Outcomes of professional misconduct by nurses: a qualitative study.

BACKGROUND: Professional misconduct by nurses is a critical challenge in providing safe quality care, which can lead to devastating and extensive outcomes. Explaining the experiences of clinical nurses and nursing managers in this regard using an in-depth qualitative method can be beneficial. This study was conducted with the aim of explaining the experiences of nurses regarding the outcomes of professional misconduct. METHODS: The present study used a qualitative descriptive with a conventional content analysis approach. A total of 22 clinical nurses and nursing managers were selected through purposive sampling until data saturation was reached. Data were collected using semi-structured in-depth interviews and analyzed using Graneheim and Lundman's approach. RESULTS: Analyzed data were categorized into four main themes and 11 subthemes: (1) Physical outcomes: critical threat and weakening patients' safety; (2) Psychological outcomes: psycho-emotional responses of patients and their families, moral distress, and cautionary tale of nurses; (3) Financial outcomes: imposing costs on the patient and financial loss of the nurse; (4) Organizational outcomes: the normalization of misconduct, chaos in the organization, waste of the organization's resources, and reputational damage to the organization. CONCLUSION: Professional misconduct by nurses can have adverse outcomes for patients in physical, mental, and financial dimensions, their families, nurses, and healthcare organizations. Therefore, it is indispensable to adopt management strategies to reduce the rate of professional misconduct.

The nurses' perception of the factors influencing professional misconduct: A qualitative study.

BACKGROUND: Professional misconduct undermines safe and quality care; however, little is known about its nature and influential factors. AIM: This study aimed to explain the factors influencing professional misconduct in nurses. RESEARCH DESIGN: This qualitative study was conducted using the conventional content analysis method. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected using semi-structured interviews with 19 nurses working in the hospital selected through a purposeful method and analyzed by Graneheim and Lundman approach. ETHICAL CONSIDERATIONS: The ethics committee of Tehran University of Medical Sciences approved this study with the ethics code IR.TUMS.FNM.REC.1400.187. Informed consent was obtained from all participants. Participants were assured of confidentiality. FINDINGS: Factors influencing professional misconduct by nurses were categorized into three main categories: human factors (nurses' professional characteristics, personal characteristics of nurses and patient/companion, patient's clinical condition), procedural factors (procedural conditions, possibility of proving misconduct), and organizational factors (recruitment process, conditions of resources, managing misconduct, bureaucracy, and ward characteristics). CONCLUSION: This study assists in explaining the factors influencing professional misconduct by nurses. Therefore this study's results can help managers and planners develop interventions to prevent and correct factors that contribute to misconduct and strengthen factors that prevent misconduct in order to ensure quality and safe patient care.

Exploring nursing managers' perceptions of nursing workforce management during the outbreak of COVID-19: a content analysis study.

BACKGROUND: The COVID-19 pandemic is a serious threat to public health worldwide. Therefore, a coordinated global response is needed to prepare health care systems to face this unprecedented challenge. Proper human resource management can increase nurses' productivity and quality of care. Therefore, the present study aims to explore the nursing managers' perception of nursing workforce management during the outbreak of COVID-19. METHODS: This is a qualitative study with conventional content analysis using Granheim and Landman approach. In this study, 15 nursing managers were selected by purposeful sampling method. Data were collected using in-depth semi-structured interviews. Ethical considerations were applied to all stages of the study. In this study, MAXQDA software version 10 was used to help manage the data. RESULTS: 66% of the participants (10/5) were female. The mean age of participants was 44 years, mean work experience of 19 years, and mean management experience of 9 years. Three categories and seven sub-categories emerged from the data analysis: 1) management of workforce recruitment (volunteer workforces, non-volunteer workforces), 2) management of workforce arrangement (flexible work schedule, rearrangement of the workforce), and 3) management of workforce retention (preventive measures, motivational measures, and psychological support). CONCLUSION: Management in critical situations requires the use of flexible and situational management principles to recruit, arrange and retain workforce, and also to compensate for the lack of manpower.

Evaluation of Factors Affecting the Severity of Diabetic Foot Ulcer in Patients with Diabetes Referred to a Diabetes Centre in Kermanshah.

INTRODUCTION: Diabetes mellitus is a metabolic disease characterized by high blood sugar (BS) levels and the change in the metabolism of lipids, carbohydrates, and insulin resistance, and is one of the main causes of disability and mortality worldwide. Among the different types of complications, which have many negative effects on personal and social life, diabetic foot ulcer (DFU) is very important. This study aims to investigate the factors affecting the severity of DFU among patients with diabetes. METHODS: The study participants included 190 diabetic patients with a diagnosis of DFU. Data were collected using a two-part questionnaire for self-care awareness and functions in diabetic patients and Wagner's scale. The questionnaire was answered in cooperation with patients and the Wagner's score was estimated by a wound supervisor in the diabetes center. RESULTS: There was 109 women (57.4%). Twenty-six patients had other diabetic complications as well as DFU. The average score of awareness in patients was 6.99±2.76 and the function was 62.22±9.92. The results found a direct relation between the age and the duration of illness with the score of the patient's awareness (P=0.008, P=0.000). There was also a direct relation between the level of education with score of awareness and the score of function in self-care (P=0.000, P=0.000), but the statistical results did not find any relation between awareness and the function in self-care of patients with the severity of DFU (P>0.05). DISCUSSION: There was no relation between the self-care awareness and function with severity of DFU (P>0.05) that can be due to the more relation between DFU severity with hygiene and physical factors after the disease and the effect of awareness and function would be only in the incidence of the DFU. CONCLUSION: Awareness and function of patients in self-care is less than average. Increasing awareness of patients and empowering them through appropriate training can be effective in preventing diabetic foot ulcers.

Cold Application on Bruising at the Subcutaneous Heparin Injection Site: A Systematic Review and Meta-Analysis.

Despite the documented clinical efficacy, the injection of subcutaneous heparin can be associated with adverse drug reactions including bruising at the injection site. This study sought to systematically assess current evidence regarding the effect of cold application as a fundamental nursing intervention on the occurrence and size of bruising at the injection site in patients receiving subcutaneous heparin. A systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies was performed. Web of Knowledge, PubMed (including MEDLINE), Scopus, Embase, Cochrane library, gray literature, and cross-referencing from reference lists were searched from 2000 to 2019. Quality of selected studies was assessed using the Cochrane risk of bias appraisal tool for randomized controlled trials and the JBI MASTARI appraisal tool for quasi-experimental studies. The search yielded 3,220 articles, but consideration of inclusion criteria led to final selection of 9 articles. The meta-analysis showed that cold application significantly reduced the relative occurrence of bruising at the subcutaneous heparin injection site by 40% (relative risk, 0.60; 95% confidence interval [0.39, 0.91]) and reduced the bruising size (standardized mean difference, -2.78; 95% confidence interval [-4.34, -1.22]). Cold application as a fundamental nursing intervention can be an effective intervention to prevent adverse drug reactions at the injection site in terms of the occurrence and size of bruising in patients receiving subcutaneous heparin.

The prevalence of obesity in older adults in Iran: a systematic review and meta-analysis.

BACKGROUND: one of the most important age-dependent physiologic alterations in the body composition of older adult people is obesity and overweight, increasing the risk of cardiovascular disease and mortality rate. OBJECTIVE: The aim of the present study is to determine the prevalence of obesity in older adults in Iran. METHODS: The present study was conducted via meta-analysis and systematic review method, from March 2000 to October 2018. Subject-related literature was obtained via searches in ScienceDirect, Medline (PubMed), SID, Magiran, Scopus, and Google Scholar databases. Heterogeneity of studies was assessed using the I2 index, and data were analyzed by Comprehensive-Meta analysis software. RESULTS: In the assessment of 18 studies and 29,943 persons aged over 50 years, the prevalence of obesity in older adults of Iran was 21.4% (95%CI: 26.6-16.9%) based on the meta-analysis. The highest obesity prevalence was obtained in older adults of Babol (Amir Shahr) which was 44.2% (95%CI: 41.1-47.2%) in 2007, while the minimum obesity prevalence was found in older adults of Razavi Khorasan which was 11.3% (95%CI, 10-12.8%) in 2007. Further, as the sample size and the study year increased, the obesity prevalence diminished in older Iranian adults (p < 0.05). CONCLUSION: This study suggests that the prevalence of obesity in the older adults of Iran is high. Accordingly, healthcare planners and politicians should consider effective and practical policies to reduce obesity in older adults.

Prevalence of unwanted pregnancy in Iranian women: a systematic review and meta-analysis.

BACKGROUND: Unwanted pregnancies are considered as one of the most important public health risks. Regarding the importance of the unwanted pregnancy in the country and helping health policy-makers obtain more accurate information on this issue, this study aims to provide a systematic review and meta-analytical on the prevalence of unwanted pregnancies in Iran. METHODS: The present study was carried out using meta-analysis. Articles related to the topic were obtained through SID, Magiran, Scopus, PubMed, and ScienceDirect and Google Scholar databases from 2001 to 2017, Articles written based on cross-sectional studies were included in the study and other overviews, case-control, cohort, and interventional studies were excluded from the list of articles. Heterogeneity of studies was investigated using I2 index and data analysis was performed in Comprehensive Meta-Analysis software (Version 3). RESULTS: In 23 articles, the prevalence of unwanted pregnancy in Iranian women was 27.9% (95%CI: 24-32.1%). The meta-regression analysis was used in two sample sizes and years of study. It was reported that as the sample size and Years increases, the prevalence of the unwanted pregnancy decrease, this difference was also statistically significant (P = 0.000). CONCLUSION: Considering that the prevalence of unwanted pregnancy is high in Iran, it is necessary that health policy makers take effective measures to enhance the awareness of couples and public information about the risks of the unwanted pregnancy.

The Prevalence of Nocturnal Enuresis among Iranian Children: A Systematic Review and Meta-Analysis.

PURPOSE: Nocturnal enuresis is one of the most common diseases in children, which can affect their mental health. The aim of the present study is to determine the prevalence of nocturnal enuresis in Iranian children through sys-tematic review and meta-analysis. MATERIALS AND METHODS: The present study was conducted through systematic review and meta-analysis of studies during March 2000- July 2018. Articled related to the subject were reviewed by searching the Medline (PubMed), Scopus, ScienceDirect, SID, Magiran, Barakat, and Google Scholar databases where the heterogeneity of studies was investigated using I2 index. The data analysis was then carried out using Comprehensive Meta-Analysis soft-ware. RESULTS: 15 articles with a sample size of 16614 individuals aged 3 to 18 years entered the meta-analysis process. The overall prevalence of nocturnal enuresis in children of Iran was 10.2% (95% CI: 7-14.8%). The highest and lowest prevalence of nocturnal enuresis was seen in children living in Tehran 28.5% (95% CI: 16.1% -45.4) and Tabriz 1.8% (95% CI: 1.2-2.8%), respectively. The findings of the present study revealed that the prevalence of nocturnal enuresis in children decreases with enlargement of the sample size. In addition, the prevalence of noctur-nal enuresis grows with an increase in the years of research, which is statistically significant (P < 0.05). CONCLUSION: Considering the high prevalence of nocturnal enuresis in the current study, health policy makers need to raise the awareness of families by taking efficient and effective policies.

The prevalence of retinopathy among type 2 diabetic patients in Iran: A systematic review and meta-analysis.

Diabetic retinopathy is one of the most major causes of blindness and disability in diabetic patients and imposes very high cost on Health Care System. Studies conducted in the country showed different and inconsistent prevalence of the disease. The study aims to determine the overall prevalence of retinopathy in patients with type 2 diabetes in Iran through a systematic review and meta-analysis. The present study was conducted via meta-analysis method during March, 2000 to October, 2018. The articles related to the subject under study were obtained from Magiran, SID, Medline (PubMed), Science Direct, Scopus and Google Scholar databases. I2 index was used to examine the heterogeneity of articles studied; and the data was analyzed by Comprehensive Meta-Analysis Software. Through the study of 34 articles and 17,079 individuals with age range of 5-83, the overall prevalence of retinopathy for type 2 diabetic patients in Iran and on the basis of meta-analysis, was obtained that was 37.8% (32.84-43%, 95% confidence interval); the highest prevalence of retinopathy for type 2 diabetic patients was in Tehran province with 78% (68.8-85.1%, 95% confidence interval) in 2006 and the lowest prevalence of retinopathy for type 2 diabetic patients was in Isfahan province with 9% (7.1-11.4, 95% confidence interval) in 2006; furthermore, the prevalence of retinopathy for type 2 diabetic patients in Iran increases with increased sample size that it was statistically significant (P < 0.05). Regarding the high prevalence of retinopathy for type 2 diabetic patients in the country, it is essential that health policy makers take effective measures to reduce the disease incidence in diabetic patients.

Effect of Near-Infrared Light Therapy Based on Acupoints on the Severity of Restless Legs Syndrome in Patients Undergoing Hemodialysis: A Single-Blind, Randomized Controlled Trial.

INTRODUCTION: Restless legs syndrome (RLS) is a common disorder in hemodialysis patients. The present study was conducted to determine the effect of near-infrared (NIR) light therapy given to acupoints on the severity of RLS in patients undergoing hemodialysis. METHODS: This single-blind, randomized controlled trial was performed on 60 hemodialysis patients with RLS. Participants who met the inclusion criteria were randomly assigned to an intervention group (n = 30) or a control group (n = 30). Data were collected using the International Restless Legs Syndrome Rating Scale (IRLSRS) and demographic information questionnaire. The intervention group received 12 sessions of NIR light therapy (940 nm) to acupoints in the legs and feet during hemodialysis three times a week, while the control group received sham treatment. Data were analyzed using SPSS version 22 software. RESULTS: The results indicated that there were statistically and clinically significant differences between the intervention and control groups at the end of the intervention sessions (P < 0.001, mean difference [MD] = 3.8). However, after the treatment was discontinued, the difference was not clinically significant (MD = 2.4). In the within-group compression, the mean RLS scores of the intervention group decreased significantly during the intervention sessions (MD = 3.2, P < 0.001); however, after the treatment was discontinued, the difference was not clinically significant (MD = 1.67). CONCLUSION: The present study showed that the application of NIR light to acupoints in the legs and feet was as an effective treatment for attenuating the symptoms of RLS in hemodialysis patients.

Impact of self management on metabolic control indicators of diabetes patients.

INTRODUCTION: Patients with diabetes play an important role in management of their illness. They should be involved in the intervention program to be able to improve their quality of life. This study investigated the effect of a self-management program based on 5A (assess, advise, agree, assist, arrange) model on metabolic control indicators of diabetic patients. MATERIAL AND METHOD: In this randomized, controlled trial, 70 diabetic insulin dependent patients who referred to Nader Kazemi clinic in Shiraz participated. They were randomly assigned to two groups of experiment and control. Then a self-management program based on 5A model was performed for the experiment group during 3-mounths and the indicators of metabolic control including hemoglobin A1c, cholesterol, triglyceride and also body mass index were measured pre- and post- intervention in both groups. Data were analyzed using SPSS ver 11.5. RESULTS: Data analysis revealed a significant reduction in mean fasting blood sugar (69 units) and HbA1c (1.16 units) in the experimental group . Pre- to post-changes in hemoglobin A1c, fasting blood sugar, and high density lipoprotein were significant between the two groups of study. However, there was no significant difference in cholesterol, triglyceride, low-density lipoprotein, and body mass index between the two groups. DISCUSSION: Regarding the results, it can be concluded that a 3-month self-management program based on 5A model is effective in reducing the fasting blood sugar, hemoglobin A1c. Application of self management program based on 5A model in diabetic clinics is recommended.