Randomized comparison of the effects of tailored text messaging versus pillbox organizers on medication adherence of heart failure patients.

BACKGROUND: Heart failure (HF) is a major public health issue worldwide, affecting approximately 64.3 million people in 2017. Non-adherence to medication is a common and serious issue in the management of HF. However, new reminder systems utilizing mobile technology, such as text messaging, have shown promise in improving medication adherence. The purpose of this study was to compare the impact of tailored text messaging (TTM) and pillbox organizers on medication adherence in individuals with HF. METHODS: A randomized controlled trial was conducted, involving 189 eligible patients with HF who were randomly assigned to either the TTM, pillbox organizer, or control group. Medication adherence was evaluated using pill counting and the Medication Adherence Rating Scale (MARS) over a period of three months and compared across the groups. The data were analyzed using Kruskal-Wallis, Analysis of Variance (ANOVA), and Repeated Measures ANOVA tests. RESULTS: The results indicate that both the TTM and pillbox organizers groups had significantly higher medication adherence compared to the control group, as measured by pill counting (MD = 0.05, 95%CI = 0.03-0.06; p < 0.001 for TTM group, MD = 0.04, 95%CI = 0.03-0.06; p < 0.001 for pillbox organizers group) and the MARS (MD = 1.32, 95%CI = 0.93 to 1.72; p < 0.001 for TTM group, MD = 1.33, 95%CI = 0.95 to 1.72; p < 0.001 for pillbox organizers group). However, there was no statistically significant difference in medication adherence between the two intervention groups using either measurement method. The TTM group exhibited a lower hospitalization rate than the other groups in the first follow up (p = 0.016). CONCLUSIONS: Both the TTM and pillbox organizers were shown to be effective in enhancing medication adherence among patients with HF. Therefore, healthcare providers should take into account the patient's condition and preferences when selecting one of these methods to promote medication adherence. Future research should aim to address the limitations of this study, such as controlling for confounding variables, considering long-term effects, and comparing the effectiveness of different interventions.

Complicated grief and related factors among nursing staff during the Covid-19 pandemic: a cross-sectional study.

BACKGROUND: The challenging working conditions during the Covid-19 pandemic created a perfect storm that can seriously impact nurses' physical and psychological well-being. Our study aimed to investigate complicated grief and its related factors among nursing staff during the Covid-19 pandemic. METHODS: This is a cross-sectional study. The participants comprised 375 nurses selected by the convenience sampling method from designated wards for patients with Covid-19 in 3 hospitals in Tabriz, Iran. Participants completed a survey containing demographic and clinical questions, the Inventory of Complicated Grief, and the Multidimensional Scale of Perceived Social Support. Multiple regression analysis was used to identify the associates of nurses' grief. The STROBE guidelines were followed in reporting the study's findings. RESULTS: A significant proportion of participants (57.6%) were found to be suffering from complicated grief. Gender, educational background, type of ward, type of nursing role, type of working shift, years of nursing work experience, and experience working in the Covid-19 settings remained the significant associates of nurses' grief in the regression analysis. CONCLUSION: Due to frequent exposure to patients' deaths, healthcare providers are at increased risk of suffering from complicated grief during the Covid-19 and post-pandemic. If it remains unresolved, complicated grief can result in significant health problems and the experience of burnout among nurses. Governments, health authorities, and nursing managers should support nurses who work in Covid-19 settings to reduce the adverse impact of the pandemic on nurses' health and well-being.

Nurses' knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus.

BACKGROUND: The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses' role in nutritional management of diabetes. This study aimed to evaluate nurses' knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes. METHODS: This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses' KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis. RESULTS: The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses' attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008). CONCLUSION: Nurses' knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

Effectiveness of implementing of an infection control link nurse program to improve compliance with standard precautions and hand hygiene among nurses: a quasi-experimental study.

BACKGROUND: Standard precautions (SPs) including hand hygiene are considered fundamental protective measures to manage health care-associated infections (HCAIs) and to reduce occupational health hazards. The purpose of this research was to examine the effectiveness of an infection control link nurse (ICLN) program on compliance with SPs and hand hygiene among nurses. METHODS: A quasi-experimental study with a pretest-post-test design was conducted with participating of 154 clinical nurses who worked in different wards of a tertiary referral teaching hospital in Iran. The intervention group (n = 77) had 16 infection control link nurses nominated. The control group (n = 77) received only the standard multimodal approach used in the hospital. Pre- and post-test assessment of compliance with standard precautions and hand hygiene compliance was performed via the Compliance with Standard Precautions Scale (CSPS) and the World Health Organization observational hand hygiene form. Two independent sample t-tests were used to examine differences between Compliance with Standard Precautions and hand hygiene Compliance among nurses in intervention and control group. Multiple linear regression analysis was used to assess the effect size. RESULTS: After developing and implementing the infection control link nurse program, no statistically significant improvement was found in the Compliance with Standard Precautions (ß = 5.18; 95% CI= -0.3-10.65, p = 0.064). An improvement in hand hygiene compliance was observed among nurses in the intervention group that improved statistically significant from 18.80% before the program to 37.32% 6 months after the program (ß = 20.82; 95% CI 16.40-25.25, p < 0.001). CONCLUSIONS: Given the continuing level of interest that exists in improving health care workers' hand hygiene practices, the findings of this study provide significant practical implications for hospitals seeking to improve compliance with hand hygiene among nurses, showing the effectiveness of using infection control link nurse program. Further research is needed to assess effectiveness of using infection control link nurse program to improve compliance with standard precautions.

Effects of early mobilization on pulmonary parameters and complications post coronary artery bypass graft surgery.

This study compared the effects of a four-phase and a three-phase early mobilization protocol on respiratory parameters and complications in patients following coronary artery bypass graft surgery. This is a three-arm, parallel-group, randomized controlled clinical trial with 120 candidates for coronary artery bypass graft surgery. Participants were randomly allocated to three groups: four-phase early mobilization protocol, three-phase early mobilization protocol, and control. Arterial blood gases, oxygen saturation, and incidence of pulmonary complications were compared among the groups. Mean arterial blood gases and oxygen saturation improved significantly over time in both four-phase early mobilization protocol and three-phase early mobilization protocol groups compared to control (p < 0.05). There were observed trends for greater improvements in the study outcomes with three-phase early mobilization protocol than four-phase early mobilization protocol; however, did not reach statistically significant levels. The incidence of pulmonary complications was significantly in both intervention groups compared to control (odds ratio: 0.48, 95 % CI 0.007-0.537; p < 0.001). Both four-phase early mobilization and the three-phase early mobilization protocols improved respiratory parameters and reduced pulmonary complications. Statistically insignificant trends were found trends in the three-phase early mobilization protocol, focusing on chest physiotherapy and breathing exercises.

Comparison of early mobilization protocols on postoperative cognitive dysfunction, pain, and length of hospital stay in patients undergoing coronary artery bypass graft surgery: A randomized controlled trial.

Although coronary artery bypass graft (CABG) surgery improves the life expectancy of patients with coronary artery disease, it is associated with various short and long-term complications. Early mobilization has been shown to reduce the risk of these complications. This study aimed to compare the effectiveness of different early mobilization protocols on postoperative cognitive dysfunction (POCD), pain intensity, and length of hospital stay (LOS) in patients undergoing CABG. This three-arm parallel randomized controlled trial included 120 patients undergoing CABG surgery who were randomly assigned to Intervention A, which received a four-phase early mobilization protocol; Intervention B, which received a three-phase early mobilization protocol; and the Control group, which received routine care. Postoperative cognitive dysfunction and pain were assessed using Mini Mental State Examination (MMSE) and visual analog scale (VAS), respectively. Groups were comparable in demographic and clinical characteristics and postoperative cognitive dysfunction at baseline. After the intervention, Group B had statistically significantly (p < 0.001) less cognitive dysfunction (25.8 ± 1.7) compared to Group A (24.1 ± 2.2) and the Control Group (23.4 ± 2.7). Likewise, hospital stay was statistically (p < 0.01) shorter for Group B (7.7 ± 1.5) than the Control group (8.9 ± 1.9). However, the experience of pain was statistically significantly lower over time in Group A than in the other groups (p < 0.001). This study concludes that an early mobilization protocol based on deep breathing exercises and chest physiotherapy may better improve postoperative cognitive dysfunction and length of hospital stay than an early mobilization protocol based on passive and active range of motion activities or routine care.

Symptom recognition and treatment-seeking behaviors in women experiencing acute coronary syndrome for the first time: a qualitative study.

BACKGROUND: Women are more likely to delay medical help-seeking for ACS symptoms. Understanding patients' experience of the symptoms and their response is essential in improving help-seeking behaviors and timely diagnosis and treatment for ACS. This study aimed to explore women's experience of ACS, their response to the symptoms, and treatment-seeking decisions. METHODS: This qualitative descriptive study was conducted in a tertiary referral specialized heart hospital affiliated with Tabriz University of Medical Sciences, Iran. Participants included 39 women who had experienced ACS for the first time. RESULTS: Four main themes emerged from the analysis of interview transcripts: (1) the onset of symptoms, (2) the types of symptoms, (3) response to symptoms and (4) arriving at the hospital. These themes and associated sub-themes explained women's experience of ACS symptoms, their response to the symptoms, and decision to seek medical help. CONCLUSIONS: This study identified and discussed factors contributing to the prehospital delay in women and their decision-making to seek medical care for ACS symptoms. The results are consistent with previous research indicating that ACS symptoms in women are somewhat different from men, and women tend to underestimate their symptoms and attribute them to non-cardiac causes. Women should be supported to develop awareness and understanding of ACS symptoms and appreciate the importance of early treatment-seeking in the disease outcomes.

Cesarean delivery in Iran: a population-based analysis using the Robson classification system.

BACKGROUND: The rise of Cesarean Sections (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector. OBJECTIVE: To analyze the CS rates in the last 2 years using the Robson Classification System in Iran. METHODS: A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported. RESULTS: Two million three hundred twenty-two thousand five hundred women gave birth, 53.6% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.4%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.6 and 10.8%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.2 and 33.1%, respectively. "Fetal Distress" and "Undefined Indications" were the most common reasons for cesarean deliveries at CS rates of 13.6 and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10. CONCLUSION: The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity units, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes.

Nurse preceptors' perceptions of benefits, rewards, support, and commitment to the preceptor role in a new preceptorship program.

BACKGROUND: Nurse preceptorship is a new concept emerging in the Iranian health care system. The purpose of this research was to assess preceptor nurses' perceived benefits, rewards, support, and commitment to the role in a new nurse preceptorship program in Iran and to examine the relationships between these concepts. METHODS: A descriptive correlational study was employed, and using total population sampling method, 45 preceptor nurses were recruited from a tertiary referral teaching hospital in Iran. Data were collected using the Preceptor's Perception of Benefits and Rewards Scale, the Preceptor's Perception of Support Scale, and the Commitment to the Preceptor Role Scale. Descriptive statistics and correlational analysis were used to analyse data. RESULTS: Preceptors' commitment to their role was positively and moderately associated with their perceived benefits and rewards (r = 0.503, p = 0.001) and perceived support (r = 0.430, p = 0.003). None of the examined demographic and practice variables showed statistically significant association with commitment to the preceptor role. CONCLUSIONS: Commitment to the preceptor role was associated with benefits, rewards and support that preceptor nurses perceive in relation to their role. To optimise the effectiveness of nurse preceptorship programs, benefits, rewards, recognition, and support should be integral to planning of these programs.

Illness acceptance, medication adherence and the quality of life in patients with heart failure: A path analysis of a conceptual model.

Heart failure (HF) is a chronic disease that negatively affects different aspects of the patients' lives, diminishing their quality of life. This research studied factors that impact the health-related quality of life (HRQoL) of patients with HF, particularly medication adherence and acceptance of illness. In this cross-sectional study, data were collected from 273 patients admitted to a tertiary hospital with the diagnosis of HF. Participants' level of illness acceptance, medication adherence, and HRQoL were assessed using validated questionnaires, and data were analyzed using the regression path analysis. There was found a moderate level of acceptance of illness (24.9 ± 6.79) and low levels of medication adherence (3.44 ± 3.15) and HRQoL (53.81 ± 17.99) among participants. Gender, education, income, history of coronary artery bypass (CABG), the New York Heart Association (NYHA) class, acceptance of illness, and medication adherence were statistically significantly associated with HRQoL. Patients with diminished HRQoL were more likely to be female, less educated, have lower income, higher NYHA class, no prior CABG, low medication adherence, and low level of acceptance of illness. The final path model demonstrated a good fit with the data (χ^2/df = 1.70, CFI = 0.92, RMSEA = 0.05, and p = 0.01). Health care providers should target and promote medication adherence and the acceptance of illness as modifiable factors to help improve the HRQoL of patients with HF.

The association between cigarette smoking attitudes and social capital among Iranian health and medical students: a cross-sectional study.

BACKGROUND: Smoking remains a leading public health challenge globally. As a psychosocial determinant of health, social capital can influence health attitudes and behaviors, and thus it may have the capacity to reduce smoking rates. The aim of this research was to examine the association between social capital and attitudes towards smoking among university students. METHODS: This cross-sectional study was conducted among 538 health and medical students, recruited using the proportionate sampling method. Participants' social capital and attitudes toward smoking were assessed using the social capital questionnaire (SCQ) and the scale of cigarette smoking attitude (CSA). Data were analyzed using descriptive statistics, Pearson correlation coefficient, and the multiple regression analysis. RESULTS: About one in four health and medical students reported smoking, either currently or in the past, and 30% had either positive or indifferent attitudes towards smoking. The mean scores of the SCQ and the CSA were 105.1 ± 19.7 and 48.6 ± 11.2, respectively. There was a statistically significant negative association between the SCQ and the CSA scores (r = - 0.24; p < 0.001). In the regression analysis, the SCQ scores were also negatively and statistically significantly associated with the CSA scores, after controlling potential confounders (B: -0.09; 95% CI: - 0.13 to - 0.004). CONCLUSIONS: As future healthcare providers, who are expected to take the primary role in reducing smoking rates in the community, health and medical students should be supported to develop appropriate attitudes towards smoking. Promoting positive social capital among university students has the capacity to improve their attitudes towards smoking. Possessing negative attitudes towards smoking should hopefully reduce smoking behaviors among future health professionals and improve their participation in anti-smoking campaigns.

Factors associated with return to work following myocardial infarction: A systematic review of observational studies.

OBJECTIVES: To identify and critically synthesise literature on return to work of patients following a myocardial infarction and to identify factors that are associated with this. BACKGROUND: Understanding when patients return to work after myocardial infarction and what factors are associated with this may be helpful in designing person-centred treatment plans to facilitate patients' rehabilitation and return to work. DESIGN: A narrative systematic review. REVIEW METHODS: Six databases, MEDLINE, CINAHL, Academic Search Complete, EMBASE, SCOPUS and ProQuest Health and Medicine, and the search engine Google were searched to retrieve peer-reviewed articles published in English from January 2008-January 2020. In total, 22,217 papers were sourced and screened, with 18 papers retained for quality appraisal using the Joanna Briggs Institute Critical Appraisal Tools. RESULTS: The mean time to return to work varied between 46-192 days; about half the participants resumed work by 3 months. Patients who were male, younger, educated, non-manual workers or owned their own business, and those who evaluated their general and mental health highly, and had shorter hospitalisation, fewer comorbidities, complications and mental health issues were more likely to return to work after myocardial infarction. RELEVANCE TO CLINICAL PRACTICE: Findings may help nurses detect patients at increased risk of failure to return to work and provide appropriate support to facilitate this.

Effects of a Life Skills-Based Intervention on Mental Health of Adolescents and Young Adults With Type 1 Diabetes.

The current study examined the effectiveness of a life skills training intervention on the psychological health of adolescents and young adults with type 1 diabetes. This quasi-randomized controlled trial recruited 80 individuals from the West Azerbaijan Diabetes Community in Urmia, Iran. Participants were randomly allocated to intervention (n = 40) or control (n = 40) groups. The intervention group received nine sessions of life skills training, and the control group received routine care only. Data collection tools included a demographics questionnaire and the Depression, Anxiety, and Stress Scale. Compared to the control group, intervention group participants achieved statistically significant improvements in their physiological health, including stress (p < 0.04), anxiety (p < 0.04), and depression (p < 0.03). Nurses, including diabetes educators, should assess patients with diabetes for psychological complications and consider empowering adolescents and young adults with diabetes through life skills training, which can be incorporated into diabetes management plans to promote health and well-being. [Journal of Psychosocial Nursing and Mental Health Services, 59(10), 41-47.].

Medication adherence and predictive factors in patients with cardiovascular disease: A cross-sectional study.

Adherence to cardiac medications makes a significant contribution to avoidance of morbidity and premature mortality in patients with cardiovascular disease. This quantitative study used cross-sectional survey design to evaluate medication adherence and contributing factors among patients with cardiovascular disease, comparing patients who were admitted to a cardiac ward (n = 89) and those attending outpatient cardiac rehabilitation (n = 31) in Australia. Data collection was completed between October 2016 and December 2017. Descriptive and regression analyses were conducted to identify medication adherence and determine factors independently predictive of medication adherence. Participants from cardiac rehabilitation had significantly lower adherence to cardiac medications than those recruited from the cardiac ward (58.1 vs 64.0%, respectively). Self-efficacy was significantly associated with participants' medication adherence in both groups. The ability to refill medications and beliefs about cardiac medications were independently significantly predictive of cardiac medication adherence. These findings indicate areas where clinical nurses could expand their role to improve cardiac patients' medication self-management.

Domestic violence and suicide attempts among married women: A case-control study.

AIMS AND OBJECTIVES: To investigate the impact of domestic violence-related factors on suicide attempt in married women. BACKGROUND: Suicide is a global public health concern that poses significant burden on individuals, families and communities. There is limited research on factors predicting suicide attempt in women. DESIGN: A retrospective case-control design was adopted. METHODS: Using a convenience sampling method, 610 participants, admitted to a teaching referral hospital in Northwest of Iran, were recruited to the study and assigned to case or control groups based on whether or not they had attempted suicide. The participants in two groups were matched in the terms of important demographic characteristics. Domestic violence-related factors were considered as independent variables and suicide attempt as dependent variable. Descriptive statistics, and simple and multivariate logistic regression analysis were used to analyse the data. Odds ratios (OR) of domestic violence-related factors were compared between the groups. We used STROBE checklist as an EQUATOR in this study. RESULTS: The mean age of participants in the case and control groups was 28.4 and 29.45 years, respectively. The infidelity was the strongest predictor of suicide attempt in women (OR 44.57, 95%CI 6.08-326. 63, p < 0.001), followed by being threatened to physical assault by husband (OR 37.01, 95%CI 11.54-118.67, p < 0.001), jealousy of husband (OR 23.46, 95%CI 11.63-47.30, p < 0.001), and previous attempts to divorce (OR 16.55, 95%CI 5.91-46.31, p < 0.001). Suicide attempt was significantly lower in women who reported a sense of peace in life or lived with their mother or father-in-law (p < 0.001). CONCLUSIONS: To reduce the risk of suicide in women, violence against women should be condemned and appropriate prevention measures be taken by health professionals. RELEVANCE TO CLINICAL PRACTICE: Recognising risk, assessment and referral of victims of domestic violence should be an integral part of healthcare systems.

The risk of cardiovascular disease in women with a history of miscarriage and/or stillbirth.

Cardiovascular disease (CVD) remains the main cause of morbidity and mortality in women worldwide. Apart from the well-established risk factors, some adverse pregnancy outcomes have been found to be associated with increased risk of CVD in women. We reviewed the literature on the risk of CVD in women with a history of pregnancy loss (miscarriage and/or stillbirth). Electronic databases including MEDLINE and CINAHL were searched for English language articles published from 2000 to July 2016. Following the application of study inclusion and exclusion criteria, we selected seven studies for review. Women with history of miscarriage and/or stillbirth are more likely to develop coronary heart disease (CHD), but not stroke in their later life compared with women without these conditions. The risk is particularly greater in women with multiple miscarriages or stillbirths. Health professionals should be aware of the risk associated with miscarriage and stillbirth, and use maternal history to identify, refer, closely monitor, and engage these high risk women in healthy lifestyle and risk factor modification programs.

Sleep Quality During and After Cardiothoracic Intensive Care and Psychological Health During Recovery.

BACKGROUND: Intensive care patients experience poor sleep quality. Psychological distress and diminished health-related quality of life (HRQOL) are also common among former intensive care unit (ICU) patients. Coronary artery bypass graft (CABG) surgery is a frequent reason adults require treatment in ICU. The effect of on- versus off-pump surgery on sleep and recovery has not been reported. OBJECTIVE: The aim of this study was to assess sleep quality of CABG patients during and after ICU, psychological well-being, HRQOL during recovery, and whether on- versus off-pump surgery affects sleep and recovery. METHODS: Data were collected in the ICU and hospital ward, and 2 and 6 months after hospital discharge using validated self-report questionnaires. RESULTS: The sample (n = 101) had a mean age of 66.6 ± 11.1 years, was 79% male, and had a median ICU stay of 2 (2-4) days and a mean body mass index of 27.3 ± 4.3; 75% underwent on-pump surgery. Poor sleep was reported by 62% of the patients at 6 months and by 12% of the patients at all time points. Off-pump CABG patients had fewer posttraumatic stress symptoms (P = .02) and better physical HRQOL (P = .01). In multivariate analysis, prehospital insomnia (P = .004), and physical (P < .0005) and mental (P < .0005) HRQOL were independently associated with sleep quality at 6 months. There was no association between on- versus off-pump CABG and sleep quality at 6 months. CONCLUSIONS: Sleep quality of postoperative CABG patients was poor in the ICU and hospital ward and up to 6 months after discharge from the hospital. Poor sleep quality at 6 months was associated with prehospital insomnia, and physical and mental HRQOL at 6 months, but not with on- versus off-pump surgery.

Factors influencing nurses' knowledge acquisition of diabetes care and its management: A qualitative study.

AIM: To identify and explore the factors nurses perceive as influencing their knowledge acquisition in relation to diabetes care and its management in Saudi Arabia. BACKGROUND: Diabetes continues to pose major healthcare challenges despite advances in diabetes management. Nurses have a crucial role in diabetes care, but diabetes knowledge deficits deter effective collaboration with other healthcare providers in educating patients about diabetes self-management. DESIGN: An exploratory descriptive qualitative design. METHOD: This qualitative study recruited 16 nurses from different specialty areas at a tertiary hospital in Saudi Arabia. Data were obtained through semistructured interviews and analysed using thematic analysis. RESULTS: Three main themes emerged: (a) diabetes care and education, (b) barriers affecting nurses' acquisition of diabetes knowledge and (c) factors to support nurses' acquisition of diabetes knowledge. CONCLUSION: To pursue the goal of continued improvement in diabetes management in the challenging settings of acute care, there is a need to develop good practice in diabetes care among nursing professionals. Understanding of the complexity of factors that influence nurses' knowledge acquisition in relation to diabetes care and its management provides clinical nurses and nursing managers with directions for future education, policy development and research. RELEVANCE TO CLINICAL PRACTICE: A range of suggestions are proposed to support the development of nursing education and practice in diabetes, including organisational and individual-level strategies to offer and enable access to education programmes to maintain up-to-date knowledge and skills in diabetes and effective communication for optimal diabetes self-management.

Examining perceived and actual diabetes knowledge among nurses working in a tertiary hospital.

BACKGROUND: With the worldwide increase in the incidence and prevalence of diabetes, there has been an increase in the scope and scale of nursing care and education required for patients with diabetes. The high prevalence of diabetes in Saudi Arabia makes this a particular priority for this country. AIM: The aim of this study was to examine nurses' perceived and actual knowledge of diabetes and its care and management in Saudi Arabia. METHODS: A convenience sample of 423 nurses working in Prince Sultan Medical Military City in Saudi Arabia was surveyed in this descriptive, cross-sectional study. Perceived knowledge was assessed using the Diabetes Self-Report Tool, while the Diabetes Basic Knowledge Tool was used to assess the actual knowledge of participants. RESULTS: The nurses generally had a positive view of their diabetes knowledge, with a mean score (SD) of 46.9 (6.1) (of maximum 60) for the Diabetes Self-Report Tool. Their actual knowledge scores ranged from 2 to 35 with a mean (SD) score of 25.4 (6.2) (of maximum of 49). Nurses' perceived and actual knowledge of diabetes varied according to their demographic and practice details. Perceived competency, current provision of diabetes care, education level and attendance at any diabetes education programs predicted perceived knowledge; these factors, with gender predicted, with actual diabetes knowledge scores. CONCLUSION: In this multi-ethnic workforce, findings indicated a significant gap between participants' perceived and actual knowledge. Factors predictive of high levels of knowledge provide pointers to ways to improve diabetes knowledge amongst nurses.

Barriers to intensive care unit nurses' autonomy in Iran: A qualitative study.

BACKGROUND: The acute nature of the intensive care unit (ICU) environment necessitates that urgent clinical decisions are frequently made by the health care team. Therefore, it is important that critical care nurses have the authority to make decisions about their patient care. PURPOSE: The purpose of this study was to explore perceived barriers to the practice of professional autonomy from the perspectives of ICU nurses in Iran. METHODS: In this qualitative study, 28 critical care nurses were interviewed using a semistructured in-depth interview method. The interviews were recorded, transcribed verbatim, and analyzed using content analysis. DISCUSSION: Data analysis led to identification of two main themes and five subthemes: (a) the profession-related barriers with two associated subthemes of "lack of capacity to exercise autonomy" and "lack of strong professional bodies"; (b) organizational barriers with the associated subthemes of "role ambiguity," "a directive rather than supportive workplace," and "lack of motivation." CONCLUSION: ICU nurses in Iran may face many challenges in gaining professional autonomy. The identified inter- and intraprofessional barriers to the exercise of autonomy need to be addressed to promote critical thinking, job satisfaction, and motivation of ICU nurses, which can in turn lead to improved patient outcomes.