Professional Autonomy of Nurses: A Qualitative Meta-Synthesis Study.

BACKGROUND: Autonomy is the main element of professional practice in nursing. However, despite the many studies conducted on nursing autonomy, this concept is not fully understood and a comprehensive explanation of this concept in nursing is necessary. Meta-synthesis offers a way to increase the understanding of this concept using existing research findings. Thus, the present study aimed to explain the concept of professional nursing autonomy. MATERIALS AND METHODS: This qualitative meta-synthesis was conducted based on a modified version of Noblit and Hare's meta-ethnography approach and qualitative studies on the concept of nursing autonomy published in databases such as PubMed, Scopus, Web of Science, Cochrane, SID, IranMedex, Magiran, and ScienceDirect in the past 15 years (2003-2018). RESULTS: Thirteen articles that reported the experiences of nurses regarding professional autonomy were included in the research. Based on the meta-synthesis of findings, the final interpretation of the professional autonomy of clinical nurses was presented in the three themes of professional competence, professional decision making, and professional interactions. CONCLUSIONS: According to the results, the concept of professional autonomy is a developmental achievement based on patient-based professional competence along with self-reliance to provide the best care plan for the promotion of patients' health through the professional decision making and professional interactions with other professional team members.

Smoking cessation: Adherence based on patients' illness perception after coronary artery bypass grafting surgery.

BACKGROUND: Coronary artery bypass grafting surgery (CABG) is a common treatment for coronary artery disease. The patient's commitment to modify risk factors is necessary to achieve the desired after surgery outcomes. The current study aimed at determining illness perception of patients after CABG, its relation to smoking cessation, and detecting other predictors of smoking cessation. METHODS: The samples of the current cross sectional study were selected from a greater study that was done on patients' adherence determining for 6 months after CABG surgery. Data collection was performed using a telephone questionnaire with 3 sections: personal and social information, smoking cessation, and illness perception. Data analysis was performed via descriptive statistics, independent t test, and multiple logistic regression analysis through SPSS version 16. RESULTS: The findings showed that 26.6% of the patients had not stopped smoking for 6 months after CABG, and the mean score of illness perception was 83.28 ±â€¯6.11. The relationship between adherence to smoking cessation and illness perception was not significant. Regression logistics via backward selection to detect factors related to smoking cessation adherence after CABG showed only a lack of hypertension history could predict adherence to smoking cessation (OR = 0.199, P = 0.03). CONCLUSIONS: Based on the results, about one-third of the subjects smoked cigarettes after CABG; therefore, it is critical to plan rehabilitation programs regarding smoking cessation after this surgery.

Medication Adherence and its Related Factors in Patients Undergoing Coronary Artery Angioplasty.

Introduction: Percutaneous Coronary Intervention (PCI) has no effect on coronary artery atherosclerosis, thus the modification of physiological risk factors seems essential to prevent coronary artery disease (CAD). Then PCI patients have to receive multiple drug therapies in an attempt to prevent the recurrence of cardiac events. In spite of the evidence based on medication adherence to prevent post-PCI CAD development, medication adherence is the main concern for health care system. Accordingly, this study aims to determine the medication adherence and its related factors among these patients. Methods: In this cross-sectional study, the statistical community was the patients undergoing PCI at medical educational hospital of Dr. Heshmat in Rasht, Iran. 269 patients were selected by convenient sampling method. The data were collected by a questionnaire consisting of 4 parts, namely the socio-individual factors, Morisky medication adherence scale, hospital anxiety and depression scale and cardiac patient's self-efficacy scale. Data analysis was done by descriptive statistics and the significance variables in univariate analysis were examined in a multi logistic regression model through considering co-linearity. Results: The results showed that 75 patients (28%) didn't adhere to the medication. In addition, the majority of them were reported to have clinical anxiety (44.2%) and mild depression (55.8%). Also, based on the results derived from multiple logistic regressions, only the spouse's educational level and family history of coronary artery disease were significant predictors of medication adherence. Conclusion: The current study findings display lack of complete post-PCI medication adherence, which underscores the importance of the existence of cardiac rehabilitation systems in the society. Therefore, it is recommended that cardiac rehabilitation centers be built in the society.