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BACKGROUND: The benefits of using Alteplase are time-dependent. This study aimed to evaluate delays between the onset of symptoms and the administration of Alteplase and related factors in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: In this cross-sectional study, 60 AIS patients receiving Alteplase were selected by census sampling from July 2020 to July 2021 from the eligible patients referred to Shahid Beheshti Hospital in Kashan, Iran. The data collection tool was a researcher-made questionnaire containing demographic information, time periods from the onset of symptoms to the injection of Alteplase, and associated factors. The required information was collected from the patients, their relatives, their health records, and Kashan Emergency Medical Service (EMS) information system. Data were analyzed in SPSS-16. RESULTS: Eighty-five percent of the 60 patients participating in the study were transferred to the hospital by EMS ambulances. The mean time intervals between different phases were as follows: Onset-To-Door (OTD) time 81.35 ± 33.76 minutes; Door-To-CT (DTC) scan time 16.12 ± 17.46 minutes; Door-To-Needle (DNT) time 51.30 ± 26.14 minutes; and the overall Onset-To-Needle (ONT) time 133.75 ± 39.17 minutes. Also, the mean ONT in people transferred by EMS was about 129 minutes, and the longest prehospital delay in these patients was related to the time between the arrival of the EMS ambulance to the hospital. Marital status and geographical location where the stroke had occurred showed a significant relationship with prehospital delay and pre-hospital notification (PHN) by EMS But there was no relationship between underlying diseases or economic status and prehospital delays; also, the patient's diastolic blood pressure at the time of receiving Alteplase showed a significant relationship with in-hospital delay. CONCLUSION: The findings of the study showed that the majority of people trust and use EMS ambulances to transfer to the hospital and the time spent in different stages, from the onset of symptoms to the injection of the thrombolytic drug, was in an acceptable range in the patients.
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BACKGROUND: One of the most prevalent problems of patients with systemic lupus erythematosus (SLE) is the uncertainty over an indefinite future. Uncertainty has significant effects on quality of life. The aim of this study was to explore uncertainty and personal strategies to cope with it among patients with SLE. MATERIALS AND METHODS: This qualitative study was conducted in 2020-2021 using conventional content analysis. Participants were 21 patients with SLE who were purposefully selected from rheumatology clinics in Kashan, Kerman, and Bandar Abbass in Iran. Data collection was performed using face-to-face, in-depth, semi-structured interviews and was continued up to data saturation. Data were analyzed concurrently with data collection through conventional content analysis approach proposed by Graneheim and Lundman. RESULTS: Two main themes, namely, "life in the fog" and "attempt to find peace" emerged from patients' experiences of illness uncertainty of SLE. Life in the fog included three main categories of "perception of threat to health", "challenge of doubt and certainty," and "indefinite future." Attempt to find peace included three main categories of "spirituality," "reflection," and "attempt to acquire SLE-related knowledge. CONCLUSIONS: Uncertainty is a major psychological stress for patients with SLE. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.
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Rationing of nursing care (RONC) refers to necessary nursing tasks that nurses refuse or fail to do because of limited time, staffing level, or skill mix. As an important process factor, it affects the quality of patient care. The concept of rationing of nursing care has not yet been clearly defined and analyzed and there are different views regarding this issue. Using Walker and Avant's eight-step method, this concept analysis was conducted to analyze the meaning, attributes, dimensions, antecedents, and consequences of nursing care rationing. The literature was collected by searching in electronic databases including PubMed, ScienceDirect, Web of Science, Scopus, and Google Scholar with no date limitation. Both qualitative and quantitative studies on rationing of nursing care, which were open-access and published in English, were included in this study. Thirty-three articles were investigated in the present study. The four defining attributes of RONC included the duty of performing nursing care, dealing with problems of doing nursing care, decision-making and prioritizing, and outcome. The antecedents included nurse-related, organization-related, care-related, and patient-related antecedents. A theoretical definition and a conceptual model of RONC were developed. The attributes, antecedents, and consequences of RONC identified in this study can be used in nursing education, research, and managerial and organizational planning.
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Introduction: Human caring combines science, art, and humanity. Humanity is the heart of care and interpersonal interactions. Despite the critical emphasis on human caring and concern for nursing care without humanity, there is no clear definition for human caring in nursing. This study aimed to analyze the concept of human caring. Methods: Walker and Avant's strategy for concept analysis was used. Electronic databases such as PubMed, Scopus, Ovid, Google Scholar, Magiran, Iran Doc, SID, and a number of dictionaries were searched without any limitation in date. Search keywords were "care", "caring", "human caring", "humanization", "patient care", "comprehensive care" and "nursing care". We searched all documents published before September 2020. In the initial search, 1637 articles were found but finally, 39 relevant articles remained in the study. Results: The nine defining attributes of human caring were establishing therapeutic communication, presence at the patient bedside, empathy, providing scientific care, subjectivity, dynamicity, respecting the patient's rights and ethics of care, helping the patient achieve a feeling of well-being, and art and creativity. Antecedents of human caring were categorized into three categories namely, human, personal, and organizational factors. The consequences were also categorized into consequences related to nurse, profession, patient, and organization. Conclusion: A theoretical definition and a conceptual model of human caring were developed. This concept should be included in the nursing curricula at all undergraduate and graduate levels and even in nurses' in-service training programs.
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BACKGROUND: The prevalence of heart failure, as a serious health problem, is increasing around the world due to underlying factors, such as hypertension and diabetes. Although the patient's cooperation in the treatment process plays a crucial role in treatment, only a few combinations of different approaches have been investigated so far. This study aimed to determine the effects of an empowerment program on the patients' self-care behaviors and hospital readmission. MATERIALS AND METHODS: In this randomized clinical trial, 120 patients with heart failure were divided into experimental and control groups. In the experimental group, the empowerment program, including face-to-face training, educational booklets, and follow-up via Telegram messaging application, was implemented, while the control group only received standard care. Data were collected before the intervention and six months after the intervention, using a researcher-made questionnaire. The Self-Care of Heart Failure Index (SCHFI) was completed for both groups. RESULTS: The results indicated that all three self-care scales, namely, self-care maintenance, self-care management, and self-care confidence, significantly improved in the experimental group compared to the baseline (P=0.000), while the scores of these scales decreased in the control group (P=0.000). The frequency of hospital admission and the length of hospital stay also reduced in the experimental group (P=0.000 and P<0.001, respectively). There was no significant difference in terms of the demographic characteristics between the two groups. CONCLUSION: The empowerment program significantly improved the patients' self-care behaviors and reduced the frequency and duration of hospitalization. Therefore, implementation of such programs is strongly suggested, especially in heart failure clinics.
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BACKGROUND: Early diagnosis and treatment of myocardial infarction can prevent life-threatening complications such as dysrhythmias and death. The aim of this study was to determine the length of delay and its related factors in seeking treatment among a group of patients with myocardial infarction. METHODS: In a cross-sectional design, all the patients who had referred to a general teaching hospital (Kashan, Iran) for treatment of myocardial infarction from April 2004 to March 2005 were recruited. Demographic characteristics, the amount of delay, and the causes of having delay were recorded. RESULTS: Two hundred patients were recruited for this study from which 131 (69%) patients had delay in seeking treatment. Factors such as gender, age, economical status, educational level, referring to a general physician before referring to the hospital, the severity of symptoms, residential place (urban vs. rural), and the time of the onset of the symptoms (day vs. night) were determined to be related to having delay. The most important causes of having delay were: "hoping the symptoms to alleviate spontaneously", "attributing the symptoms to other problems other than heart problems", and "disregarding the symptoms". CONCLUSION: Regarding the most important causes of having delay in this study, the importance of educating people about the symptoms of myocardial infarction and the importance of early referral to the hospitals is clarified.
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INTRODUCTION: A cardiovascular disease, especially the acute myocardial infarction (AMI), is the most important health problem worldwide. Pre-hospital delay in seeking medical treatment is an effective factor on patients' outcomes. The aim of this study was to identify the patients' reactions to the signs and symptoms of AMI and identifying the factors contributing to the pre-hospital delay in a central hospital in Kashan, Iran. MATERIALS AND METHODS: In this cross-sectional study, a random sample of 248 patients suffering from AMI was recruited. A questionnaire used, which contained demographic data, the time, and place of experiencing the symptoms, and the manner of responding to the initial symptoms. The SPSS software (version, 19 was used for data analysis. RESULT: 248 patients participated in the study, 183 (73.8%) were males and 65 (26.2%) were females. The mean delay time was 127 ± 174 min. Moreover, 162 patients had arrived at the hospital during the first 60 min after the onset of the symptoms. The variables of being female (P = 0.024), low level of education (P = 0.014), living in urban area (P = 0.01) and referring to the hospital by one's own car instead of using ambulance were accompanied by more pre-hospital delay. 63 patients (25.4%) referred to the hospital by ambulance. CONCLUSION: Despite having only 25% of the patients referring to this center by ambulance, most patients arrived on time to the hospital.