Diagnostic Values of the Critical Care Pain Observation Tool and the Behavioral Pain Scale for Pain Assessment among Unconscious Patients: A Comparative Study.

Background: Pain assessment in unconscious patients is a major challenge for healthcare providers. This study aims to compare the diagnostic value of the critical-care pain observation tool (CPOT) and the behavioral pain scale (BPS) for pain assessment among unconscious patients. Materials and methods: This cross-sectional study was conducted in 2019. Forty-five unconscious patients were selected randomly from four general intensive care units (ICUs) in the north of Iran. The discriminant validity of CPOT and BPS were evaluated for pain during a nociceptive and a nonnociceptive procedure. For reliability assessment, interrater agreement was obtained using Lin's concordance correlation coefficient and weighted kappa coefficient. Results: Patients who had been hospitalized in ICU due to surgery or trauma (57.70%) or medical problems (42.30%) were studied. During the nociceptive procedure, the mean scores of CPOT and BPS and all their dimensions, except for the compliance with ventilator dimension, were significantly greater than the nonnociceptive procedure (p <0.05) although the effect size of both instruments was small (0.32 vs 0.18). The Lin's concordance correlation coefficient in nonnociceptive and nociceptive procedures was respectively 0.67 and 0.62 for CPOT and 0.74 and 0.88 for BPS. Conclusion: CPOT and BPS have acceptable discriminant validity in differentiating nonnociceptive and nociceptive procedural pain although the effect size of CPOT is larger than that of BPS. Although both instruments have low reliability, the reliability of BPS is better. How to cite this article: Nazari R, Froelicher ES, Nia HS, Hajihosseini F, Mousazadeh N. Diagnostic Values of the Critical Care Pain Observation Tool and the Behavioral Pain Scale for Pain Assessment among Unconscious Patients: A Comparative Study. Indian J Crit Care Med 2022;26(4):472-476.

Identifying and Ranking the Factors Affecting the Choice of Nursing Discipline Among Nursing Students in Iran: A Fuzzy Hierarchical Analysis.

BACKGROUND: Choosing a career in nursing is frequently a complicated decision that is influenced by multiple factors. PURPOSE: This study was designed to identify and rank the main factors that influence individuals to choose to pursue a career in nursing. METHODS: This cross-sectional study was conducted at Mazandaran University of Medical Sciences, Iran. A comprehensive review of the literature was conducted to identify the factors that people consider when making a choice to pursue a career in nursing. The face and content validities of these factors were evaluated. A sample of 250 participants was invited to assess the factors using exploratory factor analysis. Finally, the analytical hierarchy process, in combination with fuzzy logic, was used to rank the criteria and related factors. RESULTS: Twenty factors were identified and extracted from 50 published studies. After confirming the face and content validity of each, these 20 factors were distinguished into four criteria, including (a) external motivation, (b) social dignity, (c) internal motivation, and (d) usefulness of discipline. Each criterion had an eigenvalue greater than 1. External motivation and usefulness of discipline were respectively identified as the most and least important criteria (38.60% vs. 16.11%) in terms of influencing individuals to pursue a nursing career. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The results of this study show that exposure to positive recommendations from family and friends, receiving positive information about studying nursing, positive perceptions regarding the general usefulness of nursing knowledge, and migration opportunities to other countries are the primary factors that influence individuals in Iran to pursue a career in nursing.

Effect of Tracheal Suctioning on Cuff Pressure in Mechanically Ventilated Patients: a Quasi-Experimental Study.

BACKGROUND: Endotracheal tube cuff pressure must be kept in an optimal range, but it might change during some nursing procedures. If the cuff pressure gets outside the normal range, it can cause mucosal damage, insufficient ventilation, and microaspiration. This study aimed to determine the effect of endotracheal suctioning on cuff pressure in patients during mechanical ventilation. MATERIALS AND METHODS: This is a quasi-experimental study utilizing repeated measures with a within-subject design. Using a simple convenience sampling method, 61 patients were studied during intubation on mechanical ventilation. Baseline cuff pressure was adjusted to 25 cm H 2 O. Then, at 15, 30, and 60 minutes' intervals, cuff pressures were measured once without suctioning and again after suctioning. RESULTS: The results showed a significant change in the mean endotracheal tube cuff pressure during suctioning (p<0.001, d=7.47). During suctioning, cuff pressure exceeded the normal range in 64% of the patients. After suctioning, although endotracheal tube cuff pressure decreased in both conditions, it decreased more significantly (F (2.17, 260.55)=238.19, p<0.001, ν=0.665, d=1.37) in the suctioning condition. CONCLUSION: The results suggest that endotracheal tube cuff pressure increases suddenly and briefly during suctioning, but within 60 minutes after suctioning, it becomes more reduced in suctioning conditions than without suctioning. Therefore, patients are at risk of mucosal damage and microaspiration after and during suctioning, respectively. It is suggested that nurses use continuous cuff pressure regulation methods to prevent potential risks.

Postgraduate Nursing Students' Expectations of their Supervisors in Iran: A Qualitative Study.

BACKGROUND: Exploring the expectations of postgraduate nursing students from their supervisors is required in order to meet the expectations, raise the general students' satisfaction, and enhance the students' capabilities to the highest degree possible. The present study was conducted to explore the expectations of postgraduate nursing students from their supervisors. MATERIALS AND METHODS: This qualitative study was done through semi-structured individual interviews with seven PhD students and 14 master's students in two focus groups from three universities in Tehran, Iran. The data were analyzed using the inductive approach and through conventional content analysis. RESULTS: The analysis of the data led to the extraction of five categories (support for the students, good communication skills, professional competence, guiding the students, and professionalism) within 12 subcategories. CONCLUSIONS: The results revealed that postgraduate students expect their supervisors not only to guide and support them in education and research but also have good communication skills, be professional, and value professionalism. Therefore, supervisors should try to meet these expectations and offer practical strategies for better realization of their needs.

Teachers' and postgraduate nursing students' experience of the educational environment in Iran: A qualitative Research.

BACKGROUND: The learning environment has a significant role in determining nursing students' academic achievements and course satisfaction. Creating a proper educational environment is therefore necessary for improving the quality of teaching and learning, and for delivering competent graduates to society. OBJECTIVE: The present study was conducted to explore teachers' and postgraduate nursing students' experience of the educational environment in Iran. METHODS: This qualitative study uses an inductive approach and conventional content analysis. Data were collected through semi-structured face-to-face interviews with seven PhD students, seven faculty members (directors) and two focus groups comprising of fourteen master's students in total, selected from three major universities in Tehran, Iran. RESULTS: Seven subcategories were extracted from the data, including the organizational context, interactive climate, teachers' competency, student appreciation, research centeredness, educational guidance and professionalism. CONCLUSION: The educational environment of postgraduate nursing programs in Iran encompasses different dimensions that can serve as both key points for educational environment evaluators and as guidelines for officials at different levels, to modify the weaknesses and improve the strengths of the system.