The impact of teach-back training method (TBTM) on treatment adherence in hemodialysis patients: a randomized controlled trial.

Introduction: Ensuring adherence to treatment is vital for individuals undergoing haemodialysis. The demanding treatment frequency and duration often present challenges for patients in maintaining a consistent routine. Non-adherence can result in adverse health effects and an increased risk of hospitalization. This study aimed to evaluate the impact of teach-back training on treatment adherence among haemodialysis patients. Method: A randomized controlled trial involved 60 end-stage kidney disease patients undergoing haemodialysis. Participants were randomly assigned to either the control or intervention group. Data were collected using the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), assessing adherence in four dimensions: HD incidence, medication use, fluid restriction, and diet recommendations. The intervention group received feedback-based training on diet and fluid restriction during four 45-60-min sessions, while the control group received regular indoor training. Result: Following the intervention, significant differences in mean scores for HD frequency, medication use, and fluid restriction were observed between the two groups (P<0.001). However, there was no significant difference in the mean score for food recommendations (P=0.108). Conclusion: The teach-back training method (TBTM) is an effective communication strategy that enhances treatment adherence in haemodialysis patients. This intervention has the potential to improve patient outcomes and overall quality of life by simplifying medical information and encouraging patient engagement.

Religio-cultural facilitators and barriers in decision-making on organ donation: The experiences of families of brain-dead patients in Iran.

This study aimed to explore the experiences of families of brain-dead patients regarding religio-cultural facilitators and barriers in decision-making for organ donation. This is a qualitative descriptive study, in which a total of eighteen families of brain-dead patients were recruited using purposive sampling. Data were collected using semi-structured face-to-face interviews. After recording and transcribing the interviews, concepts were extracted using conventional content analysis. The main theme was entitled "religio-cultural facilitators and barriers in decision-making on organ donation" and consisted of four main categories, including two facilitators of "life-giving culture" and "life-giving sacredness" and two barriers of "decision-making skepticism" and "opportunity-burning religiousization". Therefore, cultural and religious issues require further attention and a more realistic and logical cultural and religious perspective toward organ donation should be created at the societal level.

A qualitative study on barriers and strategies to hospital preparedness against chemical, biological, radiological, and nuclear incidents.

BACKGROUND: The effects of chemical, biological, radiological, and nuclear (CBRN) incidents on human society can be irreparable. Preparing the health system for these incidents is essential. This study aims to identify obstacles to hospital preparedness against CBRN incidents and provide solutions. MATERIALS AND METHODS: This qualitative study was conducted using semi-structured interview method in 2022. The research community included experts in the fields of CBRN, and 17 persons were included in the study through purposive sampling. The interviews were collected by interview guide and recorded face-to-face and online and were analyzed using thematic content analysis method in MS Word 2016. RESULTS: The interviews' analysis was classified into two main categories and 34 sub-categories. Some of the most important obstacles to the hospital preparedness against CBRN incidents were the lack of proper crisis management, the lack of specialist staff, the stress of employees, the lack of turnover and sufficient rest for employees, legal gaps, and so on. The main strategies were determining the type and extent of the risk factor, strong crisis management, the lack of parallelism, continuous monitoring, having a protocol and road map, appropriate training programs, having skilled personnel, rapid response of personnel, positive attitude of the staff, and the favorable condition of the building. CONCLUSION: The appointment of an expert in the field of CBRN and having a specialized unit, the existence of specialized and trained staff along with access to the required facilities, clear instructions, and intra-departmental and inter-departmental cooperation affect the readiness of hospitals against CBRN incidents.

"We are really starving for respect and support," the struggle of Iranian nurses in adhering to professional values: A qualitative study.

AIMS: To investigate nurses' experiences of adhering to professional values in clinical settings. DESIGN: A qualitative study with a conventional content analysis approach. METHODS: This study was conducted from January 2021 to March 2022. Semi-structured interviews were conducted with 12 nurses working in different wards of five public and private hospitals in West Azerbaijan of Iran. Data were analysed using the conventional content analysis approach proposed by Graneheim and Lundman (Nurse education today, 24, 2004, 105) RESULTS: "Barriers to nurses' professional values" emerged as the main category of Iranian nurses' experiences in adhering to professional values. Three subcategories of barriers were revealed: "nurses' challenges," "professional suppressors" and "poor working conditions." CONCLUSION: Barriers in clinical settings can overshadow nurses' professional performance and disrupt their adherence to professional values. Nursing managers must pay attention to nurses' challenges, their professional suppressors and poor working condition to help them promote their professional performance in clinical settings. Thus, nursing managers should not neglect the continuous education of nurses to assist them in increasing their clinical skills by holding practical and theoretical workshops. Improving the working conditions and clinical atmosphere by recruiting a capable workforce and applying psychological and financial support for nurses are essential to increase the quality of nursing care.

Nurse-to-nurse horizontal violence during the covid-19 pandemic and its impact on turnover intention: A cross-sectional study.

BACKGROUND: Nurse-to-nurse (N2N) horizontal violence has been documented among the main determinants of nurses' turnover intention. Even with its utmost importance, inadequate attention has been thus far drawn to the way crisis-induced pressure added to work environments, such as the coronavirus disease 2019 (COVID-19) pandemic, can impact horizontal violence, and then give rise to turnover intention. AIM: The present study was to investigate the relationship between N2N horizontal violence along with its dimensions and turnover intention among clinical nurses. METHODS: A cross-sectional survey was conducted utilizing the Turnover Intention Questionnaire (TIQ), developed by Kim et al. (2007), and the Negative Acts Questionnaire-Revised (NAQ-R; Einarsen, Hoel, & Notelaers, 2009). The participants, recruited by random sampling, included 295 clinical nurses working in referral hospitals for COVID-19. The data were also analysed using the SPSS software package (ver. 19), via descriptive and inferential statistics, Pearson correlation test and multiple linear regression. RESULTS: The study participants obtained the mean scores of 52.50 ± 11.85 and 45.38 ± 13.24 for turnover intention and horizontal violence, respectively. Among the dimensions of horizontal violence, the highest value belonged to "work-related bullying," with the mean score of 51.04 ± 15.23, and the lowest was associated with the "physically intimidating bullying" dimension, with the mean value of 15.90 ± 5.96. The Pearson correlation test results correspondingly showed that turnover intention was positively correlated with work-related bullying (r = 0.73), person-oriented bullying (r = 0.72), physically intimidating bullying (r = 0.53) and overall horizontal violence (r = 0.74). The regression analysis outcomes additionally demonstrated that the work-related and person-oriented bullying dimensions of N2N horizontal violence could predict turnover intention in nurses (F = 184.66, p < 0.001). IMPLICATIONS: The study findings help nursing managers and policymakers to immediately formulate sound measures and guidelines to prevent or at least manage the problems, viz., N2N horizontal violence and turnover intention. These measures can be thus in the form of training programs focused on communication, stress reduction and conflict resolution techniques, especially during crises, together with obvious procedures for reporting the incidents of horizontal violence.

Factors affecting the formation of nurses' moral sensitivity in cardiopulmonary resuscitation settings: A qualitative study.

Background: Certain factors may facilitate or inhibit the formation of moral sensitivity in nurses performing cardiopulmonary resuscitation (CPR). The identification of these factors in the context can help develop strategies to promote nurses' moral sensitivity and offer new insights into the consequences of their moral decisions.Objective: Taking into account the possibly multi-factorial nature of moral sensitivity, this study aimed to identify the factors affecting the formation of nurses' moral sensitivity in CPR settings.Research design and methods: This study performed a conventional qualitative content analysis. Twenty-one participants were selected via purposive and theoretical sampling. The data were collected through in-depth semi-structured interviews and simultaneously analyzed via content analysis.Participants and research context: In total, twenty-one participants (fourteen clinical care nurses, three head nurses, two educational supervisors, and two faculty members) from different cities of Iran were interviewed.Ethical considerations: The research was approved by the Ethics Committee of Urmia University of Medical Sciences in Iran (IR.UMSU.REC.1399.337).Findings: Four categories (underlying factors, professional factors, organizational inhibitors of ethics, and professional limitations) and 13 sub-categories were extracted.Discussion: The formation of moral sensitivity requires a range of ethical standards and their maintenance, not only at the individual level but also at the profession, organization, and community levels. So eliminating inhibitors of ethics in these contexts can improve nurse's ethical performance in CPR settings.Conclusion: Any measures taken or decisions made by nurses in CPR are driven by numerous ethical issues to which nurses must be morally sensitive. Some factors facilitate and some inhibit the formation of moral sensitivity in nurses.

Critical care nurses' moral sensitivity during cardiopulmonary resuscitation: Qualitative perspectives.

BACKGROUND: Cardiopulmonary Resuscitation (CPR) is one of the areas in which moral issues are of great significance, especially with respect to the nursing profession, because CPR requires quick decision-making and prompt action and is associated with special complications due to the patients' unconsciousness. In such circumstances, nurses' ability in terms of moral sensitivity can be determinative in the success of the procedure. Identifying the components of moral sensitivity in nurses in this context can promote moral awareness and improve moral performance. OBJECTIVE: This study was conducted to explore and identify the experiences of critical care nurses about moral sensitivity components in CPR. RESEARCH DESIGN AND METHODS: This study was implemented with a qualitative approach. Data were collected via 22 in-depth semi-structured interviews held with 20 eligible participants with maximum variation. The data were then analyzed using the grounded theory approach. PARTICIPANTS AND RESEARCH CONTEXT: In total, thirteen clinical nurses, three head nurses, two educational supervisors, and two faculty members from different universities of Iran were interviewed. ETHICAL CONSIDERATIONS: This study was conducted with the ethical approval (IR.UMSU.REC.1399.337) of the Ethics Committee of Urmia University of Medical Sciences. FINDINGS: Four themes and 12 sub-themes were extracted from the analysis of the data, including "Consciously and compassionate attention to resuscitate the patient," "Awareness of families' anxiety," "Understanding the teamwork and interactive guidance of the CPR process," and "Compulsory violation of moral principles." DISCUSSION: It is anticipated that this discussion will prompt further debate, raise awareness and help clarify the dimensions of moral sensitivity in unconscious patients especially during CPR, so that it can be more clearly named and defended as a moral authority in CPR. CONCLUSION: identifying the components of moral sensitivity in nurses, facilitates their encounter with moral issues and can improve their moral performance and encourage right decisions.

The COVID-19 patients' educational needs assessment questionnaire (COPENAQ): development and psychometrics.

BACKGROUND: Despite the importance of assessing COVID-19 patients' educational needs, there is currently no standard tool for a comprehensive assessment of these needs. The present study was aimed at developing a questionnaire to assess the educational needs of COVID-19 patients and determining its psychometric properties. METHODS: This study was conducted using an exploratory sequential mixed methods design in 3 stages. At the first stage, patients' educational needs were explained and determined using conventional content analysis so that a total of 15 COVID-19 patients were first selected using purposive sampling and then interviewed. At the second stage, the questionnaire items were developed using the qualitative findings and a review of valid sources related to the study subject. At the third stage, the psychometric properties of the questionnaire were determined using internal consistency reliability and the face, content, and construct validities. RESULTS: The mean content validity ratio and the content validity index were obtained to be 0.94 and 0.92, respectively. The internal consistency was evaluated using Cronbach's alpha, which was measured to be 0.97. Based on the exploratory factor analysis, the questionnaire was developed with 36 items in four subscales of "disease recognition and treatment follow-up", "prevention of infection transmission", "medication regimen", and "psychological and physiological needs". The results of confirmatory factor analysis also showed appropriateness and approval of the structural model obtained from the questionnaire. CONCLUSION: This questionnaire was found to have the necessary psychometric criteria (validity and reliability) so that it can be applied to assess the educational needs of COVID-19 patients and provide better and more effective patient education for them.

The effect of patient education based on health belief model on hospital readmission preventive behaviors and readmission rate in patients with a primary diagnosis of acute coronary syndrome: a quasi-experimental study.

BACKGROUND: The health belief model is one of the applicable methods of training health preventive behaviors, especially in patients with cardiovascular diseases. Therefore, this study aimed to determine the effect of patient education based on the health belief model on readmission preventive behaviors and readmission rate in patients with a primary diagnosis of acute coronary syndrome. METHODS: The present quasi-experimental study was conducted in 2020 on patients with a primary diagnosis of acute coronary syndrome who were discharging from Seyed Al-Shohada Hospital, Urmia, Iran. In this study, a total of 70 samples were recruited using convenience sampling and then randomly assigned to two groups of intervention and control (n = 35 in each group). A total of 7 face-to-face group training sessions were held with the participation of the patients and one of their family members during 14 days after hospital discharge. These sessions were conducted along with concentration on the structures of the health belief model. Data were collected at three time points of immediately before, one month, and three months after the intervention using a demographic questionnaire, a researcher-made questionnaire of readmission preventive behaviors in cardiovascular diseases, and a checklist of hospital readmission. Data were analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA). RESULTS: The results showed that there was a statistically significant difference in the mean score of preventive behaviors between the two groups at time points of one month and three months after the intervention (p < .05). However, there was no statistically significant difference in the readmission rate between the two groups after the intervention (p > .05). CONCLUSION: Health belief model-based education was shown to be effective on readmission preventive behaviors in patients with acute coronary syndrome, although this model had no effect on the readmission rate in these patients. Other factors affecting the readmission rate are recommended to be investigated.

The effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure: an experimental study.

BACKGROUND: Heart failure is a common and chronic heart condition with high prevalence and mortality rates. This debilitating disease as an important predictor of health outcomes is directly related to patients' quality of life. Given that one of the main goals of heart failure treatment is to promote patients' quality of life and health status, conducting effective nursing interventions seems to be necessary in this regard. Therefore, the present study aimed to determine the effect of educational intervention based on Pender's health promotion model on quality of life and health promotion in patients with heart failure. METHODS: This is an experimental study in which a total of 80 patients with heart failure were recruited and randomly allocated to two groups of intervention and control (n = 40 in each group). The educational program was designed based on Pender's health promotion model and then provided for the patients in the intervention four subgroups (10 person in each group) during six sessions. Data were collected at three time-points of before, immediately after, and three months after the intervention using a demographic questionnaire, the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Health-Promoting Lifestyle Profile II (HPLP-II). Data were then analyzed using SPSS Statistics for Windows, version 17.0 (SPSS Inc., Chicago, Ill., USA) and p value less than 0.05 was taken as statistically significant. RESULTS: Based on the results of the present study, no statistically significant difference was shown in terms of demographic characteristics between the two groups. It was also indicated that there was a statistically significant difference in the mean scores of all dimensions of quality of life (except in the physical dimension) between the two groups so that the overall mean score of quality of life increased significantly in the intervention group after the intervention (p < .05). Moreover, there were significant increases in the mean scores of health-promoting behaviors (except in the domain of physical activity) in the intervention group compared to the control group (p < .05) after intervention. CONCLUSIONS: This study demonstrates a trend that Pender's health promotion model is effective in improving the quality of life of patients with heart failure except of the physical dimension, and strengthening their health-promoting behaviors in all dimensions except of the physical activity dimension.

The Role of Beliefs and Psychological Factors in Caring of Patients With Cancer: The Lived Experiences of Informal Caregivers.

Cancer affects not only the patient but also family members as informal caregivers. In order for family caregivers to achieve balance and improve their caregiving roles, it is essential to identify the beliefs and psychological aspects affecting them. The present study was carried out qualitatively with a descriptive phenomenological design in 2020. The main participants in this study were selected from one of the major referral centers for cancer patients in West Azerbaijan Province, located in northwestern, Iran. Twenty-two family caregivers were selected through a purposive sampling method. Data analysis showed that the 3 main themes of "emotional and religious preconceptions," "feeling committed to caring for beloveds," and "resilience" played a prominent role in family caregivers. These factors led to caregivers' commitment to and responsibility for care. Holistic care necessitates consideration of all aspects of human life. The results of this study led to an understanding of the complex tendencies and feelings of family caregivers. Based on the results, it was found that care is influenced by beliefs, religious preconceptions, sociocultural, and psychological factors. Identifying these variables helps medical staff share planning, interventions, and counseling with family caregivers and address issues that affect them.

The Effect of Peer Education on Management of Chemotherapy Side Effects in Patients with Cancer.

BACKGROUND: Chemotherapy drugs may have numerous side effects for patients. Thus, this study was conducted with the aim to determine the effect of peer education on the management of chemotherapy side effects in patients with cancer. MATERIALS AND METHODS: This randomized, controlled trial was conducted on 80 patients with cancer in 2018. They were allocated to two groups of intervention and control. The self-care education on chemotherapy side effects was provided by the peers to the individuals in the intervention group. The data collection tools included a demographic characteristics form and the Self-Care Diary (SCD). Data analysis was performed using independent t-test and Chi-square test in SPSS software. RESULTS: The results showed that the mean scores of the effectiveness of self-care behaviors were significantly higher in the intervention group compared to the control group after the intervention (p < 0.05). CONCLUSIONS: Peer education is recommended for cancer patients undergoing chemotherapy.

Satisfaction with nursing care and its related factors in patients with COVID-19: A descriptive correlational study.

BACKGROUND: Patients' satisfaction is a fundamental factor in the quality of nursing care. The emergence of the novel Coronavirus Disease 2019 (COVID-19) and the highly contagious virus can affect nursing care by increasing the number of care-seekers. This study aimed to determine the patients' satisfaction and related factors in patients with COVID-19 hospitalized in Taleghani Hospital, Urmia-Iran, in 2020. MATERIALS AND METHODS: This descriptive, correlational study was conducted on 196 patients with COVID-19 hospitalized in Taleghani Hospital, Urmia. Purposive convenient sampling was used to recruit participants. Study participants completed Patient Satisfaction Instrument and demographics questionnaires. Data were analyzed with the SPSS software version 25.0. RESULTS: The majority of patients (68.9%) were moderately satisfied with nursing care. Based on Pearson Correlation Analysis, only residential status had a significant inverse relationship with satisfaction level in patients with COVID-19 (r = -0.0238, P = 0.001). CONCLUSIONS: The patients' satisfaction with nursing care was mostly at a moderate level. Thus, there is a need to educate health personnel and nurses in particular and motivate them to have active participation in achieving patients' satisfaction with COVID-19. Notably, only the institutes that take patients' satisfaction as a top priority can succeed in a competitive market of health services.

Second Victim Experience and Support Tool: Persian translation and psychometric characteristics evaluation.

BACKGROUND: Healthcare providers involved in an unexpected adverse patient safety event are affected by negative outcomes of the event and are called 'second victims'. The Second Victim Experience and Support Tool has been introduced as a reliable and valid measure to assess the second victim responses and to support recourses of healthcare professionals. AIM: The core objective of this survey was to assess the psychometric attributes of the scale within Iranian nurse. METHODS: Having translated the scale based on the WHO guidelines and assessing its face validity, a board of 8 specialists assessed the content validity of the measure. In order to assess the psychometric characteristics of the questionnaire, a survey was conducted in 5 university-affiliated hospitals of Urmia. Confirmatory factor analysis is adopted to assess the construct validity. The internal consistency and test-retest reliability of the scale were determined. RESULTS: The Persian version of the scale consists of 29 items and 9 subscales. Confirmatory factor analysis illustrated that the scale reflects a foolproof construct validity. Cronbach α coefficients revealed the reliability of the scale (0.68-0.88). CONCLUSIONS: The survey proves to be a reliable and valid measure to evaluate the second victim responses and conceivable support resources of Iranian nurses or other Persian-speaking healthcare professionals of the region. IMPLICATIONS FOR HEALTH POLICY AND PRACTICE: Health policymakers ought to build up large-scale surveys to determine the degree of second victimization of healthcare professionals so as to offer suitable support systems. Taking the scale into account would improve evaluation of the benefits of second victim support initiatives in nursing practice.

Relationship between patient safety culture and job burnout in Iranian nurses: Assessing the mediating role of second victim experience using structural equation modelling.

AIM: The study examined the mediating effect of the second victim experience between safety culture and burnout in Iranian nurses. METHODS: A convenience sample of 298 nurses from five teaching hospitals of Urmia participated in the study. Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and The Second Victim Experience and Support Tool were used to measure the major variables. We adopted structural equation modelling to examine the hypotheses. RESULTS: Safety culture was significantly associated with second victim experience and burnout (p < .01). Second victim experience had a partial mediating role on the relationship between safety culture and burnout (p < .01). The mediating model including major variables showed satisfactory fitness (χ2 /df = 2.11, p < .01, Comparative Fit Index = 0.94, root-mean-square error of approximation = 0.062). CONCLUSIONS: Establishing a safety culture is crucial for decreasing job burnout, and second victim experience has an intervening role clarifying how high level of safety culture reduces burnout. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should plan to promote safety culture and provide sufficient support to staff involved in the patient safety incident, which could reduce staff burnout.

The Effect of Peer Education on Knowledge, Comprehension, and Knowledge Application of Patients Regarding Chemotherapy Complications.

BACKGROUND: The aim of the present study was to determine the effect of peer education on the level of knowledge, comprehension, and knowledge application of patients regarding chemotherapy complications. MATERIALS AND METHODS: This study was performed on 80 patients with cancer undergoing chemotherapy in 2018. The participants were selected through convenience sampling and randomly allocated to the two groups of control and intervention (40 participants per group). Before the intervention, the participants in both groups completed a demographic characteristics form and the Educational Needs Assessment Questionnaires. Then, the peer education intervention was designed based on the educational needs of the patients regarding chemotherapy complications for the intervention group. Peer education was performed face-to-face and individually during two chemotherapy sessions. The questionnaires were re-administered to both groups 2 weeks after the end of the second chemotherapy session and data analysis was performed using independent t-test, Chi-square. RESULTS: The means of knowledge (t78 = 19.74, p < 0.001), comprehension (t78 = 17.27, p < 0.001), and knowledge application (t78 = 14.84, p < 0.001) were significantly increased after peer education in the intervention group compared to the control group. The difference in the means of knowledge (t39 = 17.40, p < 0.001), comprehension (t39 = -18.53, p < 0.001), and knowledge application (t39 = -13.94, p < 0.001) after peer education, compared to before the intervention, was significant in the intervention group. CONCLUSIONS: Peer education can lead to increased level of knowledge, comprehension, and knowledge application of patients in terms of chemotherapy complications.