of emergency nurses in the care of trauma patients: A multicenter cross-sectional study.

INTRODUCTION: Emergency nurse's teamwork competency and readiness are crucial to improve the quality of care and patient outcome in trauma patients. This study aimed to determine teamwork competence and readiness of emergency nurses in the care of trauma patients. METHODS: A cross-sectional study was conducted among 230 emergency nurses and nursing assistants in emergency departments of three university hospitals in Iran in 2020. Data were collected using a researcher-made questionnaire on nurses' readiness and the nontechnical skills scale. RESULTS: The mean score for nurses' readiness was 3.55 ±â€¯0.60 (maximum 5) and for nurses' teamwork competence was 3.49 ±â€¯0.77 (maximum 5). The significant variables related to teamwork competency were gender and type of hospital. Emergency nurses with master's degrees, who had completed training courses of advanced trauma life support and triage, their source of information were from seminars' participations and clinical experiences, and worked at trauma hospital reported a higher level of readiness. Older age and higher work experiences were positively associated with readiness in emergency nurses. CONCLUSION: The significant variables associated with the teamwork competence and readiness identified in this study may be used to improve the teamwork competence and readiness of emergency nurses in emergency settings.

The Effect of the Teach-Back Method on Knowledge, Performance, Readmission, and Quality of Life in Heart Failure Patients.

BACKGROUND: Among chronic diseases, heart failure has always been a serious challenge imposing high costs on health systems and societies. Therefore, nurses should adopt new educational strategies to improve self-care behaviors and reduce the readmissions in heart failure patients. This study aimed to determine the effect of the teach-back method on knowledge, performance, readmission, and quality of life in these patients. METHODS: This clinical trial was conducted in patients with heart failure (n = 70) hospitalized in the internal wards of the Baqiyatallah al-Azam Medical Center in Tehran (2019). Routine discharge educations were provided in control patients. Self-care topics were taught to the intervention groups by the teach-back method. A cardiac self-care questionnaire was used to assess the knowledge and practice of patients immediately after intervention and three months after patient discharge. Also, SF-36 was presented to each patient. Readmission(s) and quality of life were followed up by telephone interviews three months after patient discharge. Repeated measures analysis of variance and related post-hoc tests were performed for within-group comparisons before, immediately after, and 3 months after teach-back education. Wilks' lambda multivariate tests were conducted for simultaneous comparison of quality of life subscales between intervention and control groups. Also, logistic regressions were after controlling for baseline measures and confounders. RESULTS: Findings showed significant improvement in the patients' knowledge and performance immediately after teach-back education, though this effect was slow in the long term after discharge. Also, the frequency of readmissions decreased and the quality of life (except physical function) increased in the patients through teach-back education. By controlling for the pretest effect, the posttest scores for the relevant components of the quality of life suggested improvement in both intervention and control patients. This improvement in the quality of life was confirmed by controlling for baseline measurements using binary logistic regression analysis. CONCLUSION: Teach-back education improved patients' knowledge and performance, readmission frequency, and quality of life.

The Challenges of Living With an Implantable Cardioverter Defibrillator: A Qualitative Study.

BACKGROUND: Dysrhythmia is one of the most common causes of sudden cardiac death worldwide. An implantable cardioverter defibrillator is the most effective method of treatment for dysrhythmias causing cardiac arrest. However, living with an implantable cardioverter defibrillator is associated with challenges such as fear, anxiety, and depression. OBJECTIVES: The purpose of this study was to identify the challenges of living with an implantable cardioverter defibrillator. PATIENTS AND METHODS: In this qualitative study, an interpretive phenomenological approach was used, with thirteen participants (seven men and six women) between the ages of 21 and 70 years old (mean = 58.15, SD = 14.4). The duration of having an implantable cardioverter defibrillator was 1 - 120 months (mean = 23.15, SD = 33.31). Maximum variation sampling was used to purposefully select the participants from the governmental Imam Khomeini hospital in Tehran, Iran, between May and October of 2013. Semi-structured interviews were conducted for 30 to 45 minutes, and Van Manen's six-step method was used in this study. RESULTS: The challenges of living with an implantable cardioverter defibrillator include: living with fear, concerns about the future, concerns about device malfunction, fearing death during the shock, pain due to the shock, loss of control, the cost of the device, and the lifestyle limitations. CONCLUSIONS: Patients who live with implantable cardioverter defibrillators face many concerns and challenges. Therefore, the role of nurses in teaching patients before and after implementation is very important.

Nursing students' perspectives on clinical education.

INTRODUCTION: The importance of optimal clinical nursing education in professional skills development is undeniable. In clinical education, nursing students are often faced with problems. Recognizing nursing students' perception on clinical education is the first step to remove the barriers of this challenge. Methods This descriptive cross-sectional study was conducted to determine the nursing students' perspectives on clinical education. 150 nursing students were selected randomly from nursing and midwifery schools (Tehran). Data collection instrument was a researcher made questionnaire consisting of five domains: objective and curricula, instructor, feedback to student in clinical field, clinical environment, supervision and evaluation. Mean and standard deviation were calculated for each item, using SPSS, ver.14. Chi- square test was used to compare the nursing students' perspectives on clinical education based on age, sex and the work experience. The significance level was considered 0.05. RESULTS: Mean age of the students was 21.58±26.97 students (66%) were male. 44 students (30.1%) had work experience (3.58±6.48 month). Male and female students had different perceptions in domains of clinical education (p<0.05). Nursing student had different perceptions as to objectives and curricula (p=0.039), how to deal with students in the clinical environment (p=0.032), supervision, and evaluation (p<0.001) with respect to their work experience duration. The most positive responses were in clinical instructor (81.5%) and the most negative ones were the clinical environment (33.66%), respectively. CONCLUSION: Providing an optimal clinical environment and improving the supervision and evaluation of student practice should prioritized in schools of nursing and midwifery.

Passion for Life: Lived Experiences of Patients after Coronary Artery Bypass Graft.

BACKGROUND: Coronary artery bypass graft surgery (CABG) improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. METHODS: This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG. Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. RESULTS: Passion for life was the main theme extracted from the participants' interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. CONCLUSION: The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery.