An investigation of the effect of the universal model of family-centered care on patient and family outcomes in patients under home invasive mechanical ventilation.

BACKGROUND: The number of patients under home mechanical ventilation is increasing worldwide. The unique nature of these patients and their complex health needs exposes home caregivers to various needs and challenges regarding different dimensions of care. OBJECTIVE: The present study was conducted to investigate the effect of the universal model of family-centered care on the clinical outcomes of the patient and the family. METHODS: This clinical trial was conducted between 2020 and 2021. A total of 60 patients under invasive mechanical ventilation was selected and divided into control (routine training that is usually given by hospital staff to families to care for patients) and intervention (comprehensive pre-discharge training program to post-discharge follow-up using the universal model of family-centered care) groups using random block design and universal model of family-centered care. Home caregivers' functional skills and burden, as well as patients' readmission and mortality rates, were compared in the two groups. RESULTS: Implementing the intervention 1 and 3 months later effectively increased home caregivers' functional skills. Moreover, a statistically significant difference was observed between the two groups in terms of the psychological burden of caregiving (P < .001); the implementation of the intervention could highly reduce the psychological burden of caregiving in the intervention group (EF = 0.94). The hospital readmission and mortality rate in the intervention group was significantly lower than in the control group (P = .02 and P = .03, respectively). CONCLUSIONS: Given the significant impact of the universal model of family-centered care on the clinical outcomes of the patient and the family, pre-discharge training and its post-discharge follow-up and continuity of education with an active presence of nurses, as one of the main pillars of the treatment, seems essential.

Effectiveness of a Supportive Program on Caregiver Burden of Families Caring for Patients on Invasive Mechanical Ventilation at Home: An Experimental Study.

The prevalence of patients on mechanical ventilation who are being supported at home is increasing. Due to these patients' complex and chronic conditions, the subjective burden on their family caregivers increases after discharge. The aim of this study was to evaluate the effectiveness of a supportive home care program on the caregiver burden of families caring for patients on invasive mechanical ventilation at home. Sixty patients hospitalized in three university-affiliated hospitals in Tehran, Iran between 7/2020 and 8/2021 were randomly assigned to one of two groups: A supportive home care program, and routine hospital education. The supportive home care program included six educational sessions delivered in the hospital before discharge, and home visits and continued education after discharge. Caregiver burden was measured using the Zarit Burden Interview. Results showed that caregiver burden increased significantly (p ≥ .001) after discharge without the supportive home care program intervention. Follow-up by nurses after discharge is essential to reduce the psychological burden of caring for patients on invasive mechanical ventilation at home.

Can addressing family education improve outcomes of patients under home invasive mechanical ventilation? A randomized controlled clinical trial.

The use of home mechanical ventilation is increasingly developing. The present study aimed to examine the effect of a family-centered training program on patients under home invasive mechanical ventilation. A total of 60 adult patients under invasive mechanical ventilation were selected and randomly allocated into two groups. The supportive home care program consisting of six training sessions using a teach-back technique and follow up training at home. The rate of hospital readmission and mortality in the intervention group was significantly lower than the control group(P = .02 and P = .03, respectively). Moreover, the home caregivers' level of knowledge in the intervention group was significantly higher than that of the control group(P = 0/000). In addition, implementing the intervention effectively increased home caregivers' ability of functional skills. Therefore, comprehensive preparation of the patient and family before discharge and coherent support and continuity of care after discharge with the effective presence of nurses.

Explaining the process of formation of ageism among the iranian older adults.

BACKGROUND: Ageism is considered as one of the consequences of the industrialization of societies, which appears in various forms in different cultures. This study aimed to explain the process of formation of ageism among the older adults people. METHODS: The research was conducted using grounded theory method. Data were collected from 28 participants using in-depth semi-structured interviews and field notes. Data were analyzed using open, axial, and selective coding. RESULTS: Fear of loneliness and rejection striving to tackle ageism "was identified as the core category of the study. Concepts such as "family context" and "cultural context" were relevant. After identifying the strategies used by the older adults in response to the context ("maintaining integrity", "socio-cultural care" and "proper health care", "striving to tackle ageism") was the most important process in ageism by the Iranian older adults. CONCLUSION: Findings of this study indicated that individual, family and social factors play an important role in the process of ageism among the older adults. These factors sometimes exacerbate or moderate the process of ageism. By recognizing these factors, various social institutions and organizations (including the health care system and the national media (radio and television)) can help the older adults achieve successful aging by emphasizing the issues related to the social aspect.

Comparison of Hydrocolloid Dressings and Silver Nanoparticles in Treatment of Pressure Ulcers in Patients with Spinal Cord Injuries: A Randomized Clinical Trial.

Introduction: There are numerous dressings used to treat pressure ulcers (PUs), depending on their advantages to achieve optimum patient outcomes. This study aimed to compare hydrocolloid dressings and silver nanoparticles in treating PUs among patients with spinal cord injury (SCI). Methods: This randomized clinical trial was conducted on 70 patients with SCI in Iran. Participants were randomly divided into two equal groups (n=35) receiving silver nanoparticle dressing and hydrocolloid dressing, respectively. The groups were evaluated in four assessment periods using the Bates-Jensen Wound Assessment Tool (BWAT). Data analysis was performed using SPSS software version 13, repeated measures ANOVA, non-parametric tests, and chi-square. Results: Chi-square test was used to investigate the difference between the scores before the intervention, the results of which were not statistically significant. In repetitive measurements, the results of the analysis of variance showed that the average assessment score in both groups decreased and both dressings were effective in the treatment process. Although PU improvement status in the group that received silver nanoparticles was better, between-group analysis of variance did not show any statistically significant difference between the two groups. Conclusion: Our results indicated that silver nanoparticles and hydrocolloid dressings can be used interchangeably in the treatment of PUs.

Nurses' experience of patient care using extracorporeal membrane oxygenation.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is an advanced form of temporary life support, to aid respiratory and/or cardiac function, which diverts venous blood through an extracorporeal circuit and returns it to the body after gas exchange through a semipermeable membrane. It may be used for oxygenation, carbon dioxide removal, and hemodynamic support. ECMO has been available to patients in Iran for only about 4 years. Because nurses do not widely use ECMO in Intensive Care Units (ICUs), for many it is still a unique experience and more needs to be understood about that experience in order to support nurses in that role. AIM: This study aimed to explore Iranian nurses' experience of caring for patients receiving ECMO. METHODS: This interpretive phenomenological study was conducted in Iran in 2019. Semi-structured interviews were conducted in Farsi to collect data from 18 nurses who had cared for patients receiving ECMO. The interviews continued until data saturation, and thematic analysis of the interview transcripts was undertaken. RESULTS: Following thematic analysis, three main themes of "running on a suspension bridge," "sense of duality," and "bewilderment in the mirage of hope," and with seven sub-themes, emerged. CONCLUSION: Based on the results of this study, it is proposed that caring for patients receiving ECMO is a source of emotional turmoil for nurses. Nurses are constantly thinking about whether their patients receiving ECMO are recovering or dying, and the nature of this care may lead to stress and burnout. Therefore, it is recommended that these nurses receive counselling and psychological support. RELEVANCE TO CLINICAL PRACTICE: Nurses are able to provide comprehensive and holistic patient care when they enjoy good physical and mental health themselves. To prevent distress in nurses and to provide safe care for the patient receiving ECMO, provision of psychological support for these nurses is recommended.

A contextual needs assessment of families with home invasive mechanical ventilation patients: A qualitative study.

OBJECTIVES: With the advancement of technology the number of patients surviving critical illness has increased. Home mechanical ventilation (HMV) is a growing option for patients requiring long-term mechanical ventilation. Caring for these patients is demanding and challenging. The aim of this study was to explore family caregivers'(carers) needs when providing care to adult patients under HMV from the perspective of nurses, home care attendants, and the caregivers themselves. METHODS: Overall, 15 participants (nine carers, three home nurses, and three home care attendants) were selected by purposive sampling. Data were collected by in-depth semi-structured interviews and structured observation. Finally, data were analyzed through conventional content analysis with MAXQDA software. RESULTS: Three categories of carers'needs were identified, including educational needs (basic and emergencies), psychological needs, and economic needs. In addition, since the needs, feelings, and views of caregivers change over time, the noted needs were divided into three periods: Pre-discharge preparation, initial transition from hospital to home, and appropriate long-term follow-up. CONCLUSION: The study results showed that the families of patients under invasive HMV require a standard discharge plan based on their care needs, financial concerns, and psychological screening before discharge as well as a suitable long-term follow-up plan in collaboration with a multidisciplinary treatment team, insurance providers, and home care services.

Integration Process With a Donated Heart: A Grounded Theory Study.

BACKGROUND: In the posttransplant period, recipients face a complex phenomenon called the new heart, which is a symbol of physical and emotional life. They use different methods to get used to the new heart. OBJECTIVE: The aim of this study was to explore the integration process with a donated heart in heart transplant patients. METHODS: A qualitative study design with a grounded theory approach following Corbin and Strauss was used. Purposive and then theoretical sampling led to the inclusion of 15 heart transplant patients with diverse characteristics. Observations and semistructured interviews were conducted during a 1-year period in 2019 to 2020. Data collection and analysis occurred simultaneously. RESULTS: The process of integration with the new heart in the transplant patients or the core category in this study was "rebirth." The process involved thre3 sequential and overlapping phases, which over time led to toleration and management of the situation. Religious issues, emotional chaos, additional worries, and sense of duality in the early stages after transplantation form a cycle, and the person is moving in this cycle. DISCUSSION: The results of this study indicated that the patients experienced several emotional and psychological changes after heart transplantation. It was also shown that the participants experienced a change in the emotions and feelings over time. On the basis of the findings of this study, it can be suggested that health care providers need to improve their knowledge about posttransplant changes, recipients' feelings, and adaptation strategies.

Experiences of Families with Adult Home Invasive Mechanical Ventilation Patients: A Meta-Synthesis.

Adult home mechanical ventilation (HMV) represents a small but growing vulnerable population in the community. Caring for these patients exposes families to many positive and negative experiences. This study aimed to synthesize the existing qualitative research that examined family members' experiences of caring for adult patients using HMV. Medline, PubMed, CINAHL, Scopus, and Web of Science were searched for qualitative studies conducted with family caregivers of adult patients receiving HMV. Thematic synthesis was conducted to interpret the findings. The GRADE-CERQual approach was used to assess the level of confidence. After completion of the screening process, 11 studies were included. The main theme from the meta-synthesis was the Experience of changing as a person. Families' experiences were divided into three stages over time: (1) Mixed feelings, (2) Challenging, and (3) Continuity. Family experiences illustrate that teamwork with an interprofessional approach based on patient and family needs is required to deliver care, improve clinical outcomes, reduce adverse experiences, and increase family satisfaction.

When Technology Enters at Home: The Challenges of Home Health Care Providers in a Developing Country.

The number of patients with chronic diseases requiring invasive mechanical ventilation at home is increasing. Thus, identifying the challenges of this valuable type of care can be an elective step for achieving health-related goals. This study was conducted to determine the challenges faced by home health care providers. Three themes emerged from the data analysis: (1) hospital-based challenges with 2 subthemes: the family unpreparedness for home care and the lack of continuous education; (2) home health care agency challenges with 2 subthemes: home health care workers and the deficiency in organizational policies; and (3) economic challenges. Three themes of hospital-related challenges, home health care agency challenges, and economic challenges that emerged in the study showed that support from the insurance system, improvement of home care agency policies, and holistic care for patients through a multidisciplinary team approach are essential for addressing the current challenges of care for patients under invasive mechanical ventilation at home.

A Resilient Care of the Patient With COVID-19: A Phenomenological Study.

This study a utilized phenomenological hermeneutic design. Fourteen Iranian family caregivers of patients with COVID-19 who were isolated at home were included in the study using purposive sampling. In-depth unstructured interviews were conducted via WhatsApp. Sampling continued until data saturation. Interviews were transcribed and analyzed using Van Manen's approach. Three primary themes and eight subthemes emerged. The primary themes included: "captured in a whirlpool of time", "resilient care' and "feeling helpless". It seems that the families of patients with COVID-19 attempt to resist the pressures of this disease with religious practices and problem solving. However, due to the nature of the disease and its severity, they sometimes feel ashamed or lonely and are afraid of losing their loved ones. It is recommended that psychiatric nurses should develop programs in the form of comprehensive spiritual care packages or psychological support and utilize multiple media channels to deliver these.

Adjustment to a New Heart: Concept Analysis Using a Hybrid Model.

BACKGROUND: Although the phenomenon of adjustment to a new heart in transplant recipients is very complex, very few studies have been conducted on this important issue. Therefore, no careful and clear definition exists for this concept. MATERIALS AND METHODS: This concept analysis was conducted in Iran in 2018 on 13 patients undergoing heart transplantation. In the theoretical phase, a conceptual framework was created according to the existing data in the literature about the phenomenon. In this study, 13 participants were selected using purposive sampling with maximum diversity.-Z In the fieldwork phase, 20 deep and semistructured interviews were conducted with patients undergoing heart transplantation over 4 months. After data saturation, interviews were analyzed using the qualitative content analysis method proposed by Granheim and Lundman (2009). At the final analytical phase, the results of the two previous phases were integrated using a hybrid model. RESULTS: Adjustment to a new heart is a unique multiphase process in patients undergoing heart transplantation. The antecedents include the transplantation time, physical conditions, social and family support, relationship with congeners, and spiritual beliefs. The desirable consequences of adjustment to a new heart may include a new life, inner peace, and spiritual excellence, and the undesirable consequences may include psychological abuse and emotional stagnation. CONCLUSIONS: According to the results, the health-care team should consider the patient as a unique client and initiate discussions before and following heart transplantation that address patients' adjustment to a new heart in all their physical, sexual, and emotional aspects.

Relationship between health literacy and quality of life among hemodialysis patients, Tehran, Iran, 2019.

BACKGROUND: Chronic kidney disease and dialysis are associated with various complications. OBJECTIVE: This study aimed to determine the relationship between health literacy and quality of life among patients receiving hemodialysis in hospitals affiliated with Tehran University of Medical Sciences. METHODS: In this study, a descriptive - correlational study design with 138 sample size was used. Convenience sampling was used to select the study participants. We collected the data on May-September 2019. Data collection was done using the HELIA and KDQOL SF™. RESULTS: In this study, 133 respondents fully completed the questioners. The mean score of health literacy of the respondents was 49.03 (± 22.37) while the average score of quality of life of the respondents in this study was 53.01 (± 14.86). CONCLUSION: Based on the findings, patients receiving haemodialysis had insufficient health literacy and a better quality of life. In order to address the health literacy needs of the patients, consideration of continuous health education and assessment in this patient subpopulation could gradually improve their health literacy and quality of life. Health care providers such as nurses could improve Health Literacy and substantially Quality of Life through interventions aimed at determining existing literacy needs in the long and short term treatment course for individual dialysis patients.

Dancing With Death in the Dust of Coronavirus: The Lived Experience of Iranian Nurses.

The novel coronavirus disease (COVID-19) pandemic as a public health emergency poses dramatic challenges for health-care systems. The experiences of health-care workers are important in planning for future outbreaks of infectious diseases. This study explored the lived experiences of 14 nurses in Tehran, Iran caring for coronavirus patients using an interpretative phenomenological approach as described by Van Manen. In-depth interviews were audio-recorded between March 10 and May 5, 2020. The essence of the nurses' experiences caring for patients with COVID-19 was categorized as three themes and eight subthemes: (a) Strong pressure because of coronavirus: initial fear, loneliness, communication challenges, exhaustion. (b) Turn threats into opportunities: improvement of nursing image, professional development. (c) Nurses' expectations: expectations of people, expectations of government. The findings of this study showed that identifying the challenges and needs of health-care providers is necessary to create a safe health-care system and to prepare nurses and expand their knowledge and attitudes to care for patients in new crises in the future.

Comparative study of nursing curriculum in nursing faculties of Canada, Turkey, and Iran according to SPICES model.

BACKGROUND: Innovation in the development and review of curriculums is one of the requirements of medical education in the present era. SPICES model has been taken into consideration by nursing faculties to promote quality of nursing education and to eliminate conventional curriculums. In Iran, for competency-based nursing education, review and development of curriculums are necessary. OBJECTIVE: The objectives of the present study were to determine the implementation of SPICES model in nursing curriculums of Tehran (Iran), Western (Canada), and Hacettepe (Turkey) nursing faculties and also to present recommendations to operationalize it in the nursing curriculum of Iran. MATERIALS AND METHODS: This study using comparative method with Brady's model was conducted in 2018. In this study, curriculums of nursing faculties of Tehran, Western Canada, and Hacettepe were compared. Data were extracted through texts and documents available at electronic pages of universities. Curriculums of these nursing faculties were compared from the perspective of SPICES model strategies (student-based, problem-based, integration, community-based, elective, and systematic) at four steps of description, interpretation, juxtaposition, and comparison. RESULTS: The results showed that curriculums in Western Canada reside at the end of the innovative spectrum of SPICES model. Curriculums in Tehran and Hacettepe in most of the strategies of this model reside at the beginning of the spectrum, and in most cases, conventional methods were used. CONCLUSIONS: According to successful experiences of Western Canada in the implementation of SPICES model's strategies and also considering this fact that still conventional approaches are prevalent in Iran, it is recommended to focus on experiences and, according to social conditions and facilities of the nursing community, to implement necessary changes in the curriculums based on this model.

Effect of White Noise on Sleep in Patients Admitted to a Coronary Care.

INTRODUCTION: Sleep disorders are a common problem in patients in the critical care unit. The objective of the present study was to determine the effect of white noise on the quality of sleep in patients admitted to the CCU. METHODS: The present study was single-blind, quasi-experimental study. A total of 60 patients were selected using the purposive sampling method. Quality of sleep was measured with PSQI on the first day in admission, then after three nights of admission without any intervention for control group and for the experimental group quality of sleep measured by white noise with intensity of 50-60 dB then Quality of sleep was measured with PSQI. Data were analyzed by SPSS 13 software. RESULTS: The average total sleep time in the control group before the study reached from 7.08 (0.8) to 4.75 (0.66) hours after three nights of hospitalization, while in the experimental group, no significant changes were seen in the average sleep hours (6.69 ± 0.84 vs. 6.92 ± 0.89, P = 0.15).The average minutes of sleep in the control group before the study reached from 12.66 (7.51) to 25.83 (11.75) minutes after a three- night stay, while in the experimental group, no significant changes were observed in the average sleep duration (12.16 ± 7.50 vs. 11 ±6. 07, P = 0.16). CONCLUSION: The use of white noise is recommended as a method for masking environmental noises, improving sleep, and maintaining sleep in the coronary care unit.

The effect of educational program on stress, anxiety and depression of the mothers of neonates having colostomy.

OBJECTIVE: One of the problems that mothers of neonates having colostomy face is their disability in caring colostomy at home. This article is going to demonstrate the impact of educational program for these mothers on their sense of empowerment in caring their neonates. METHODS: This clinical trial was performed in the Neonatal Intensive Care Units (NICUs) to evaluate the level of stress, anxiety and depression of mothers of neonates having colostomy before and after the educational program. In this program, 42 mothers were divided into two groups: experimental group (21 mothers who went under educational plan) and control group (21 mothers who only received the routine care). The levels of stress, anxiety and depression in all mothers were evaluated before and after the educational program with DASS 21 questionnaire. RESULTS: The results showed that educational program in the NICU for experimental groups made them independent and also empowered to care better for their babies. In addition, their depression, anxiety and stress levels were decreased. CONCLUSION: Since the educational program led to a decrease in the levels of stress, anxiety and depression in mothers, this program is recommended to mothers of neonates having colostomy.

Honey and Radiation-Induced Stomatitis in Patients With Head and Neck Cancer.

BACKGROUND: Stomatitis is a common oral complication which affects 100% of patients undergoing head and neck radiotherapy. Acute stomatitis might cause failure and delay radiotherapy. Attention to mouth hygiene, particularly using mouthwash, has a fundamental importance for these patients. OBJECTIVES: The current study came to addresses the effects of pure natural honey on radiation-induced stomatitis in patients with a variety of head and neck cancers. PATIENTS AND METHODS: The present single-blinded nonrandomized controlled trial was conducted on 105 patients undergoing radiotherapy due to head and neck cancer at the radiation unit of Shafa hospital in Kerman, Iran, from October 2012 to March 2012. The research groups were selected by writing the names of the protocols (the mouthwashes of chamomile, honey and the common caring protocol at ward which uses water) on three cubes. The first extracted cube was related to the chamomile mouthwash (Matrica), the second to the honey mouthwash and the last cube to the water mouthwash. The first experimental group (n = 35) gurgled a solution containing 20 mL diluted honey, the second group gurgled a solution containing German chamomile, and the 35 patients in the control group were advised to gurgle 20 mL water (the ward routine). RESULTS: The results showed that severe stomatitis in groups of honey, chamomile and control was 0, 5.7%, and 17.6%, respectively. On the 14th day, it was 0, 0, and 17.6%, respectively. There were significant differences between the three groups regarding the severity of stomatitis in the 14th day (P < 0.001). CONCLUSIONS: The application of natural honey is effective in managing and preventing radiation-induced stomatitis in patients with head and neck cancers.

Family-Centered Education and Its Clinical Outcomes in Patients Undergoing Hemodialysis Short Running.

BACKGROUND: Poor adherence to treatment in patients undergoing hemodialysis leads to many complications, including death of the patient. OBJECTIVES: This study was aimed to investigate the effect of family-based training on common side-effects during dialysis. PATIENTS AND METHODS: The present randomized controlled trial study was conducted on 60 patients undergoing hemodialysis at hospitals of Tehran University of Medical Sciences, Iran, from May 2012 to October 2012. Samples were randomly divided into two groups of patient-education (n = 30) and education of patient associated with an active member of the family (n = 30). Blood pressure, chest pain, nausea, vomiting, headaches and muscle cramps were followed with a check list and a questionnaire. The frequencies of the abovementioned complications at the mentioned intervals were recorded in three stages (before the intervention as well as two and four weeks after the intervention). Data analysis was performed using SPSS software, version 16, with chi-square test, Fisher's exact test and independent t-test. RESULTS: The mean ages of the patients in patient-centered and the family-oriented groups were 47.41 ± 10.31 and 48.16 ± 9.21, respectively. The result showed that some of the variables such as chest pain (P = 0.50, P = 0.01), nausea (P = 0.50, P = 0.01), headache (P = 0.81, P = 0.016), and blood pressure (P = 0.91, P = 0.016) were statistically significant before and four weeks after the intervention. CONCLUSIONS: According to the result of this study, the presence of families in a treatment plan could be essential to follow the treatment plan and subsequently reduced the complications of hemodialysis.