Factors Affecting the Use of Physical Restraints by Nurses for Patients in Intensive Care Units.

How to cite this article: Shakeri B, Vatandost S, Nouri B, Valiee S. Factors Affecting the Use of Physical Restraints by Nurses for Patients in Intensive Care Units. Indian J Crit Care Med 2023;27(5):372-373.

Nursing faculty's point of view regarding noncompliance with ethics in academic environments: a qualitative study.

BACKGROUND: An academic environment is the first place that nursing students are introduced to ethics related to nursing and healthcare. In this study, we explored the nursing faculty members' point of view regarding noncompliance with these academic ethics. METHODS: This study was a qualitative descriptive study conducted in 2018. Faculty members at a nursing school were selected through purposeful sampling. Data was collected using semi-structured interviews. The interviews were digitally recorded and transcribed verbatim. Data collection and data analysis were conducted simultaneously. Data saturation was ensured with 11 interviews. The interview transcripts were analyzed using a qualitative content analysis method introduced by Elo and Kyngäs. RESULTS: The participants were six women and five men with 12.72 ± 6.64 years of experience as nursing instructors. After data analysis, seven categories were identified: discrimination, violence, misuse, out-of-date instruction and knowledge, conflicts of evaluation, hypocrisy, and disorganization. CONCLUSION: The findings of this study indicated the existence of noncompliance regarding academic ethics. It is recommended that faculty members be informed about possible instances of ethical noncompliance in academia. There is a need to develop strategies to promote a faculty's compliance with academic ethics. Academic administrators need to emphasize the importance of ethics in academia and use further methods to enhance academic ethics.

Exploration of service recipients' image of a perfect nurse: A qualitative descriptive study.

AIM: The aim of this study was to explore the image of the perfect nurse from service recipients' perspective. BACKGROUND: The public image of nursing is one of the long-term challenges of this profession. Specific cultures affect the views and satisfaction of nursing service recipients. METHODS: This study was a qualitative descriptive study conducted in 2018. Purposive sampling was used and continued until saturation. Twelve semi-structured interviews were conducted with service recipients who had experience in using nursing services in the past six months. Participants were 5 men and 7 women. Interviews transcript verbatim and analyzed by qualitative content analysis. RESULTS: Four themes emerged from the perspective and experience of the participants concerning perfect nurse including the followings: affable (compassionate, sympathetic and good-tempered), responsive (answering questions, answering requests), tower of strength (listener, being patient, understanding and attention) and efficient (providing careful care, providing timely care, providing proper care). CONCLUSION: From the participants' perspective, a perfect nurse should be responsive to the patient and be well-mannered and patient with them in addition to providing expert care. Therefore, nurses should not only improve their skills in providing care but also focus on the communication dimension and respond to the patients. Identifying communication barriers with the clients in the context of the study is also suggested.

Nurses' experience of providing ethical care following an earthquake: A phenomenological study.

BACKGROUND: Ethical care provided by nurses to earthquake victims is one of the main subjects in nursing profession. OBJECTIVES: Given the information gap in this field, the present study is an attempt to explore the nurses' experience of ethical care provided to victims of an earthquake. RESEARCH DESIGN AND METHOD: A hermeneutic phenomenological study was performed. The participants were 16 nurses involved in providing care to the injured in Kermanshah earthquake, Iran. They were selected using purposeful sampling, and in-depth and semi-structured interviews were carried out. The transcribed interviews were analyzed based on the hermeneutic approach using the analysis method proposed by Diekelmann et al. ETHICAL CONSIDERATIONS: The study was approved by the Research Council and Ethics Committee of Urmia University of Medical Sciences, Iran. FINDINGS: Data analyses revealed four themes and 10 sub-themes that illustrated nurses' experience of ethical care during earthquake. The themes were (1) Respecting humanistic values (sacrifice, stepping beyond task description, and voluntary work), (2) Commitment to ethics (honesty, confidentiality, and trustworthiness), (3) Respecting dignity of victims (respecting cultural values, maintaining privacy, having humanistic perspective, and effective communication), and (4) Spiritual support (helping patients to do religious rituals Psychological support). CONCLUSION: The results showed the nurses' experience with providing care to earthquake victims. The findings underlined ethics and ethical values in providing nursing care during disasters. It is suggested that special courses on the importance of nursing ethics in critical situations be incorporated into nursing curriculums and in-service educations.

Effect of Interventional Educational Programs on Intensive Care Nurses' Perception, Knowledge, Attitude, and Practice About Physical Restraints: A Pre-/Postclinical Trial.

The article reports results of an educational program designed to modify negative attitudes of intensive care nurses regarding the use of physical restraints. Findings revealed that increased knowledge about appropriate utilization of various types of restraints positively impacted perceptions, attitudes, and patient care practices. Authors also explore restraint use in several countries and identify variations in use of restraining methods.

Clinical Instructors' Experience of Managing Students' Errors: A Qualitative Study.

Given the importance of patient safety, this study aimed to explore clinical instructors' experience of managing students' errors. A qualitative approach was adopted to conduct semistructured interviews with 12 clinical nursing and midwifery instructors. Three main categories emerged: prevention (orienting, review of the knowledge, repeating procedure by instructor, checking steps prior to performing procedure, and reminding), action (correcting, monitoring and follow-up, and informing), and feedback (cause analysis, notifying, and affecting assessment). Patient safety and error management programs should be included in the nursing curriculum and nursing education.

A Clinical Trial of the Effect of Warm Intravenous Fluids on Core Temperature and Shivering in Patients Undergoing Abdominal Surgery.

PURPOSE: This study was conducted to investigate the effect of warm intravenous fluids on shivering and core temperature of patients undergoing abdominal surgery. DESIGN: This study was a two-group clinical-control trial. METHODS: Ringer's solution at normal room temperature and serum at 38°C were infused in the control and intervention groups, respectively. Shivering, core temperature, SpO2, and vital signs were measured at admission to the operating room and postanesthesia care unit (PACU) and 30 minutes after the admission to the PACU. FINDINGS: There was a significant difference between the two groups in terms of shivering, core temperature, and pulse rate at the time of admission to the PACU and 30 minutes after. CONCLUSIONS: Ringer's solution at 38°C instead of room temperature can be used to reduce the incidence of postanesthetic hypothermia and shivering in patients undergoing abdominal surgery. Using this method in addition to other nursing care is recommended preoperatively.

Status of Violence in a Selected Faculty: The Students' Experience.

The present study is aimed at examining the status of violence among the students of nursing, midwifery, and operating room. A self-reporting questionnaire with two sections of demographic characteristics and experience of violence was used. The data obtained were analyzed, using SPSS software. 58.7 percent of the students had a history of violence in the previous year. The maximum percentage of violence exposure belonged to the students of operating room (76.9%). The highest incidence of violence was verbal (76.4%), happened in patients' rooms (32.9%) and was in the form of insult (75.1%). Accordingly, preventive actions are required to prevent and control violence and support students. Informing students about violence, communicative skills, reaction, and coping with violence during studying is necessary. Therefore, educational authorities and theoretical and clinical instructors should take appropriate measures in order to prevent violence and create supportive mechanisms for the students.

Nurses' Error Management in Critical Care Units: A Qualitative Study.

Nursing errors are common in critical care units, and nurses are in the first line of confrontation. The purpose of this study was to explore the processes of managing nursing errors in critical care units in Iran and to develop a theoretical explanation of the phenomenon. This was a grounded theory study. We recruited a sample of 18 critical care nurses for the study. The sampling method was purposive and then changed to theoretical. The data were collected through in-depth interviews. For data analysis, we employed the constant comparative analysis technique. The core category of the study was "continuous situational analysis." The main categories were situational analysis and error removal. When nurses confronted an error, they opted for analyzing the error situation in terms of the nature of error, probable consequences, monitoring, and life threat. Accordingly, they employed error removal strategies such as self-action, cooperation, notifying, and censoring. These steps happened concurrently, successively, or cyclically. To manage their committed errors, nurses usually go through an informal process. Nurse-managers need to design effective error management strategies and require the practicing nurses to adhere to them. A practical model for effective prevention and management of nursing errors in critical care units is necessary.

Effectiveness of a psychoeducation program on the quality of life in patients with coronary heart disease: A clinical trial.

AIM: The present study was conducted to evaluate effectiveness of a psychoeducation program (PEP) on the quality of life in patients with coronary heart disease (CHD). BACKGROUND: CHD affects patients' quality of life. PEPs may be useful to help patients reach maximum functional health. METHODS: A pretest-posttest controlled clinical trial was conducted on a study population of 70 CHD patients, who were selected through convenience sampling and randomly allocated to either the intervention or the control group. The MacNew Quality of Life Questionnaire in heart disease was completed by participants twice: first as a pretest, and then in a follow-up posttest. RESULTS: After the intervention, the quality of life (QOL) score was 157.97±25.51 in the intervention group and 105.03±8.38 in the control group, making for a significant difference (p<0. 05). CONCLUSION: Based on the findings, PEPs helped CHD patients improve their quality of life through reducing tension, relieving their negative emotions, and improving their social relationships.

Critical care nurses' perception of nursing error and its causes: a qualitative study.

Nurses' perceptions of nursing error could affect their professional practice. The aim of the study was to explore critical care nurses' perceptions of nursing error and its causes. This was a qualitative study in which 12 critical care nurses were recruited through purposive sampling. The data were collected via in-depth interviews and analyzed through qualitative content analysis method (Elo & Kyngäs, 2008). Nursing error was deemed as an unavoidable issue which consisted of the lack of congruence with standards, doing extra-nursing tasks and giving care against the agreed-upon routines. Five categories emerged as the causes of error: individual reasons, work pressure, caring blindly, the uniqueness of caring environment and the lack of coordination among health care team members. The perception of nursing error is sort of unique; hence, managers should provide support for critical care nurses and pave the way for the prevention of errors.

Factors associated with the quality of dying and death and missed nursing care.

BACKGROUND: Patients in intensive care units need full nursing care due to the high mortality rate. However, some aspects of nursing care can be forgotten. AIMS: To investigate the quality of death and dying and its association with aspects of missed nursing care, alongside the overall perception of nurses in intensive care units about factors associated with missed nursing care. METHODS: This cross-sectional study used a census sampling method of 105 nurses working in intensive care units. In order to collect data, the Quality of Dying and Death Questionnaire (QODD), missed nursing care (MISSCARE survey) and factors associated with missed nursing care questionnaire were used. Data analysis was performed by using SPSS 16. FINDINGS: The quality of death and dying, as perceived by nurses, was found to be lower than the average (Range score: 0 to 100). The range of missed nursing care was average (Range of score: 24 to 96) and the most noticeable reason for this missed nursing care was the shortage of nursing staff. CONCLUSION: Managers should ensure that nurses provide complete nursing care for terminally ill patients in intensive care units and eliminate factors that lead to aspects of nursing care being missed, such as staffing levels, material resources and communication between staff members.

The Relationship Between Attitude, Belief, Experience, and Knowledge of Iranian Nurses Toward the Use of Personal Protective Equipment: A Cross-Sectional Study.

Background: Utilizing Personal Protective Equipment (PPE) is pivotal in averting infection transmission to both patients and nurses. The attitude of nurses is a critical determinant in their compliance with PPE usage. This study seeks to explore the correlation between the attitudes of Iranian nurses and their beliefs, experiences, and knowledge concerning the application of PPE. Materials and Methods: In this cross-sectional study, 303 nurses employed in hospitals affiliated with Kurdistan University of Medical Sciences (Iran) were chosen using a quota sampling technique. Between April and June 2022, they completed self-administered questionnaires, which consisted of a Demographic Information form and a four-part questionnaire on "Attitude, Belief, Experience, Knowledge" concerning the utilization of PPE. Data were analyzed utilizing descriptive and inferential statistical methods. The multiple linear regression model was applied to investigate the relationship between attitude scores and various examined variables. Results: The findings indicated that most participants held bachelor's degrees (93.07%), and their attitude scores toward using PPE exceeded 3.25 out of 6 for all 12 questions. Female gender, increased work experience, and higher organizational positions exhibited positive and significant associations with a favorable attitude toward PPE utilization. Conversely, the absence of training related to PPE, a lack of belief in infection control, and limited knowledge displayed negative correlations. Conclusions: Nurses have an ethical obligation to adhere to infection control guidelines, including consistently utilizing PPE, regardless of the level of infection risk or the visibility of the infection. Continuous training and regular monitoring of nurses in this context are indispensable.

Comparing the Performance of Emergency Department Personnel and Patients' Preferences in Breaking Bad News.

Objective: Breaking bad news (BBN) is a critical aspect of healthcare delivery that can have significant implications for patients' outcomes. Inadequate and inappropriate delivery of bad news can result in detrimental psychological and emotional effects. This study aimed to compare the performance of emergency department (ED) personnel and patients' preferences in BBN. Methods: This descriptive-analytical study was conducted in 2022, and 135 patients who were admitted to the ED were included using quota sampling. Data were collected using a demographic questionnaire, a researcher-made questionnaire, and a standard questionnaire on attitudes toward the methods of BBN in the ED. The data were analyzed using SPSS software (version 16), and a p-value<0.05 was considered statistically significant. Results: The results showed that the majority of patients (69.6%) received bad news from nurses. Based on the conditions mentioned in the standard questionnaire, the overall performance of personnel was 6.08±4.22 out of 19, while the overall attitude score (59.66±7.66 out of 76) revealed patients' high tendency to receive bad news. There was a statistically significant difference between the total score of personnel performances and the total score of patients' attitudes (p=0.001). Conclusion: The performance of ED personnel concerning patients' attitudes toward the method of BBN in the emergency department was not optimal. Therefore, it is recommended to implement appropriate training programs for medical professionals, especially physicians, and nurses, to enhance their communication skills and reduce the detrimental effects of inappropriate delivery of bad news in medical settings.

Level of Self-Care and Patient Care Against COVID-19 Among Emergency Medical Services Personnel; a Cross-sectional Study.

Introduction: Provision of pre-hospital care by emergency medical services (EMS) requires paying attention to self-care and patient care against possible infections. The present study was conducted with the aim of determining the level of self-care and patient care against COVID-19. Methods: The present correlational, descriptive, analytical study was carried out on 301 EMS personnel in Iran. Data were collected using a demographic information form and questionnaires made by the researcher on the level of self-care and patient care against COVID-19. Results: The results showed that more than half of the participants (55%) were aged 27 to 34 years. The majority of the participants had an experience of participating in self-care (88.7%) and patient care (83.7%) training courses against COVID-19. The overall score of self-care was 55.96 ± 6.97 out of 72 and that of patient care was 26.86± 3.39 out of 32, both of which revealed a favorable level. However, in some questions, the mean score was lower than the optimal level. The lowest mean score among items related to self-care against COVID-19 was allocated to wearing protective clothing (1.77±1.19). Among items related to patient care against COVID-19, the lowest mean score was related to training the patient about hand hygine after touching contaminated equipment (2.83±1.08 out of 4). There was a positive (r=0.491) and significant correlation between self-care and patient care against COVID-19 (p=0.001) based on our findings. Conclusion: Although the general level of self-care and patient care against COVID-19 was favorable, due to the undesired level of some domains, it seems necessary to implement corrective planning through periodical training and monitoring the performance of the personnel.

COVID-19 stress and coping strategies among older adults: a systematic review of qualitative evidences.

BACKGROUND: The COVID-19 pandemic has brought about far more stressful conditions for people worldwide. As a vulnerable group, older adults have suffered various psychological problems, such as stress, because of this pandemic and have applied various strategies to cope with the dire consequences. This study aimed to synthesize qualitative evidence regarding coping strategies for stressful situations among older adults throughout the COVID-19 pandemic. METHODS: We searched electronic databases, including Scopus, Embase, PubMed, ProQuest, and the Cochrane Library, based on PRISMA standards. The protocol of this systematic review was registered on the PROSPERO (registration code: CRD42022364831). All relevant English-language articles published between 2019 and November 10, 2022, were searched. We reviewed the reference lists for all the included studies and key references. Two reviewers conducted screening, data extraction, and quality appraisal independently, with disagreements resolved by consensus with all team members. The Joanna Briggs Institute (JBI) checklist was used to assess the quality of studies. A thematic synthesis of the selected studies was conducted. RESULTS: We included 13 studies in our review. Most studies were conducted in the early months of the COVID-19 pandemic. The stress caused by the COVID-19 pandemic was classified into six categories: health management challenges, stress caused by quarantine, economic challenges, media and bad news stress, virus threats, and challenges related to the use of communication technologies. The strategies used by older adults to cope with these challenges were categorized into five categories: protective strategies, avoidance strategies, maintaining social connections, meaning-based strategies, and fun strategies. This research showed that depending on the situation and conditions, older adults use various strategies to cope with COVID-19. CONCLUSION: Older adults experience much stress during the COVID-19 pandemic. In most cases, older adults can cope with these challenges with simple strategies from previous experiences and learnings. Older people require educational interventions in some cases, such as those involving communication skills. A better understanding of older adults coping strategies may enable policymakers to develop more effective policies and manage the problems of older adults in post-COVID situations.

Effect of acupressure on preoperative anxiety: a clinical trial.

Preoperative anxiety, as an emotional reaction, is common among patients undergoing surgery. The purpose of this study was to examine the effect of acupressure on preoperative anxiety before abdominal surgery. The 70 subjects of this clinical trial were randomly assigned into the acupressure group (n=35), which received acupressure at the true points, or the placebo group (n=35), which received acupressure at sham (false) points. Preoperative anxiety and vital signs before and after the intervention were measured in both groups. The findings demonstrated a reduction in the level of preoperative anxiety for both groups (P<.001). Furthermore, they showed a statistically significant difference between the mean of vital signs before and after the intervention in the acupressure group (P<.001) and only statistically significant results for cardiovascular (P=.016) and respiratory rates (P=.007) in the placebo group. Overall, findings revealed that acupressure at true points (third eye and Shen men) can reduce higher preoperative anxiety of patients before abdominal surgery and that it has had a more clinically beneficial effect than sham points.

Exploration of Iranian intensive care nurses' experience of end-of-life care: a qualitative study.

BACKGROUND: A challenge for intensive care nurses is providing the best possible care to patients in an end-of-life stage. The fact that some patients will die despite the efforts of the health care team can affect the psychological state of the nurses and families. Lack of attention to such an issue can bring about unpleasant consequences for both patients and nurses. AIM: Using a qualitative design, the aim is this article explores the experiences of intensive care nurses providing care for end-of-life patients. METHODS: The data were collected through in-depth interviews with a purposive sample of 10 nurses working at intensive care units (ICUs). Interviews were transcribed and finally analysed through the conventional content analysis. FINDINGS: Two themes emerged out of the experience of providing care to the end-of-life patients. The findings revealed that for Iranian intensive care nurses providing care to such patients was accompanied by emotional burden and values and beliefs. CONCLUSION: The results of the study have increased the current knowledge over the experience of providing care to end-of-life patients at ICUs. It also has revealed the need for providing the nurses with psychological support, accommodating the possibility for offering a complete care, attending to and managing the conditions of the patient and their families and engaging nurses in decision making about end-of-life patients. RELEVANCE TO PRACTICE: Managers ought to provide specialized units for providing care to end-of-life patients. Nurses working on these units will require emotional support.

Exploring the Experience of Nurses in Providing Care to Patients With COVID-19: A Qualitative Study.

BACKGROUND: The COVID-19 pandemic has caused conflicts in the world health system. The role of nurses is prominent because of their close contact with patients. PURPOSE: The aim of this study was to explore the experiences of nurses in providing care to patients with COVID-19. METHODS: This phenomenological study was conducted in 2020. Purposive sampling was used and continued until data saturation. Semistructured interviews were conducted with 14 nurses at Tohid Hospital, Sanandaj, Iran, all of whom had experience providing care to patients with COVID-19. Interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological method. RESULTS: The participants included four men and 10 women. Data analysis revealed four main themes (14 subthemes) related to the experience of the participants in providing care to patients with COVID-19. These themes included (a) fear (fear of being infected, fear of being a carrier, fear of the disease, and high mortality of patients), (b) compulsion (compulsion to care, being under pressure), (c) distinct experience (need for self-care, working with personal protective equipment, and ambiguity in care/treatment), and (d) sacrifice (altruism, compassion, self-sacrifice, and being proud of yourself). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The experience of participants in caring for patients with COVID-19, in addition to the unique experience of care, was associated with fear, compulsion, and sacrifice. Because of the ongoing COVID-19 pandemic and the unique experience of nurses serving in COVID-19 units, it is necessary to educate and support nurses to deal effectively with this situation.

Views of Iranian patients on life with cancer: a phenomenological study.

Cancer is one of the major causes of death worldwide. The diagnosis of this disease can cause significant stress, which destroys the patient's hopes, dreams and expectations. The aim of this qualitative phenomenological study was to explore the perceptions of 23 Iranian patients about life with cancer using in-depth and semi-structured interviews as the method of data collection. The data were analyzed using Benner's interpretive thematic analysis method. Four main themes were clarified by studying the patients' experiences of life with cancer: (i) cancer as a kind of divine test; (ii) a very bitter and debilitating experience; (iii) chemotherapy as the most difficult experience of cancer; and (iv) a continuous struggle. Life with cancer is full of suffering, stress and bitterness. Fear and hope are intertwined; this phase can be successfully endured by patience, tolerance and stability. It is also helpful if close relatives can raise the patient's morale. Certainly, in this process, religious beliefs, faith and culture-oriented interventions can significantly help patients deal with cancer.