Comparison of professional competency and anxiety of nursing students trained based on two internship models: a comparative study.

BACKGROUND: Improving the professional competency of nursing students during the internship is critical. This study aimed to compare the professional competency and anxiety of nursing students trained based on two internship models. METHODS: This is a two-group posttest-only quasi-experimental design study. One hundred nursing students who passed internship models A (a previous internship model) and B (an intervention with more educator support and a more planned and programmed process) were randomly enrolled in this study. Internship model groups A and B were conducted for the students in semesters 7 and 8. The outcomes assessed in both groups were "The Competency Inventory for Registered Nurses" and Spielberger "State-Trait Anxiety Inventory". T-test and MANOVA were used to analyze the data. RESULTS: The mean scores of competency were 134.56 (SD = 43.23) and 160.19 (SD = 35.81) for the nursing students in the internship model groups A and B, respectively. The mean scores of nursing students' anxiety were 92.14 (SD = 15.36) and 80.44 (SD = 18.16) in the internship model groups A and B, respectively. MANOVA test showed a significant difference between the groups regarding professional competency (F = 10.34, p = 0.002) and anxiety (F = 11.31, p = 0.001). CONCLUSIONS: The internship model group B could improve the professional competency of nursing students to a great extent and they experienced mild anxiety; it is suggested that this intervention should be done for nursing students. Conducting more studies to evaluate the effect of this model on the nursing students' competency and anxiety after graduation and as a novice nurse is suggested.

How to prepare nursing students for mental health clinical engagement: a qualitative study.

BACKGROUND: Since clinical experience is challenging, identifying the factors influencing the learning process and acquiring clinical competence in mental departments is essential. Limited studies have investigated students' concerns regarding attending this clinical setting and how they are mentally and academically prepared. AIM/QUESTION: Explaining the various aspects of nursing students' preparation to attend the mental clinical environment. METHODS: This qualitative study was conducted on bachelorette nursing students and college professors using in-depth, semi-structured interviews. Inductive content analysis was used for data analysis, and Lincoln and Guba's criteria were used for the rigor of the data. RESULTS: The participants' viewpoints regarding how to prepare nursing students to enter mental clinical settings can be summarized in 4 categories: "understanding the students' concerns" "understanding the students' expectations" "the necessity of the students' mental preparation" and "preparing the scientific materials needed to attend in a mental ward". CONCLUSION: Nursing students have fears and worries about entering mental departments and have expectations of themselves and their instructors. To help students deal with these concerns, psychological and educational preparations should be provided, among which the role of new educational technologies can be mentioned.

Prevalence of chronic pain and contributing factors: a cross-sectional population-based study among 2,379 Iranian adolescents.

Background: This study aimed to determine the prevalence of chronic pain and its contributing factors among teenagers aged 12-21 years in Shiraz, Iran. Methods: This cross-sectional study was conducted on adolescents aged 12-21 years. Demographic variables of the adolescents and their parents as well as the pain characteristics were assessed. Descriptive statistics, multinomial logistic regression, and regression models were used to describe the characteristics of the pain and its predictive factors. Results: The prevalence of chronic pain was 23.7%. The results revealed no significant difference between the male and female participants regarding the pain characteristics, except for the home medications used for pain relief. The results of a chi-square test showed that the mother's pain, education, and occupation, and the father's education were associated significantly with chronic pain in adolescents (P < 0.05). Multinomial logistic regression also showed the mother's history of pain played a significant role in the incidence of adolescents' chronic pain. Conclusions: The prevalence of chronic pain was relatively high in these adolescents. The results also provided basic and essential information about the contributing factors in this area. However, consideration of factors such as anxiety, depression, school problems, sleep, and physical activity are suggested in future longitudinal studies.

The impact of physical and psychological pain management training on pain intensity, anxiety and disability in patients undergoing lumbar surgeries.

BACKGROUND/CONTEXT: Lumbar surgery is one of the interventions performed for patients with degenerative conditions. PURPOSE: This study aimed to investigate the effect of pain management education on pain intensity, anxiety, and disability after the lumbar surgery. STUDY DESIGN/SETTING: This randomized controlled trial was performed on 70 30-65-year-old patients with lumbar canal stenosis and lumbar disc herniation from 2018 to 2019. PATIENT SAMPLE: Seventy participants were randomly divided into a control and an intervention group by a randomized block design. Participants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions. OUTCOME MEASURES: All participants in the two groups completed the study instruments (numeric rating scale [NRS], Oswestery disability index [ODI], and pain anxiety symptoms scale [PASS]) before, immediately after, and 3 months after the study. METHODS: Participants in the intervention group received in-person pain management training twice a week for seven 60-90-minute sessions. To analyze the treatment effects, repeated-measures multivariate analysis of variance (MANOVA) and effect sizes were used where appropriate and calculated by Partial ɳ2. Clinical outcome (MDC) for pain intensity and PASS was also reported. For participants lost to follow-up, we also used an "intention-to-treat" (ITT) approach. RESULTS: The results of MANOVA indicated that there were significant differences between the two groups on ratings of pain intensity, anxiety, and disability. According to the MDC, the mean differences of pain intensity for the intervention group was also clinically improved. Meanwhile, the mean differences in pain anxiety between three different times in the two groups were not above the MDC (20.14), suggesting that the clinical improvements were not significant. The results were confirmed for all outcome measures; a statistically significant difference was found between the groups in ITT analyses (p<.001). CONCLUSIONS: Physical and psychological pain management education was shown to be effective in decreasing pain intensity, anxiety, and disability. This strategy may be beneficial for such patients. Variables such as smoking behavior, past history of psychological disorders, and previous surgeries should be considered in future studies.

Comparing the Effects of Virtual Reality and Home Chair-Based Exercises on Balance, Daily Living Activities, and Loneliness Among Older Adults With Balance Disorders.

The current quasi-experimental study aimed to compare the effects of virtual reality (VR) and home chair-based (HCB) exercises on balance, daily living activities, and loneliness among older adults (N = 90) with balance disorders living in nursing homes. Participants were assigned to three groups: (a) VR exercises, (b) HCB exercises, and (c) routine nursing home programs. Findings indicated that VR and HCB exercises significantly increased participants' balance and daily living activities compared to routine programs (p < 0.001). However, there was no clinical difference among groups regarding Berg Balance Scale and Barthel Index scores. Main effect of time regarding loneliness mean score (p = 0.991) was not significant among groups. The minimal detectable change pre-set standard for loneliness also showed no significant clinical difference. Exercise had no significant impact on loneliness; however, it had a positive role in improving balance and daily living activities, with no significant difference between VR and HCB exercises. Further studies are recommended to evaluate adherence to such exercises. [Research in Gerontological Nursing, 16(1), 33-42.].

Evaluation of the effectiveness of a training programme for nurses regarding augmentative and alternative communication with intubated patients using Kirkpatrick's model: A pilot study.

AIM: Communicating with conscious intubated patients who are unable to communicate verbally is one of the challenges faced by intensive care unit (ICU) nurses. The present study was conducted to evaluate the effectiveness of a training programme for nurses regarding augmentative and alternative communication (AAC) with intubated patients using Kirkpatrick's model. DESIGN: This study had a one-group, before-after, quasi-experimental design. METHODS: Totally, 45 nurses working in ICUs participated in a blended training programme using AAC strategies to communicate with intubated patients. Their contribution was evaluated based on Kirkpatrick's model at four levels. The study data were collected using the "satisfaction and ease questionnaire," "observation checklist" and "communication knowledge test." Then, the data were analysed using the SPSS 22 software and p < 0.05 was considered statistically significant. RESULTS: Most participants were satisfied with the implementation of the programme. The nurses' mean score of communication knowledge increased after the intervention (p < 0.05). The results of evaluation of the third and fourth levels of Kirkpatrick's model also showed an increase in the success of communication, use of AAC, and satisfaction with and ease of communication (p < 0.001). IMPLICATION: Short-term and long-term effects of the blended training programme about AAC were investigated using Kirkpatrick's model. The results indicated the positive effect of the programme on the quality of the nurses' communication with intubated patients, their understanding of the patients' messages and meeting the patients' needs at a more desirable level. Thus, nurses and other staff are recommended to use this simple method of communication with patients to provide better services. In addition, further quantitative and qualitative studies are suggested to assess these communication strategies in other patients with impaired consciousness.

The experience of chronic pain among adolescents: suffering and attempt to overcome pain?

BACKGROUND: Chronic pain (CP) among adolescents has received less attention than adultsandthere is limited qualitative studies about it in Iran. This study explored the experience of CP among adolescents. METHODS: This exploratory qualitative study was conducted in April-October 2019. Participants were 14 adolescent students purposively recruited from schools in Shiraz, Iran. Semi-structured interviews were conducted for data collection and data analysis was done through conventional content analysis. FINDINGS: Adolescents' experiences of CP came into nine subcategories and three main categories, namely perceived suffering, attempt to overcome pain, and attempt to find sources of support. CONCLUSION: Adolescents with CP experience physical and mental suffering and attempt to manage their pain and its associated suffering through different physical and psychological strategies and using different sources of support such as family, peers, healthcare providers, and school staff.

Comparing the effects of multimedia and face-to-face pain management education on pain intensity and pain catastrophizing among patients with chronic low back pain: A randomized clinical trial.

INTRODUCTION: Previous studies into Low Back Pain (LBP) assessed the effects of physical interventions or face-to-face (FTF) education mostly in western cultures. The present study aimed to compare the effects of multimedia and FTF pain management education (PME) on pain intensity and pain catastrophizing among participants with chronic LBP. METHODS: This double-blind randomized controlled clinical trial was conducted on ninety participants with chronic LBP randomly allocated to either multimedia, FTF, or control groups. Participants in the multimedia group received PME through watching seven educational CDs at home and their counterparts in the FTF group received the same educations in seven weekly FTF educational sessions. Pain intensity (using a numerical rating scale) and pain catastrophizing (using the Pain Catastrophizing Scale) were assessed before, immediately after, and one month after the study intervention. The effects of the interventions were assessed using the repeated-measures multivariate analysis of variance (MANOVA). Effect size and minimal detectable change (MDC) were reported for both variables. The regression model used in the present study was Generalized Estimating Equations (GEE). FINDINGS: The findings of MANOVA showed the significant effects of time on pain intensity and pain catastrophizing (P<0.001). The Tukey's test showed that before and immediately after the intervention, the mean scores of pain intensity and pain catastrophizing in the FTF and PME groups were significantly different from the control group (P<0.001 and P = 0.001, respectively). MDC did not show clinically significant changes in the mean score of pain intensity and GEE revealed significant difference among the groups. CONCLUSION: The findings suggested that multimedia PME is as effective as FTF education in reducing pain intensity and pain catastrophizing among participants with LBP. Future studies into the effects of education on LBP are recommended to consider longitudinal designs, a reliable cutoff score for pain catastrophizing, and participants' physical ability. IRCT REGISTRATION CODE: IRCT20180313039074N1.

Effect of a multimedia training programme for pain management on pain intensity and depression in patients with non-specific chronic back pain.

OBJECTIVES: To determine the effect of multimedia training on pain intensity and depression in patients with chronic low back pain. METHODS: In this randomized controlled trial study, the intervention group was trained about pain management consisted of communication skills, assertiveness, stress management, lifestyle enhancement skills and physical activity prepared in seven CDs using multimedia method and the control group received routine training included physician's visits, medication prescriptions and receiving the recommendations of the physician and healthcare providers. Beck Depression Inventory and Jensen Pain Questionnaire were completed for the two groups in three stages: pre-training, post-training and 2 months thereafter. RESULTS: The results showed that there were no significant statistical difference between two groups in terms of demographic variables indicated homogeneity of research groups. Repeated measure ANOVA showed that the mean scores of pain intensity and depression changed significantly over time in both control and intervention groups (p<0.001); however, the effect of the group was not significant (p=0.565, p=0.748, respectively). Hence, the results of time-group interaction showed that there was significant difference between the two groups in terms of pain intensity and depression (p<0.001, p=0.003, respectively). The effect size revealed that the difference between mean scores of depression before and after the intervention in the both group was high (1.04 and 1.45, respectively). CONCLUSIONS: The study results indicated that multimedia training has the potential in relieving pain intensity and depression in patients with non-specific chronic low back pain.

The prevalence of using complementary and alternative medicine products among patients with pressure ulcer.

BACKGROUND: The use of complementary and alternative medicine (CAM) therapies has increased in recent years throughout the world and in Iran. Nonetheless, there are limited data about the prevalence of their use. This study aimed to assess the prevalence of using CAM therapies among patients with pressure ulcer (PU). METHODS: This cross-sectional study was conducted in 2019-2020. Participants were 299 patients with PU conveniently selected from wound clinics and healthcare settings in Shiraz, Iran. A demographic questionnaire and the International Questionnaire to Measure Use of CAM were used for data collection. The data were analyzed using the SPSS software (v. 22.0). RESULTS: All 299 participants completed the study. Their mean age was 59.56 ± 18.76 years. The most common CAM therapies used for PU management were herbal products (100%), vitamin supplementation therapy (45.2%), spiritual therapies (21.7%), wet cupping therapy (16.4%), leech therapy (9.4%), acupuncture (1.7%), dry cupping therapy (1.3%), and massage therapy (1.3%). The most common herbal product used for PU management was Pistacia atlantica gum either alone or in combination with other herbal products (15.5%). The use of CAM therapies had significant relationship with participants' age, underlying conditions, and PU stage (P < 0.05) and the most significant predictor of using herbal products for PU was educational level (P < 0.05, OR = 5.098). CONCLUSIONS: The use of CAM therapies, particularly herbal products, for PU management is high in Iran. Quality public education and close professional supervision are needed for the safe use of these products.

Effect of a multimedia training programme for pain management on pain intensity and depression in patients with non-specific chronic back pain / Efecto del entrenamiento con multimedia sobre la intensidad del dolor y la depresión en pacientes con dolor de espalda crónico no específico / Efeito do treinamento com multimídia sobre a intensidade da dor e a depressão em pacientes com dor nas costas crónico não específico

Objective. To determine the effect of multimedia training on pain intensity and depression in patients with chronic low back pain. Methods. In this randomized controlled trial study, the intervention group was trained about pain management consisted of communication skills, assertiveness, stress management, lifestyle enhancement skills and physical activity prepared in seven CDs using multimedia method and the control group received routine training included physician's visits, medication prescriptions and receiving the recommendations of the physician and healthcare providers. Beck Depression Inventory and Jensen Pain Questionnaire were completed for the two groups in three stages: pre-training, post-training and 2 months thereafter. Results. The results showed that there were no significant statistical difference between two groups in terms of demographic variables indicated homogeneity of research groups. Repeated measure ANOVA showed that the mean scores of pain intensity and depression changed significantly over time in both control and intervention groups (p<0.001); however, the effect of the group was not significant (p=0.565, p=0.748, respectively). Hence, the results of time-group interaction showed that there was significant difference between the two groups in terms of pain intensity and depression (p<0.001, p=0.003, respectively). The effect size revealed that the difference between mean scores of depression before and after the intervention in the both group was high (1.04 and 1.45, respectively). Conclusion. The study results indicated that multimedia training has the potential in relieving pain intensity and depression in patients with non-specific chronic low back pain.

Objetivo. Determinar el efecto del entrenamiento con multimedia sobre la intensidad del dolor y la depresión en pacientes con lumbalgia crónica. Métodos. Ensayo clínico controlado y aleatorizado: el grupo de intervención recibió educación sobre el manejo del dolor consistente en unos temas (habilidades de comunicación, asertividad, manejo del estrés, habilidades para mejorar el estilo de vida y actividad física) disponibles en siete CD mediante el método multimedia; y el grupo de control recibió la educación rutinaria brindada durante las visitas al médico, consistente en la prescripción de medicamentos y la recepción de las recomendaciones del médico y de otros profesionales sanitarios. El Inventario de Depresión de Beck y el Cuestionario de Dolor de Jensen se aplicaron a los dos grupos en tres momentos: antes del entrenamiento, después del entrenamiento y dos meses después de acabar la intervención. Resultados. El ANOVA de medidas repetidas mostró que las puntuaciones medias de la intensidad del dolor y de la depresión cambiaron significativamente a lo largo del tiempo tanto en el grupo de control como en el de intervención (p<0.001); sin embargo, el efecto del grupo no fue significativo (p=0.565, p=0.748, respectivamente). Por lo tanto, los resultados de la interacción tiempo-grupo mostraron que sí había una diferencia significativa entre los dos grupos en cuanto a la intensidad del dolor y la depresión (p<0.001, p=0.003, respectivamente). El tamaño del efecto reveló que la diferencia entre las puntuaciones medias de depresión antes y después de la intervención en ambos grupos era alta (1.04 y 1.45, respectivamente). Conclusión. Los resultados del estudio indicaron que el entrenamiento multimedia tiene potencial para aliviar la intensidad del dolor y la depresión en pacientes con lumbalgia crónica inespecífica.

Objetivo. Determinar o efeito do treinamento com multimídia sobre a intensidade da dor e a depressão em pacientes com lombalgia crónica. Métodos. Ensaio clínico controlado e aleatório, o grupo de intervenção recebeu educação sobre o manejo da dor consistente nuns temas (habilidades de comunicação, assertividade, manejo do estresse, habilidades para melhorar o estilo de vida e atividade física) disponíveis em sete CD mediante o método multimídia; e o grupo de controle recebeu a educação rotineira brindada durante as visitas ao médico, consistente na prescrição de medicamentos e a recepção das recomendações do médico e de outros profissionais sanitários. O Inventário de Depressão de Beck e o Questionário de Dor de Jensen se aplicaram aos dois grupos em três momentos: antes do treinamento, depois do treinamento e dois meses depois de acabar a intervenção. Resultados. O ANOVA de medidas repetidas mostrou que as pontuações médias da intensidade da dor e da depressão mudaram significativamente ao longo do tempo tanto no grupo de controle como no de intervenção (p<0.001); porém, o efeito do grupo não foi significativo (p=0.565, p=0.748, respectivamente). Por tanto, os resultados da interação tempo-grupo mostraram que se havia uma diferença significativa entre os dois grupos enquanto à intensidade da dor e a depressão (p<0.001, p=0.003, respectivamente). O tamanho do efeito revelou que a diferença entre as pontuações médias de depressão antes e depois da intervenção em ambos os grupos era alta (1.04 e 1.45, respectivamente). Conclusão. Os resultados do estudo indicaram que o treinamento multimídia tem potencial para aliviar a intensidade da dor e a depressão em pacientes com lombalgia crónica inespecífica

Nurses' perception of workplace discrimination.

BACKGROUND: Discrimination and injustice are big obstacles in nurses' way to socialization and are among the major clinical challenges faced by nurses. Workplace discrimination is associated with such negative consequences as stress, fatigue, demoralization, loss of professional commitment, tension and conflicts at work, and resignation. A review of literature shows that not much research has been dedicated to workplace discrimination in nursing. OBJECTIVE: This study aims to investigate nurses' perception of workplace discrimination. METHOD: This cross-sectional study was conducted in the hospitals affiliated with a university of medical sciences in the largest city in the south of Iran in 2019. The participants consisted of 597 nurses who were selected through stratified random sampling. Data were collected using a researcher-made workplace discrimination questionnaire and analyzed in SPSS v. 21. FINDINGS: The mean of the nurses' workplace discrimination scores was found to be 102.57 ± 14.5, which is considered as moderate. The nurses' mean scores for the dimensions of vertical and horizontal discrimination (44.53 ± 6.8), consequences of discrimination (20.52 ± 5.55), and unfair promotion (12.38 ± 2.44) were moderate. As for the two other dimensions of workplace discrimination, namely, gender discrimination (14.41 ± 3.28) and cultural-organizational discrimination (11.88 ± 2.99), the participants' mean scores were low. There was a significant relationship between the nurses' workplace discrimination mean score on the one hand and their employment status (p = 0.016) and work experience (p = 0.002) on the other. However, the nurses' workplace discrimination mean score was not found to correlate with their level of education (p = 0.65), marital status (p = 0.274), and gender (p = 0.479). ETHICAL CONSIDERATION: This study has been approved by the ethics committee of the university. All the participants had signed the written informed consent form before participation. CONCLUSION: Hospital managers should take measures to reduce discrimination and establish organizational justice to raise nurses' morale and improve the quality of their performance as caregivers.

Effect of virtual reality exercises on balance and fall in elderly people with fall risk: a randomized controlled trial.

BACKGROUND: Deficient balance and fear of falling in elderly people can lead to disturbed daily activities, falling, and finally reduced quality of life. Therefore, evaluation of low-risk methods that might partially improve balance in this group of people is of utmost importance. The present study aimed to investigate the impact of Virtual Reality (VR) exercises based on Xbox Kinect on balance and fear of falling among elderly people. METHODS: This clinical trial was performed on 60 elderly individuals living in nursing homes divided into two groups of control and Xbox. The participants in the intervention group received VR exercises based on Xbox Kinect in form of two 30-45-min sessions held on a weekly basis for 6 weeks. The individuals in the control group, on the other hand, received routine exercises of the nursing homes. The research tools used in this study included a demographic questionnaire, the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falling Efficacy Scale (FES). RESULTS: The findings of the current study demonstrated that the scores of BBS and TUG test as the indices of balance among elderly people improved significantly in the Xbox group after the intervention (p < 0.001 for both BBS and TUG test). Moreover, the score of fear of falling diminished significantly in the intervention group compared to the control group (p < 0.001). CONCLUSION: According to the results of the present investigation, 6 weeks of VR balance exercises could enhance balance and fear of falling among elderly people living in nursing homes. TRIAL REGISTRATION: Code: IRCT20190727044347N1 , Date: 17-8-2019.

The Process of Promoting Spiritual Health in Iranian Muslim Adults: A Grounded Theory.

BACKGROUND: Spiritual health is a complex concept and it is important to review its promotion and evolution from a Muslim point of view in Iran. So, the present study was designed to explore the process of spiritual health promotion among Iranian Muslims. MATERIALS AND METHODS: This study is a grounded theory in which the continuous comparative analysis method Strauss & Corbin (1998) was used to analyze data. This study's sampling method was purposive in trying to select participants with the maximum variation. RESULTS: The "striving effort to promote spiritual health" was the core category which was the participants' strategy of the participants to confront their main concern, "to achieve transcendence". The essential spiritual process in this study was "the journey in the transcendence path". People would find the purpose and meaning of life by interconnecting and relying on their inner forces, and by establishing the moderation between the dimensions of existence. In this way, individuals will become closer to human perfection with the help of these components. They will achieve immersive wellbeing and moral maturity through the consolidation of spiritual health. Such a person lives to serve among the people. CONCLUSIONS: Adult promotion of spiritual health is dynamic and complex. The main process in this path is spiritual growth, which begins and continues as a result of the striving to advance spiritual health and refinement. Considering these findings has become a concern for holistic care within the scope of nursing care.

The effect of a smartphone-based pain management application on pain intensity and quality of life in adolescents with chronic pain.

The development, implementation, and qualitative evaluation of smartphone-based pain management applications may provide an opportunity for more optimal management of pediatric pain in the homesetting. The present mixed-method study was conducted to assess a smartphone-based pain management application regarding the feasibility, adherence, participant satisfaction, and effectiveness on pain intensity and quality of life in adolescents with chronic pain. The study was carried out in the quantitative and qualitative stages using a mixed-method approach. The quantitative stage included 128 adolescents who met the ICD-11 criteria of chronic pain. After random allocation, adolescents allocated to the intervention group received a pain management program through a smartphone-based application. No education was given to the adolescents in the control group. The adolescents were assessed regarding pain intensity and different dimensions of quality of life at pre-intervention, post-intervention, and three-month follow-up. The findings in the quantitative stage were explained by qualitative interviews. The findings of the quantitative stage showed significant improvements in the pain intensity, emotional, social, and school functioning but not in the physical functioning of the adolescents. A high level of adherence (78.12%) and satisfaction (Mean = 26.45, SD = 6.45) with thes martphone-based pain management program was found. Based on the qualitative interviews, adolescents' pain management strategies can be classified in three main categories: physical management, psychological management, and interpersonal resources. The results confirm the positive effect of a smartphone-based pain management program on the pain intensity and different dimensions of quality of life of adolescents with chronic pain. Within the context of chronic pain management, a mobile application incorporating both the psychological and physical management of pain may help adolescents with chronic pain to reduce the negative impacts of pain on their life.

The effect of a stress and anxiety coping program on objective structured clinical examination performance among nursing students in shiraz, Iran.

BACKGROUND: Evaluation of the competence and practical skills of nursing students, using the objective structured clinical examination (OSCE), is an integral part of the nursing education program. However, their performance could be negatively influenced by a significant level of stress and anxiety prior to the test. The present study aimed to evaluate the effect of an anxiety coping program on the OSCE performance level of first-year nursing students in Shiraz, Iran. METHODS: The present quasi-experimental study was conducted among 76 nursing students; control group (n = 35) and intervention group (n = 41). To attain the study purpose, the intervention group received a pre-exam anxiety coping program that included relaxation and soothing techniques, diaphragmatic breathing training, and progressive muscle relaxation training accompanied by light instrumental music, while the control group received no intervention before the exam. Data collection instruments included a demographic characteristics form and State-Trait Anxiety Inventory (STAI) questionnaire. Demographic characteristics of the participants indicated an overall homogeneity within the study population. The STAI questionnaire was filled in before and after the OSCE and the results were compared with those of the control group. The data were analysed using SPSS software (version 22.0). P < 0.05 was considered statistically significant. RESULTS: As a result of the anxiety coping program, a substantial reduction in the anxiety score (by 11.61 units) in the intervention group was observed. There was a significant difference in the pre- and post-exam anxiety scores between the control and intervention groups (P < 0.001). The anxiety coping program improved the examination results of nursing students in the final exam compared to the midterm results (an increase of 0.9487 units, P < 0.001). CONCLUSION: The anxiety coping program reduced the anxiety level among nursing students and improved their OSCE results. Our findings can be utilized to better evaluate clinical activities in different medical and paramedical groups. Moreover, educators can implement such coping programs prior to evaluations in order to effectively assess the knowledge, attitude, and performance of the students.

Quality of Nurses' Communication with Mechanically Ventilated Patients in a Cardiac Surgery Intensive Care Unit.

OBJECTIVES: To describe the quality of the relationship between nurses and patients under mechanical ventilation. METHODS: This observational study, performed in a cardiac surgery intensive care unit in Iran, selected 10 nurses and 35 patients through simple random and convenience sampling, respectively. One of the researchers observed 175 communications between nurses and patients in different work shifts and recorded the results according to a checklist. Nurse and patient satisfaction with the communication was assessed by using a six-item Likert scale, 8 to 12 h after extubation. RESULTS: Most of the patients were male (77.1%), while most of the nurses were female (60%). Patients started over 75% of the communications observed. The content of the communication was related mostly to physical needs and pain. Besides, the majority of patients used purposeful stares and hand gestures, and head nod for communication. Most of the communications between patients and nurses were satisfied 'very low' (45.7% in nurses, versus 54.3% in patients). However, 'complete satisfaction' was lower in nurses (0%), compared with patients (5.7%). No statistically significant correlation was found between patients' and nurses' satisfaction and demographic variables. CONCLUSIONS: The results showed that communication between nurses and mechanically ventilated patients was built through traditional methods and was based on the patients' requests. This issue might be the cause of an undesirable level of their satisfaction with the communication, given that effective communication can lead to understanding and meeting the needs of the patients.

Effectiveness of Standardized Patient in Abdominal Physical Examination Education: A Randomized, Controlled Trial.

INTRODUCTION: Simulation and virtual technologies currently are used to enhance basic and advanced nursing skills. Information on the use of simulation methods in the Iranian nursing education system, particularly regarding standardized patients (SP), is scarce. Hence, the present study aimed to evaluate the effect of using SP on the performance of Iranian nursing students in the physical examination of the abdomen. In addition, the SP method was compared with the purely lecture-based education method. METHODS: The present study was of a pre-test/post-test design carried out at the School of Nursing and Midwifery, Kazerun Islamic Azad University (Kazerun, Iran) during 2014. Third-year nursing students were recruited and assigned to either a control or an intervention group. The study was conducted in three phases: pre-test knowledge evaluation, training sessions, and post-test/recall test evaluation of objective structured clinical examination (OSCE). Data were analyzed using the SPSS software (version 16.0). A total of 87 students were included in our analysis. RESULTS: All participants were female with a mean age of 21.99±1.73 years. The mean pre-test score of the control and intervention groups were 4.98±2.17 and 5.35±1.77, respectively. No significant difference was observed between the groups regarding the OSCE overall scores (P>0.05). However, there was a significant difference between the mean pre-test and post-test scores in each group (P<0.05). Compared to the control group, the difference in the mean pre-test and post-test scores was higher in the intervention group (4.98±2.17 and 14.43±3.93 in control group vs. 5.35±1.77 and 15.39±3.2 in intervention group, respectively). Furthermore, there was no statistically significant difference between the groups in terms of the post-test and recall test scores. CONCLUSION: Our study demonstrates the SP method is an effective tool for learning to perform the physical examination of the abdomen as compared to the purely lecture-based educational method. The present pilot study could be extended to cover training on the physical examination of other human organs.