The effects of environmental factors in waiting rooms on anxiety among patients undergoing coronary angiography: A randomized controlled trial.

BACKGROUND: According to Florence Nightingale's hypothesis, the environment can play a central role in the healing of the patient's body and mind. The nurse should, therefore, strive to provide a healing and stress-reducing environment for patients about to undergo invasive procedures. AIMS: This study aimed to investigate the effects of environmental factors on anxiety as experienced by patients in waiting rooms prior to coronary angiography. METHODS: In this randomized controlled trial, 200 patients undergoing coronary angiography in an urban area of Iran were assigned randomly to the following intervention groups: (1) nature sounds; (2) nature sounds and daylight; (3) nature sounds, daylight, and colour enhancements; and (4) control. Portable monitors were used to measure the patients' physiological indices upon admission and 30 and 60 minutes thereafter. RESULTS: Patients who experienced environmental affecting interventions had significantly lower physiological indices of anxiety than the control group (P < 0.001). Some significance was demonstrated between the three interventions groups, with patients in the intervention group that experienced maximum environmental interventions demonstrating the most overall reduction in anxiety indices. CONCLUSION: Environmental factors were shown to have a positive effect on the indices of anxiety experienced by patients waiting for the procedure of coronary angiography; this is therefore an area of study and practice worthy of further development.

The effect of the emotional intelligence education programme on quality of life in haemodialysis patients.

AIM: This study investigated the effect of the emotional intelligence education programme on quality of life of haemodialysis patients. BACKGROUND: Nurses need knowledge development regarding the impact of educational strategies on patients' quality of life suffering from chronic diseases. METHODS: A pragmatic quasi-randomized controlled trial was conducted with 47 haemodialysis patients attending a university hospital in an urban area of Iran. The patients were randomly assigned to intervention (n=23) and control (n=24) groups. A socio-demographic questionnaire, the Cyberia-Shrink Emotional Intelligence Questionnaire, and the Kidney Disease Quality of Life-Short Form were used to gather data. The intervention group attended an educational programme on emotional intelligence that consisted of six-group discussion sessions. To ensure the continuity of learning and to measure the subsequent expected behavioural changes, the patients filled out the data collection tools six and 12weeks after the completion of the education programme. RESULTS: The mean score of quality of life in the intervention group was 39.94±15.88 in pre-test, 44.87±16.04 six weeks and 52.47±16.07 at the 12weeks after the intervention (p=0.032). CONCLUSION: The consideration of emotional intelligence educational strategies by nurses requires its incorporation into pre-qualifying nursing degrees and professional development programmes. Nurse managers need to lead nurses for applying emotional intelligence in daily practice with the aim of providing an holistic patient care.

The assessment of safe nursing care: development and psychometric evaluation.

AIM: To develop an instrument for the assessment of safe nursing care (ASNC) within the Iranian context and psychometrically evaluate its reliability and validity. BACKGROUND: There is a need for a valid and reliable instrument to assess how nurses employ the components of safe nursing care in clinical practice in non-Western countries. METHOD: This methodological study was conducted in two phases: (1) a qualitative phase of instrument development, and (2) a quantitative phase of psychometric evaluation of the assessment of safe nursing care (ASNC). The instrument's content validity was assessed by experts in the field of safe nursing care. The reliability of this instrument was examined using internal consistency reliability and intra-rater reliability analysis. Exploratory factor analysis was then conducted to establish the instrument's initial construct validity. RESULTS: The instrument developed was a questionnaire with 32 items. The Cronbach's alpha of the scale was 0.92, and Intra-class Correlation Coefficient for intra-rater reliability was 0.78. Exploratory factor analysis resulted in a four-factor solution: (1) evaluation of nursing skills, (2) assessing the patient's psychological needs, (3) assessing the patient's physical need, and (4) Assessing nurses' teamwork. The four factors accounted for 63.54% of the observed variance. CONCLUSION: The ASNC can be applied to a wide variety of settings because of the broad range of methods utilised to generate items and domains, its comprehensive consideration of the principles of safe care, and its initial reliability and validity. IMPLICATIONS FOR NURSING MANAGEMENT: The ASNC can help nurse managers assess whether clinical nurses are prepared to apply their safe care skills in clinical practice. It can also be used by clinical nurses to assess their own and peers' practice to detect potential areas for improvement in nursing care and help nurse managers with planning appropriate quality improvement programmes.

Transformational leadership in nursing and medication safety education: a discussion paper.

AIMS: This paper discusses the application of transformational leadership to the teaching and learning of safe medication management. BACKGROUND: The prevalence of adverse drug events (ADEs) and medication-related hospitalisations (one hundred thousand each year in the USA) are of concern. EVALUATION: This discussion is based on a narrative literature review and scrutiny of international nursing research to synthesise pedagogical strategies for the application of transformational leadership to teaching medication safety. KEY ISSUES: The four elements relating transformational leadership to medication safety education are: 'Idealised influence' or role modelling, both actual and exemplary, 'Inspirational motivation' providing students with commitment to medication safety, 'Intellectual stimulation' encouraging students to value improvement and change, and 'Individualised consideration' of individual students' educational goals, practice development and patient outcomes. The model lends itself to experiential learning and a case-study approach to teaching, offering an opportunity to reduce nursing's theory-practice gap. CONCLUSION: Transformational leadership for medication safety education is characterised by a focus on the role of nurse educators and mentors in the development of students' abilities, creation of a supportive culture, and enhancement of students' creativity, motivation and ethical behaviour. This will prepare nursing graduates with the competencies necessary to be diligent about medication safety and the prevention of errors. IMPLICATIONS FOR NURSING MANAGEMENT: Teaching medication safety through transformational leadership requires the close collaboration of educators, managers and policy makers. Investigation of strategies to reduced medication errors and consequent patient harm should include exploration of the application of transformational leadership to education and its impact on the number and severity of medication errors.

Iranian nurses perspectives on assessment of safe care: an exploratory study.

AIM: To explore the perspectives and experiences of nurse instructors and clinical nurses regarding the assessment of safe nursing care and its components in clinical practice. BACKGROUND: Safe nursing care is a key aspect of risk management in the healthcare system. The assessment of safe nursing care and identification of its components are primary steps to establish patient safety and risk management and enhance the quality of care in clinical practice. METHODS: This was an interview study, with qualitative content analysis. Semi-structured interviews were conducted with 16 nurse instructors and clinical nurses including nurse managers chosen by purposive sampling based on theoretical saturation. Data collection and analysis were carried out simultaneously until data saturation was reached. RESULTS: Data analysis led to the extraction of four main themes: holistic assessment of safe nursing care; team working and assessment of safe nursing care; ethical issues; and challenges of safe nursing care assessment. CONCLUSION: Identifying these four components in the assessment of safe nursing care offers a contribution to the understanding of the elements of safe care assessment and the potential for improved patient safety. IMPLICATIONS FOR NURSING MANAGEMENT: Safe care management requires the accurate and reliable assessment of safe nursing care and the need for strategies for reporting actual or potential unsafe care and errors to ensure patient safety.

A community of practice: the nurses' role on a medical assessment unit.

AIM: To explore the nurses' role on a medical assessment unit. BACKGROUND: Medical assessment units facilitate the acceptance of medical emergencies to one dedicated clinical space and are a response to politically driven strategies to enhance the provision of acute medical care in the UK. Despite the essential contribution that nurses make, there is a paucity of research-based literature that has investigated the nurses' role in these units. DESIGN: An ethnographic study of a medical assessment unit in Wales, UK. METHOD: Data were collected over a three-year period from 2003-2006 by participant observation (200 hours) with the researcher, a registered nurse and university lecturer, working alongside the nurses as a contributor to care delivery, semi-structured interviews with nurses, doctors, paramedics and patients (n = 19) and the collection of documentary and artefact evidence. RESULTS: Three main themes were identified: 'making beds': organising the clinical space; 'knowing your stuff': having professional knowledge; and 'loving the buzz': having the ability to work under pressure. CONCLUSION: A distinctive community of practice had developed to satisfy the workplace demands that the nurses faced in a culture that valued autonomous practice and provided a positive working environment. However, a cautionary note must be raised in that new approaches to care delivery, such as medical assessment units, whilst being operationally efficient, may not reflect a nursing ethos of holistic and individualised care delivery. RELEVANCE TO CLINICAL PRACTICE: The concept of community of practice aids the exploration of the interplay of the goals of practice and the attendant social relations developed in nursing teams. Findings from this study have identified aspects of the role of the nurse in a medical assessment unit setting and so can help inform educational programmes. Further research is required to enable the development of this distinctive nursing role.

The Role of the Nurse in the Management of Medicines During Transitional Care: A Systematic Review.

PURPOSE: To synthesise knowledge and to explore the role of the nurse in medicines management during transitional care. METHODS: An integrative systematic review was conducted. Electronic databases such as PubMed [including Medline], Web of Knowledge, Scopus, and Cinahl from January 2010 to April 2020 were searched. Original qualitative and quantitative studies written in English that focused on the role of the nurse in medicines management during transitional care, which included movement between short-term, long-term, and community healthcare settings were included. RESULTS: The search process led to the retrieval of 10 studies, which were published in English from 2014 to 2020. They focused on the role of the nurse in patients' medicines management during transitional care in various healthcare settings. Given variations in the aims and methods of selected studies, the review findings were presented narratively utilizing three categories developed by the authors. In the first category as 'medication reconciliation process' the nurse participated in obtaining medication history, performing medication review, identifying medication discrepancies, joint medication reconciliation and adjustment. The second category as 'collaboration with other healthcare providers' highlighted the nurses' role in clarifying medicines' concerns, interdisciplinary communication and consultation, discharge planning and monitoring. In the third category as 'provision of support to healthcare recipients', the nurse was responsible for interpersonal communication with patients, education about medicines, and simplification of medication regimens, and symptoms management during transitional care. CONCLUSION: Nurses play a crucial role in the safety of medicines management during transitional care. Therefore, they should be empowered and more involved in medicines management initiatives in the healthcare system. Patient safety and avoidance of medication errors during transitional care require that medicines management becomes a multidisciplinary collaboration with effective communication between healthcare providers.

The effect of the eye movement desensitization and reprocessing intervention on anxiety and depression among patients undergoing hemodialysis: A randomized controlled trial.

PURPOSE: This study examined the effect of the eye movement desensitization and reprocessing intervention on depression and anxiety in patients undergoing hemodialysis. DESIGN AND METHODS: In this randomized controlled trial, 90 patients were enrolled. The intervention group received six sessions of the eye movement desensitization and reprocessing intervention. Data were collected before and 2 weeks after the intervention using the Hospital Anxiety and Depression Scale. FINDINGS: Measured levels of anxiety and depression were significantly reduced in the intervention group compared with preintervention levels and to the control group. PRACTICE IMPLICATIONS: Nurses can use the eye movement desensitization and reprocessing intervention in clinical practice in combination with psychotropic drugs for the reduction of depression and anxiety in patients undergoing hemodialysis.

Learning Situations in Nursing Education: A Concept Analysis.

BACKGROUND AND PURPOSE: The nursing student requires opportunities to learn within authentic contexts so as to enable safe and competent practice. One strategy to facilitate such learning is the creation of learning situations. A lack of studies on the learning situation in nursing and other health care fields has resulted in insufficient knowledge of the characteristics of the learning situation, its antecedents, and consequences. Nurse educators need to have comprehensive and practical knowledge of the definition and characteristics of the learning situation so as to enable their students to achieve enhanced learning outcomes. The aim of this study was to clarify the concept of the learning situation as it relates to the education of nurses and improve understanding of its characteristics, antecedents, and consequences. METHODS: The Bonis method of concept analysis, as derived from the Rodgers' evolutionary method, provided the framework for analysis. Data collection and analysis were undertaken in two phases: "interdisciplinary" and "intra-disciplinary." The data source was a search of the literature, encompassing nursing and allied health care professions, published from 1975 to 2016. RESULTS: No agreement on the conceptual phenomenon was discovered in the international literature. The concept of a learning situation was used generally in two ways and thus classified into the themes of: "formal/informal learning situation" and "biologic/nonbiologic learning situation." Antecedents to the creation of a learning situation included personal and environmental factors. The characteristics of a learning situation were described in terms of being complex, dynamic, and offering potential and effective learning opportunities. Consequences of the learning situation included enhancement of the students' learning, professionalization, and socialization into the professional role. IMPLICATION FOR PRACTICE: The nurse educator, when considering the application of the concept of a learning situation in their educational planning, must acknowledge that the application of this concept will include the student's clinical learning experiences. More studies are required to determine factors influencing the creation of a successful learning situation from the perspectives of nurse educators and nursing students, clinical nurses and patients.

The effect of guided imagery on anxiety, depression and vital signs in patients on hemodialysis.

BACKGROUND AND PURPOSE: Patients on hemodialysis experience anxiety and depression. This study aimed to investigate the effect of guided imagery on anxiety, depression, and vital signs in patients on hemodialysis. MATERIALS AND METHODS: This randomized controlled clinical trial was conducted on 80 patients undergoing hemodialysis. The subjects were randomly assigned into two groups: a guided intervention group and a control group. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale. RESULTS: After the intervention, the level of anxiety and depression were significantly lower in the intervention group compared with the control group (p = 0.030, p = 0.001, respectively). A statistically significant reduction in the respiratory rate and heart rate was reported in the intervention group (p < 0.05). CONCLUSION: Nurses are suggested to use guided imagery along with other interventions for the management of anxiety and depression. It can alleviate adverse psychological responses among patients on hemodialysis.

The effect of Tai Chi on quality of life in male older people: A randomized controlled clinical trial.

BACKGROUND AND AIM: Physical activity can improve the mental and physical functioning of older people. This study investigated the impact of Tai Chi exercise on the quality of life of older men. METHODS: This randomized controlled clinical trial was conducted on 132 older men in an urban area of Iran. The subjects were randomly assigned into two groups: a Tai Chi intervention group and a control group (n = 66 per group). Quality of life was evaluated using the Leiden-Padua quality of life questionnaire before and after the intervention. Data analysis was performed using analytical statistics via the SPSS software. RESULTS: After eight weeks of Tai Chi exercise, the mean scores of quality of life in different areas demonstrated a statistically significant difference between the two groups (p < 0 0.05). CONCLUSION: This study illustrated that the 8-week Tai Chi intervention had a positive effect on quality of life in older men.

Psychometric properties of the Farsi version of Attitudes to Aging Questionnaire in Iranian older adults.

BACKGROUND: Attitudes to the aging process are affected by the individual's sociocultural background. The measurement of this important concept among older people in various societies requires the use of tools that are able to demonstrate both reliability and validity. OBJECTIVE: The objectives of this study were to translate and validate the Attitudes to Aging Questionnaire (AAQ) and investigate its psychometric features among Iranian older people. METHODS: In this methodological study, the Farsi version of the AAQ was validated among 400 Iranian older adults who were members of citizen clubs in an urban area of Iran. Content, face and construct (exploratory factor analysis) validities of the AAQ were assessed. In addition, its reliability was assessed in terms of internal consistency and stability. For discriminant validity, the discriminant power of the AAQ in terms of gender and education levels was evaluated. Criterion validity showed a significant correlation between the most subscales of the AAQ and the Short Form 36 (SF-36) and World Health Organization Quality of Life (WHOQOL) questionnaires. Descriptive and inferential statistics were used for data analysis. RESULTS: The exploratory factor analysis confirmed the construct validity of the AAQ. The result of the test-retest reliability with a 2-week interval was satisfactory and reported as r=0.90 (p<0.001). The Cronbach's alpha coefficient was reported as 0.75 for the whole instrument and 0.85-0.93 for its dimensions. There were associations between the AAQ subscales, SF-36 quality of life (r=0.56, p<0.001) and WHOQOL-BREF (r=0.78, p<0.001), indicating an appropriate convergent validity. The ability to discriminate between male and female participants and those with lower and higher education levels was demonstrated, thus lending support to claims for adequate known-group validity. CONCLUSION: The Farsi version of the AAQ showed favorable validity and reliability. Therefore, it can be used for assessing attitudes toward aging among older adults.

Being a research participant: the nurse's ethical and legal rights.

Nurses and their patients/clients are increasingly being approached to participate in research projects conducted in the clinical setting. However, such research involving human participants raises many ethical and legal concerns. This article provides nurses with an overview of their rights when asked to participate in such research. The ethical and legal principles that must be respected when such research is being conducted are presented and questions to ask of the researcher suggested. The role of the nurse, as required by their professional duty of care, to protect patients' rights during research in the clinical setting is highlighted.