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OBJECTIVE: Pneumatic tourniquets are among the most essential equipment for controlling bleeding in orthopedic surgeries. However, incorrect application of pneumatic tourniquets is accompanied by many hazards and complications for patients. Evaluation of surgical teams' use of pneumatic tourniquets and establishment of protocols can play an important role in improving patient safety, minimizing risks, and increasing the lifetime of this equipment. Accordingly, the present study was conducted to develop and assess the psychometric properties of a pneumatic tourniquet work standards scale. METHODS: The present study is a methodological work carried out in two stages. In the first stage, an initial version of the scale was developed based on existing research and panel reviews. In the second stage, the psychometric properties of the scale were tested in terms of face validity (measured qualitatively and quantitatively), content validity (measured qualitatively and quantitatively), item analysis, construct validity, and reliability (internal consistency and stability). RESULTS: The initial version of the scale consisted of 91 items. After several meetings of the research team, the number of items decreased to 81. In the course of face and content validity testing, 40 items were eliminated, leaving 41 items on the scale when it entered the construct validity testing stage. For evaluation of construct validity, a sample of 300 operating room nurses was recruited. The Exploratory Factor Analysis (EFA) results showed a structure supported by seven factors and 41 items. The reliability of the scale was confirmed by internal consistency analysis, with a good Cronbach's alpha (0.85), and test-retest analysis, with good values of ICC (0.95). CONCLUSION: The present instrument is a reliable and valid scale which fills the gap in assessment of surgical team members' use of pneumatic tourniquets. The developed scale can be employed by researchers and managers of medical centers to identify hazards in applying pneumatic tourniquets and devise educational programs to eliminate or reduce the existing issues.
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Psicometria , Torniquetes , Humanos , Feminino , Masculino , Adulto , Reprodutibilidade dos Testes , Procedimentos Ortopédicos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto JovemRESUMO
Background and Aim: It is essential that healthcare providers display ethical behavior toward their patients. Despite development of codes of ethics for clinical practice, the occurrence of unethical behaviors toward patients is alarmingly high. The present study was conducted to identify the barriers to ethical treatment of patients in clinical environments. Methods: Through systematic narrative review, the present study investigated the barriers to ethical treatment of patients. This study was carried out in line with Assessment of Multiple Systematic Reviews 2 and Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines. Results: Ethical challenges in clinical environments can be classified into two categories: "organizational factors" and "personal factors." Organizational factors consist of three domains: managers and regulations, organizational environment, and human resources. Personal factors consist of two domains: factors related to patients and their families and factors related to care providers. Conclusion: Research shows that encouraging healthcare teams to adopt ethical behaviors through education and having them persistently observe ethics in their clinical practice will not completely bridge the gap between theory and practice: it seems that the clinical environment, the personal characteristics of healthcare team members and patients, and the organizational values of the healthcare system pose the greatest barrier to bridging this gap. Accordingly, in addition to raising healthcare providers' awareness of the existing issues in clinical ethics, measures should be taken to improve organizational culture and atmosphere.
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BACKGROUND: Aesthetics is a branch of philosophy that has been entered into the philosophy of education for a long time. Reviewing the concept of aesthetics in education, we can see the components that can cover a number of challenges in the field of patient education. Focusing on the conceptual dimensions obtained from the analysis of this concept, the aim is matching the resulting conceptual categories with the gaps in the field of patient education. MATERIALS AND METHODS: Using a scoping review, we reviewed the literature dealt with different dimensions of aesthetic-based education. Walker and Avant's concept analysis approach was used to inductively analyze the content obtained from the review of literature. The data were divided into three general groups of antecedents, attributes, and consequences of the aesthetic-based education concept, and the final conceptual model was defined. Interdisciplinary comparisons between educational and medical sciences were made to match the concept of aesthetic education with the field of patient education to cover its issues. During the scope review process of the texts, after screening the articles, 17 articles selected to enter the concept analysis stage. RESULT: Concept analysis phase showed that the main conceptual categories of antecedents of aesthetic-based education are aesthetic-based intrapersonal competencies and aesthetic capacities of educational setting. The attributes include aesthetic-based educational content and teaching methods including unity in diversity, combination with art and being based on empathy. The consequences include subliminal learning and constraint-free learning. These conceptual dimensions can cover four important issues in patient education including patient satisfaction, pedagogical competences of health educators, patient centeredness, and empathetic relationship. CONCLUSION: Applying aesthetic concept in the patient education process can bridge part of the gaps in this process. So, this study can be an introduction to future innovative models based on aesthetic paradigm in the field of patient education.
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BACKGROUND: According to the significance of patient education, new conceptual models are constantly required to promote pedagogical competences of health educators. In the field of educational sciences, aesthetic-based education is known as one of the effective types of curriculum planning which has shown many positive pedagogical outcomes. Thus, the researcher's assumption is that, the concept of "aesthetic education" could be transposed from educational sciences to health sciences in order to develop a new formula in the patient education process. The purpose of this study is to explain methods in detail, to develop an aesthetic-based patient education conceptual model through the concept derivation strategy. MATERIALS AND METHODS: 1. Scoping review and inductive data analysis using Walker and Avant's approach to achieve conceptual categories of the concept "aesthetic education." 2. Semi-structured qualitative interviews and directed content analysis to extract the main categories of the concept "aesthetics in the patient education process." 3. Drawing an aesthetic-based patient education conceptual model by allocating new conceptual components to each general step of the patient education process, including needs assessment, goal setting, implementation, and evaluation. 4. Modified Delphi technique to validate the final conceptual model. RESULTS: The first phase will represent the main categories and subcategories of attributes, antecedents, and consequences of "aesthetic education." The second phase will show the main categories and subcategories of attributes, antecedents, and consequences of the new concept named "aesthetic-based patient education." In the third phase, it is expected to achieve a new conceptual model representing the components of aesthetics in the general steps of the patient education process. The fourth phase will propose the final validated conceptual model. CONCLUSIONS: The provided study protocol can be a road map to developing derivative models through concept derivation strategy in health sciences.
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Objective. To investigate the effect of teach-back education on patient asthma control and family care pressure of patients with asthma. Methods. The present study is a clinical trial and the study population was patients referred to Shahid Faghihi and Shahid Motahhari clinics in Shiraz, Iran. 58 patients with asthma and their caregivers were randomly assigned to the intervention and control groups, for a total of 29 subjects in each group. In the intervention group: the teach-back method was delivered individually to the patient and his or her primary caregiver in three sessions of approximately 60 minutes at one-day intervals. each session included presentations, practical techniques and a booklet. In this study, patients and caregivers in the control group were not trained. Before the intervention, 4 and 8 weeks after the intervention, asthma control test and spirometry test were performed to evaluate asthma control; Also, before the intervention and 8 weeks after the intervention, Zarit test was performed to evaluate the care burden. Results. The findings of repeated measures tests showed that, compared to the control group, the intervention group obtained a greater increase in the vital capacity index (p=0.028) and in the disease control score (p=0.001), as well as a reduction in the burden of care on family members (p<0.001). Conclusion. The present study showed that teaching asthma related topics to the patient and her caregiver along with the follow-up and supervision of the nurse improves the asthma control of the patient and also reduces the caregiver pressure.
Objetivo. Investigar el efecto de la educación con el método teach-back sobre el control del asma y la carga del cuidado familiar de estos pacientes. Métodos. Ensayo clínico cuya población de estudio fueron los pacientes remitidos a las clínicas Shahid Faghihi y Shahid Motahhari en Shiraz, Irán. Se asignaron aleatoriamente 58 pacientes con asma y sus cuidadores a los grupos de intervención y control, con un total de 29 díadas en cada grupo. Las personas del grupo de intervención recibieron formación con el método teach-back que se impartió individualmente al paciente y a su cuidador principal en tres sesiones de aproximadamente 60 minutos en tres días consecutivos. Cada sesión incluía presentaciones, técnicas prácticas y un folleto. Los pacientes y cuidadores del grupo de control no recibieron formación. Antes de la intervención y a las 4 y 8 semanas después de la misma, se aplicaron las escalas de control del asma y la de Zarit para evaluación de la carga del cuidado y, además se practicó una espirometría. Resultados. Las pruebas de medidas repetidas entre los grupos de estudio mostraron que, comparando con el grupo control, el grupo de intervención obtuvo mayor aumento del índice de capacidad vital (p=0.028) y del puntaje de control de la enfermedad (p=0.001), además, se redujo la carga del cuidado en los familiares (p<0.001). Conclusión. El presente estudio mostró que con la enseñanza de temas relacionados con el asma al paciente y a su cuidador, junto con el seguimiento y la supervisión de la enfermera, se mejora el control del asma en el paciente y también se reduce la carga del cuidador.
Objetivo. Investigar o efeito da educação com o método teach-back sobre o controle da asma e a carga do cuidado familiar destes pacientes. Métodos. Ensaio clínico no qual a população de estudo foram os pacientes enviados às clínicas Shahid Faghihi e Shahid Motahhari em Shiraz, Irã. 58 pacientes com asma e seus cuidadores foram designados aleatoriamente aos grupos de intervenção e controle, com um total de 29 díade em cada grupo. As pessoas do grupo da intervenção receberam formação com o método teach-back que se transmitiu individualmente ao paciente e ao seu cuidador principal em três sessões de aproximadamente 60 minutos em três dias consecutivos. Cada sessão incluía apresentações, técnicas práticas e um folheto. Os pacientes e cuidadores do grupo de controle não receberam formação. Antes da intervenção e às 4 e 8 semanas depois dela, se aplicaram as escalas de controle da asma e a de Zarit para avaliação da carga do cuidado e, além disso se praticou uma espirometria. Resultados. As provas de medidas repetidas entre os grupos de estudo mostraram que, comparando com o grupo de controle, o grupo de intervenção obteve maior aumento do índice de capacidade vital (p=0.028) e da pontuação de controle da doença (p=0.001), ademais de que se reduziu a carga do cuidado nos familiares (p<0.001). Conclusão. O presente estudo mostrou que o ensino de temas relacionados com a asma ao paciente e ao seu cuidador, junto com o seguimento e a supervisão da enfermeira, se melhora o controle da asma no paciente e também se reduz a carga do cuidador.
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Humanos , Asma , Comunicação para Apreensão de Informação , Sobrecarga do Cuidador , EducaçãoRESUMO
Objective. To evaluate the effects of application of a manual on the improvement of alarms management in Intensive Care Units (ICU). Methods. This quasi-experimental study evaluated the effectiveness of the introduction into of a manual for alarm management and control in the ICU of a hospital in southeastern Iran. The intervention was a 4-hour workshop was on topics related to the adverse effects of alarms, standardization of ECG, oxygen saturation and blood pressure monitoring systems, and the use of ventilators and infusion pumps. Data were collected thorough 200 hours of observation of 60 ICU nurses (100 hours' pre-intervention and 100 hours' post-intervention). Response time, type of response, customization of alarm settings for each patient, the person responding to an alarm, and the cause of the alarm were analyzed. Alarms were classified into three types: false, true and technical. Results. The results showed a statistically significant difference between the pre- and post-intervention frequency of alarm types, frequency of monitoring parameters, customized monitoring settings for patients, and individuals who responded to alarms. The percentage of effective interventions was significantly higher for all parameters after the intervention (46.9%) than before the intervention (38.9%). Conclusion. The employment of a manual for management of alarms from electronic equipment in ICUs can increase the frequency of appropriate responses to alarms in these units.
Objetivo. Evaluar los efectos de la aplicación de un manual en el mejoramiento de la gestión de las alarmas en enfermeros las Unidades de Cuidados Intensivos -UCI-. Métodos. Estudio cuasi- experimental en el que se evaluó la efectividad de la introducción de un manual en la práctica para la prevención y el control de alarmas en una UCI de un hospital del sudeste de Irán. Se realizó un taller de 4 horas de duración que incluía temas relacionados con los efectos adversos de las alarmas, la estandarización en los sistemas de monitoreo de ECG, saturación de oxígeno y presión arterial, y del uso de ventiladores y de bombas de infusión. Se realizaron 200 horas de observación a 60 enfermeras de la UCI (100 horas antes y 100 horas después de la intervención). Se analizó el tiempo de respuesta, el tipo de respuesta, la personalización de los ajustes de la alarma para cada paciente, la persona que responde a una alarma y la causa de la alarma. Las alarmas se clasificaron en tres tipos: falsas, verdaderas y técnicas. Resultados. Los hallazgos mostraron diferencias estadísticamente significativas entre la frecuencia de los tipos de alarma antes y después de la intervención, la frecuencia de los parámetros de monitorización, los ajustes de monitorización personalizados para los pacientes y las personas que responden a las alarmas. El porcentaje de intervenciones efectivas para el total de parámetros fue significativamente mayor después de la intervención (46.9%) que antes de la misma (38.9%). Conclusión. Los resultados del estudio muestran que el empleo del manual para la gestión de las alarmas de los equipos electrónicos en una UCI puede aumentar la frecuencia de respuestas adecuadas de los enfermeros de estos servicios.
Objetivo. Avaliar os efeitos da aplicação de um manual na melhoria do gerenciamento de alarmes em enfermeiros de Unidades de Terapia Intensiva -UTI-. Métodos. Estudo quase-experimental no qual foi avaliada a eficácia da introdução na prática de um manual para prevenção e controle de alarmes em uma UTI de hospital no sudeste do Irã. Foi realizado um workshop de 4 horas que incluiu tópicos relacionados aos efeitos adversos dos alarmes, padronização dos sistemas de monitoração de ECG, saturação de oxigênio e pressão arterial e uso de ventiladores e bombas de infusão. Foram realizadas 200 horas de observação em 60 enfermeiras de UTI (100 horas antes e 100 horas após a intervenção). O tempo de resposta, o tipo de resposta, a personalização das configurações de alarme para cada paciente, a pessoa que responde a um alarme e a causa do alarme foram analisados. Os alarmes foram classificados em três tipos: falso, verdadeiro e técnico. Resultados. Os resultados mostraram diferenças estatisticamente significativas entre a frequência dos tipos de alarme antes e depois da intervenção, a frequência dos parâmetros de monitoração, configurações de monitoração personalizadas para pacientes e pessoas que respondem aos alarmes. O percentual de intervenções eficazes para todos os parâmetros foi significativamente maior após a intervenção (46,9%) do que antes (38,9%). Conclusão. Os resultados do estudo mostram que a utilização do manual para gerenciamento de alarmes de equipamentos eletrônicos em UTIs pode aumentar a frequência de respostas adequadas aos alarmes nos enfermeiros desses serviços.
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Humanos , Observação , Alarmes Clínicos , Unidades de Terapia Intensiva , Enfermeiras e EnfermeirosRESUMO
Objective. This work aimed to define and assess the parental competence of parents with autistic children. Methods. This study was conducted through a systematic review. The search was done in databases, including Cochrane Library, PubMed, CINAHL, Science Direct, Wiley Scopus, Pro Quest, Web of Science, Elsevier, Google Scholar, and Ovid by using keywords, like "children, autism, parenting, competence, and scale" from 1974 to 2019. Inclusion criteria were that the article should be quantitative, qualitative, and mixed-method studies in nursing, psychology, and medicine; the full text of the article should be available and the article should be in English or Persian. Results. Competence among these parents was affected by more factors and they reported lower competence compared to other parents. Moreover, only two instruments were available to assess parenting competence, which were not designed for parents of autistic children. Variables and factors affecting parenting competence has not been examined well in parents of children with autism, and no specialized instrument is available to evaluate parenting competence in parents with autistic children either. Conclusion. Although parental competence has been known as the main element to improve the quality of care, it has been studied restrictively from the viewpoints of the parents of children with autism. Therefore, the development of this concept is highly essential for clinical application and investigating its outcomes support.
Objetivo. Evaluar la competencia parental de los padres con hijos autistas. Métodos. Revisión sistemática narrativa. La búsqueda se realizó en las bases de datos de la Biblioteca Cochrane, PubMed, CINAHL, Science Direct, Wiley Scopus, ProQuest, Web of Science, Elsevier, Google Scholar y Ovid, mediante el uso de las palabras clave "niños, autismo, crianza, competencia y escala". Los criterios de inclusión fueron: artículos originales o de revisión publicados entre 1974 a 2019; estudios cuantitativos, cualitativos o de métodos mixtos en las disciplinas de enfermería, psicología o medicina, y estar disponible en texto completo en inglés. Resultados. La competencia de los padres de niños con trastorno del espectro autista fue menor en comparación con padres de niños sin este trastorno. Existen dos escalas para la evaluación de la competencia parental, pero no se diseñaron para su evaluación en padres de niños autistas. Los factores que afectan la competencia parental tampoco se han examinado exclusivamente para estos padres. Conclusión. Aunque se sabe que la competencia de los padres es un elemento primordial para mejorar la calidad del cuidado del niño con autismo, el tema se ha estudiado de manera restrictiva. Es necesario el desarrollo de este concepto para la aplicación en la práctica clínica y para la investigación de sus resultados.
Objetivo. Avaliar a competência parental dos pais com filhos autistas. Métodos. Revisão sistemática narrativa. A busca se realizou nas bases de dados da Biblioteca Cochrane, PubMed, CINAHL, Science Direct, Wiley Scopus, ProQuest, Web of Science, Elsevier, Google Scholar e Ovid, mediante o uso das palavras clave "crianças, autismo, criança, competência e escala". Os critérios de inclusão foram: artigos originais ou de revisão, publicados entre 1974 a 2019, ser estudos quantitativos, qualitativos ou de métodos mistos, nas disciplinas de enfermagem, psicologia ou medicina, e estar disponível em texto completo em inglês. Resultados. A competência dos pais de crianças com transtorno do espectro autista foi menor em comparação com pais de crianças sem este transtorno. Existem duas escalas para a avaliação da competência parental, mas não foram desenhadas para sua avaliação em pais de crianças autistas. Os fatores que afetam a competência parental tampouco se hão examinado exclusivamente para estes pais. Conclusão. Embora se sabe que a competência dos pais é um elemento primordial para melhorar a qualidade do cuidado da criança com autismo, o tema se há estudado de maneira restritiva. É necessário o desenvolvimento deste conceito para a aplicação na prática clínica e para a investigação de sus resultados.
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Humanos , Pais , Transtorno Autístico , Criança , Revisão SistemáticaRESUMO
Objective. Research on the nature of living with Irritable Bowel Syndrome. Methods. Qualitative study of the hermeneutical phenomenology, which conducted in-depth semi-structured interviews with people trained on the irritable bowel syndrome. The sampling was intentional type and open questions were used to collect data. The Thematic Analysis Method by Van Manen was used. Results. Two principal themes and five subthemes emerged in this research to determine the meaning of living with the irritable bowel syndrome: Storm in corporality (body with pain and affliction, tension and sequence of symptoms, and: distress during moments of life) and Relief (sense of liberation of the body symptoms, and moments with pleasure). Conclusion. The experience lived by patients with irritable bowel syndrome is of a transitory crisis and liberation.
Objetivo. Conocer la experiencia de vivir con el Síndrome del Intestino Irritable. Métodos. Estudio cualitativo de la fenomenología hermenéutica en el que se realizaron entrevistas semiestructuradas en profundidad a personas con diagnóstico de síndrome del intestino irritable. El muestreo fue de tipo intencional y se utilizaron preguntas abiertas para recopilar los datos. Se empleó el método de análisis temático de Van Mennen. Resultados. Dos temas principales y cinco subtemas emergieron en la presente investigación para determinar el significado de vivir con este síndrome: Tormenta en la corporalidad (cuerpo con dolor y aflicción, tensión y secuencia de síntomas, y: angustia en los momentos de la vida) y Alivio (sensación de liberación de los síntomas corporales, y momentos con placer). Conclusión. La experiencia vivida de pacientes con síndrome del intestino irritable es de una crisis transitoria y de liberación.
Objetivo. Investigar a natureza de viver com a Síndrome do Intestino Irritável. Métodos. Estudo qualitativo da fenomenologia hermenêutica na qual se realizaram entrevistas semiestruturadas em profundidade a pessoas com diagnóstico de síndrome do intestino irritável. A amostragem foi de tipo intencional e se utilizaram perguntas abertas para recopilar os dados. Se empregou o método de análises temático de Van Mennen. Resultados. Dois temas principais e cinco subtemas emergiram na presente investigação para determinar o significado de viver com a Síndrome do Intestino Irritável: Tormenta na corporalidade (corpo com dor e aflição, tensão e sequência de sintomas, e: angustia nos momentos da vida) e Alívio (sensação de liberação dos sintomas corporais, e momentos com prazer). Conclusão. A experiência vivida de pacientes com síndrome do intestino irritável é de uma crises transitórias e liberação.
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Humanos , Pesquisa Qualitativa , Síndrome do Intestino Irritável , HermenêuticaRESUMO
Objective. To investigate the relationship between knowledge management and creativity in undergraduate compared with master degree nursing students.Methods. This cross-sectional study was conducted with nursing students of the faculty of nursing and midwifery in an urban area in the southeast of Iran from August 2017 to January 2018. In this study, 180 students were selected using a simple random sampling method (Bachelor degree=120 and Master degree=60). Data was collected using the Nonaka and Takeuchi's knowledge management and Randsip's Creativity questionnaires. Results. There was a direct and significant relationship between knowledge management and creativity in the students (r=0.47 in Bachelor degree and r=0.36 in Master degree). The mean scores of knowledge management dimensions and creativity were higher in the master degree students. Conclusion. There was a relationship between knowledge management and creativity in the bachelorand master degree students. It is necessary to corroborate the Efforts for the implementation of strategies for the knowledge management in all its dimensions. Therefore, the education environment can help with the development of students' knowledge and skills.(AU)
Objetivo. Investigar la relación entre la gestión del conocimiento y la creatividad en los estudiantes de pregrado en comparación con los alumnos de Maestría de Enfermería. Métodos. Este estudio de corte transversal se realizó con estudiantes de la Facultad de Enfermería y Partería en un área urbana en el sureste de Irán. Para el efecto, se seleccionaron 180 alumnos mediante un método de muestreo aleatorio simple (pregrado=120 y maestría=60). Los datos se recolectaron utilizando la escala de gestión del conocimiento de Nonaka y Takeuchi y el cuestionario de Creatividad de Randsip. Resultados. Hubo una relación directa y significativa entre la gestión del conocimiento y la creatividad en los dos grupos de estudiantes (r=0.47 en Pregrado y r=0.36 en Maestría). Las puntuaciones medias de los instrumentos de gestión del conocimiento y de creatividad fueron más altas en los estudiantes de Maestría. Conclusión. Hubo una relación directa entre la gestión del conocimiento y la creatividad en los estudiantes de pregrado y Maestría en Enfermería, por lo tanto, el entorno educativo puede ayudar con el desarrollo del conocimiento y habilidades de los estudiantes (AU)
Objetivo. Investigar a relação entre a gestão do conhecimento e a criatividade nos estudantes de graduação em comparação com os estudantes de Mestrado de Enfermagem. Métodos. Este estudo de corte transversal se realizou com estudantes da Faculdade de Enfermagem e Parteira em uma área urbana no sudeste de Irão. Foram selecionados 180 alunos mediante um método de amostragem aleatório simples (graduação=120 e mestrado=60). Os dados se coletaram utilizando a escala de gestão do conhecimento de Nonaka e Takeuchi e o questionário de Criatividade de Randsip. Resultados. Houve uma relação direta e significativa entre a gestão do conhecimento e a criatividade nos dois grupos de estudantes (r=0.47 em graduação e r=0.36 em Mestrado). As pontuações médias dos instrumentos de gestão do conhecimento e de criatividade foram mais altas nos estudantes de Mestrado. Conclusão. Houve uma relação direta entre a gestão do conhecimento e a criatividade nos estudantes de graduação e Mestrado em Enfermagem, por tanto, o entorno educativo pode ajudar com o desenvolvimento do conhecimento e habilidades dos estudantes.(AU)