Missed nursing care and its relationship with nurses' moral sensitivity: a descriptive-analytical study.

BACKGROUND: Missed care rates are an indicator of healthcare quality. Missed nursing care can reduce patient safety and lead to adverse events. Moral sensitivity enables nurses to interpret and respond to clients' needs according to ethical principles. Despite the importance of moral sensitivity and its role in the quality of care, the relationship between nurses' moral sensitivity and missed nursing care has not been extensively studied. This raises the question of whether there is an association between nurses' moral sensitivity and missed care. This study was conducted to investigate the relationship between nurses' moral sensitivity and missed nursing care in the medical and surgical departments of Imam Khomeini Hospital in Urmia, Iran. METHODS: A cross-sectional study was conducted in 2022, on 202 nurses working in the medical and surgical departments of Imam Khomeini Medical Education Center, Urmia, Iran. Stratified random sampling was used to select the participants. A questionnaire on demographic characteristics, Kalisch's missed care questionnaire, and Lutzen's moral sensitivity questionnaire were used to collect data. Data were analyzed using the Pearson correlation test and linear regression analysis. RESULTS: Most participants (52.97%) showed moderate moral sensitivity. Nurses' mean moral sensitivity and total missed care scores were 149.07 ± 21.60 and 59.45 ± 4.87, respectively. Pearson correlation test showed no significant correlation between moral sensitivity scores and the total missed care scores (r = 0.041, p = 0.152). However, in the regression analysis, moral sensitivity (ß = 0.213, p < 0.001), age (ß = 0.131, p < 0.001), working in rotating shifts (ß = 0.183, p < 0.001), monthly income (ß = 0.079, p = 0.004), work experience (ß = 0.030, p = 0.010), and monthly work hours (ß = 0.247, p = 0.010) influenced missed care. Approximately, 0.98% of the variance in the missed care was explained by these variables. CONCLUSION: Our nurses reported moderate levels of moral sensitivity and a concerning level of missed care. Missed care can have detrimental effects on patient safety. Therefore, nursing managers must address this issue promptly.

Assessment of frequency and types of drug interactions in intensive care units: a cross-sectional study.

Background: Drug interactions can cause adverse reactions, from treatment inefficiency to serious treatment complications in the patient. Due to the complexity of drug therapy and the simultaneous use of several drugs and different drug groups, patients hospitalized in intensive care units are exposed to more drug interactions. Therefore, this study was conducted to investigate the frequency of drug interactions in patients hospitalized in the ICU. Methods: In this cross-sectional study, the files of 300 patients hospitalized in the ICU were examined. Drug interactions were determined using Lexicomp software and the book drug iteration facts. Data analysis was done using SPSS 21 software. Findings: The findings showed that there were a total of 1121 cases of interference. Two hundred thirty-one (77%) patients had moderate interference, 94 (31.3%) patients had mild interference, and 67 patients (22.3%) had severe interference. One hundred eight patients had B-type interference, 223 C-type interference, 116 D-type interference, and 6 X-type interference, so most of the interactions are C-type interference. One hundred eighty-six patients had pharmacokinetic interference and 201 patients had pharmacodynamics interference. The highest interaction was between two drugs, heparin and aspirin with 58 cases. Conclusion: This study highlights the alarming frequency and types of drug interactions observed in ICU. The high prevalence of drug interactions emphasizes the need for improved medication management and vigilance in these critical care settings. Polypharmacy and certain drug combinations were identified as major contributing factors to the occurrence of drug interactions, which calls for regular medication reviews and cautious prescribing practices.

The COVID-19 patients' educational needs assessment questionnaire (COPENAQ): development and psychometrics.

BACKGROUND: Despite the importance of assessing COVID-19 patients' educational needs, there is currently no standard tool for a comprehensive assessment of these needs. The present study was aimed at developing a questionnaire to assess the educational needs of COVID-19 patients and determining its psychometric properties. METHODS: This study was conducted using an exploratory sequential mixed methods design in 3 stages. At the first stage, patients' educational needs were explained and determined using conventional content analysis so that a total of 15 COVID-19 patients were first selected using purposive sampling and then interviewed. At the second stage, the questionnaire items were developed using the qualitative findings and a review of valid sources related to the study subject. At the third stage, the psychometric properties of the questionnaire were determined using internal consistency reliability and the face, content, and construct validities. RESULTS: The mean content validity ratio and the content validity index were obtained to be 0.94 and 0.92, respectively. The internal consistency was evaluated using Cronbach's alpha, which was measured to be 0.97. Based on the exploratory factor analysis, the questionnaire was developed with 36 items in four subscales of "disease recognition and treatment follow-up", "prevention of infection transmission", "medication regimen", and "psychological and physiological needs". The results of confirmatory factor analysis also showed appropriateness and approval of the structural model obtained from the questionnaire. CONCLUSION: This questionnaire was found to have the necessary psychometric criteria (validity and reliability) so that it can be applied to assess the educational needs of COVID-19 patients and provide better and more effective patient education for them.

Spiritual Self-care in Stroke Survivors: A Qualitative Study.

Self-care and quality of life challenges significantly affect post-stroke life. Stroke patients look for strategies to improve their performance and cope with their new situation. The aim of this study was to explore spirituality in self-care from the perspective of stroke survivors in the northwest of Iran. Purposive sampling is done on 15 participants through Semi-structured interviews of obtained data through conventional content analysis approach. Two categories of "spiritual self-care" as the main theme included "supplication" comprising subcategories of "worship and prayer", "resort" and "trust" and "religious beliefs" with subcategories of "divine providence" and "divine blessing". Based on results of this study, Spirituality increases motivation for self-care and adaptation, reduces stress and helps patiently manage diseases as realities.

Do the patient education program and nurse-led telephone follow-up improve treatment adherence in hemodialysis patients? A randomized controlled trial.

BACKGROUND: End-Stage Renal Disease (ESRD) is the final and permanent stage of Chronic Kidney Disease (CKD). Hemodialysis (HD) is the most common treatment for CKD. To have desirable therapeutic outcomes, patients have to adhere to a specific therapeutic regimen that reduces the hospitalization rate and side-effects of HD. The present study aimed to determine the effects of the patient education program and nurse-led telephone follow-up on adherence to the treatment in hemodialysis patients. METHODS: This is a randomized controlled trial in which a total of 66 patients were recruited using convenience sampling and then randomly assigned to two groups of control (n = 33) and intervention (n = 33). Data were collected using a demographic questionnaire, the laboratory results record sheet, and the End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which included four dimensions of HD attendance, medication use, fluid restrictions, and diet recommendations. The intervention group received a patient education program and nurse-led follow-up services through telephone communication and the Short Message Service (SMS) for 3 months. All participants filled in the questionnaire before and after the intervention. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, N.Y., USA). RESULTS: The results showed a significant difference in the mean scores of HD attendance, medication use, fluid restrictions, and diet recommendations between the two groups immediately, 1 month, and 3 months after the intervention (p < .001). The results also indicated a significant difference in the mean scores of four dimensions during the four-time points of measurement in the intervention group (P < 0.0005). Therefore, the level of treatment adherence in the intervention group was higher than in the control group. Moreover, there was a significant difference in the mean score of laboratory values between the two groups after the intervention, except for the level of serum sodium (P = 0.130). CONCLUSION: Implementation of the patient education program and nurse-led follow-up can lead to better adherence to hemodialysis in four dimensions of HD attendance, medication use, fluid restrictions, and dietary recommendations in HD patients. TRIAL REGISTRATION: IRCT registration number: IRCT20190127042512N1 ; Registration date: 2020-09-12; Registration timing: retrospectively registered: Last update: 2020-09-12.

Protective reactions of ICU nurses providing care for patients with COVID-19: a qualitative study.

BACKGROUND: The exponential spread of COVID-19 has caused a huge threat to public health worldwide. Providing care for patients with COVID-19 is a stressful experience for ICU nurses, which can affect their protective reactions. The present study was conducted to explore the protective reactions of ICU nurses providing care for patients with COVID-19. METHODS: This qualitative descriptive study was conducted to discover the protective reactions of nurses providing care for patients with COVID-19. A total of 14 ICU nurses were selected by purposive sampling. Data were collected using individual semi-structured face-to-face interviews. All interviews were recorded, and then codes and themes were extracted using content analysis method. FINDING: Seventeen subcategories, six categories and two themes were extracted from the analysis of data. These themes include "Unbalanced self-protective reactions" and "Responsible self-protective reactions". CONCLUSION: During the COVID-19 epidemic and crisis, ICU nurses exhibit different self-protective reactions when providing care for patients with COVID-19, which include unbalanced and responsible reactions. Nursing managers can mitigate these unbalanced reactions by identifying them and their roots. Identifying the protective reactions of ICU nurses in providing care for patients with COVID-19 could assist in developing the necessary interventions to promote positive reactions and reduce unbalanced reactions by finding their root causes.

Psychological reactions of COVID-19 patients to the stress caused by the disease crisis: A descriptive phenomenological study.

PURPOSE: This study was conducted to explain the psychological reactions of COVID-19 patients to the stress caused by the disease crisis from the perspective of the survivors. DESIGN AND METHODS: A phenomenological approach was adopted to the qualitative study of 14 COVID-19 survivors selected through purposive sampling. FINDINGS: Two themes extracted as the psychological reactions of the patients to the COVID-19-induced stress included "self-moderating effect of stress" and "psychological maladaptation." PRACTICE IMPLICATIONS: The present findings appear effective in laying the foundations for performing interventions to improve constructive psychological reactions such as using self-moderating mechanisms of the COVID-19-induced stress and reducing or eliminating maladaptive psychological reactions such as depression, anger, self-blaming, and regret.

"It was like nobody cared about what I said?" Iranian women committed self-immolation: a qualitative study.

BACKGROUND: Suicide-attempts have increased across the world and have become higher among females. There has been a high prevalence of self-immolation in Iran, mostly young married women admitted to the burn centers. This study aimed to explore the factors and experiences of self-immolation in Iranian married women to develop prevention strategies to prevent the personal, social, and economic impacts of suicide and suicide attempts. METHODS: A qualitative descriptive approach using open-ended, in-depth, face-to-face interviews was conducted in a purposive sample of 16 married Iranian women aged 16-40 years in the burn centers in Urmia city, a place in northwest Iran. Conventional content analysis was used to analyze the data. RESULTS: Three themes emerged from the data, including (1) antecedents of self-immolation, (2) suicidal ideation method, and (3) pathway to recovery. Each of these themes is supported by sub-themes. CONCLUSIONS: The study highlights the demand for health professionals to support self-immolation survivors to continue their normal lives. According to survivors' needs, a comprehensive supportive program is recommended to support their pathways to recovery in all its complexities. Health professionals should also not forget that the survivors' family also will need help to overcome this trauma. A family counseling program may also be provided.

Observation of Patients' Privacy by Physicians and Nurses and Its Relationship with Patient Satisfaction.

The present study was conducted to determine the extent of observation of patients' privacy by physicians and nurses and its relationship with patient satisfaction. This descriptive correlational study was conducted on 600 patients selected by convenience sampling. Based on the patients' points of view, the level of observation of patients' privacy and its dimensions, especially the psychosocial dimension, were reported to be higher in nurses than in physicians. Pearson's correlation coefficient showed a direct and significant relationship between the observation of privacy by the nurses and physicians and different dimensions of patient satisfaction.

Challenges experienced by ICU nurses throughout the provision of care for COVID-19 patients: A qualitative study.

AIM: To explore the challenges experienced by ICU nurses throughout the provision of care for COVID-19 patients. BACKGROUND: The intensive care unit nurses, who are at the frontline of fighting against COVID-19 and defusing this crisis, are faced with various challenges throughout the provision of care for COVID-19 patients. METHODS: In this qualitative descriptive study, a total of 17 nurses working in intensive care units were selected using purposive sampling. Data were collected using semi-structured face-to-face interviews. After recording and transcribing interviews, the concepts were extracted using the content analysis method. FINDINGS: The nurses reported the four following challenges throughout the provision of care for COVID-19 patients: 'organization's inefficiency in supporting nurses', 'physical exhaustion', 'living with uncertainty' and 'psychological burden of the disease'. CONCLUSION: The present study portrayed a clear understanding of the challenges faced by nurses working in intensive care units during the crisis of the COVID-19 pandemic based on their lived experiences. IMPLICATIONS FOR NURSING MANAGEMENT: A profound understanding of these challenges in the current critical situation can help health care authorities adopt appropriate measures to resolve these challenges, provide health care facilities, support the health workforce, give accurate and evidence-based information and perform psychological interventions on how to handle the current crisis.

Second Victim Experience and Support Tool: Persian translation and psychometric characteristics evaluation.

BACKGROUND: Healthcare providers involved in an unexpected adverse patient safety event are affected by negative outcomes of the event and are called 'second victims'. The Second Victim Experience and Support Tool has been introduced as a reliable and valid measure to assess the second victim responses and to support recourses of healthcare professionals. AIM: The core objective of this survey was to assess the psychometric attributes of the scale within Iranian nurse. METHODS: Having translated the scale based on the WHO guidelines and assessing its face validity, a board of 8 specialists assessed the content validity of the measure. In order to assess the psychometric characteristics of the questionnaire, a survey was conducted in 5 university-affiliated hospitals of Urmia. Confirmatory factor analysis is adopted to assess the construct validity. The internal consistency and test-retest reliability of the scale were determined. RESULTS: The Persian version of the scale consists of 29 items and 9 subscales. Confirmatory factor analysis illustrated that the scale reflects a foolproof construct validity. Cronbach α coefficients revealed the reliability of the scale (0.68-0.88). CONCLUSIONS: The survey proves to be a reliable and valid measure to evaluate the second victim responses and conceivable support resources of Iranian nurses or other Persian-speaking healthcare professionals of the region. IMPLICATIONS FOR HEALTH POLICY AND PRACTICE: Health policymakers ought to build up large-scale surveys to determine the degree of second victimization of healthcare professionals so as to offer suitable support systems. Taking the scale into account would improve evaluation of the benefits of second victim support initiatives in nursing practice.

Psychological disturbances of survivors throughout COVID-19 crisis: a qualitative study.

BACKGROUND: In addition to physical problems, patients with COVID-19 suffer from considerable stress throughout the disease crisis. It is important to address mental health needs and not to ignore the psychological dimension in this group of patients. In this regard, the first practical step is to have a clear understanding of patients' psychological issues. Therefore, this study aimed to explore the psychological disturbances of COVID-19 survivors throughout the disease crisis. METHOD: This qualitative study was conducted using a phenomenological approach through 14 individual semi-structured in-depth interviews with patients recovered from COVID-19. Data were analyzed using Colaizzi's seven-step method. RESULTS: Three themes of "living in limbo", "psychological distress behind the wall" and "psychological burden of being a carrier" were extracted as the psychological disturbances of COVID-19 survivors throughout the disease crisis. CONCLUSION: This study portrayed a better understanding of psychological disturbances of COVID-19 survivors throughout the disease crisis based on their lived experiences. Given the ambiguity in the time of the disease eradication and its continuing course, a deep understanding of these experiences in the current critical situation can help healthcare officials to make appropriate decisions and take measures to assess and identify psychological traumas and perform interventions to improve the mental state of these patients.

Relationship between patient safety culture and job burnout in Iranian nurses: Assessing the mediating role of second victim experience using structural equation modelling.

AIM: The study examined the mediating effect of the second victim experience between safety culture and burnout in Iranian nurses. METHODS: A convenience sample of 298 nurses from five teaching hospitals of Urmia participated in the study. Hospital Survey on Patient Safety Culture, Maslach Burnout Inventory and The Second Victim Experience and Support Tool were used to measure the major variables. We adopted structural equation modelling to examine the hypotheses. RESULTS: Safety culture was significantly associated with second victim experience and burnout (p < .01). Second victim experience had a partial mediating role on the relationship between safety culture and burnout (p < .01). The mediating model including major variables showed satisfactory fitness (χ2 /df = 2.11, p < .01, Comparative Fit Index = 0.94, root-mean-square error of approximation = 0.062). CONCLUSIONS: Establishing a safety culture is crucial for decreasing job burnout, and second victim experience has an intervening role clarifying how high level of safety culture reduces burnout. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should plan to promote safety culture and provide sufficient support to staff involved in the patient safety incident, which could reduce staff burnout.

The effect of collaborative care model training on diabetic foot ulcer patients' quality of life: a semi-experimental study.

PURPOSE: The aim of this semi-experimental study was the determination of collaborative care model training on diabetic foot ulcer patients' quality of life. METHODS: Demographic characteristics and life's quality questionnaires were used, and to implement the collaborative model that included (including four steps of motivation, preparation, engagement, and evaluation), 60 patients divided into two "experiment" and "control" groups. For the experimental group, the program was done by face to face education and pamphlet through one hour in seven sessions. Data were analyzed by descriptive and inferential statistical methods. SPSS 24 was used for data analysis. RESULTS: Findings showed the differences of the scores of life's quality dimensions (except the economic situation), which was significant between both groups after the implementation of the collaborative care model (p < 0.001). CONCLUSION: The implementation of collaborative care model can be effective to improve diabetic foot ulcer patients' quality of life.

Moral distress and burnout in Iranian nurses: The mediating effect of workplace bullying.

BACKGROUND: Moral distress and workplace bullying are important issues in the nursing workplace that appear to affect nurse's burnout. AIM: To investigate the relationship between moral distress and burnout in Iranian nurses, as mediated by their perceptions of workplace bullying. ETHICAL CONSIDERATIONS: The research was approved by the committee of ethics in research of the Urmia University of Medical Sciences. METHOD: This is a correlation study using a cross-sectional design with anonymous questionnaires as study instruments (i.e. Moral Distress Scale-Revised, Maslach Burnout Inventory and The Negative Acts Questionnaire-Revised). Data were collected from 278 nurses from five teaching hospitals in Urmia, the capital of Western Azerbaijan, northwest of Iran. Structural equation modeling and bootstrapping procedures were employed to recognize the mediating role of their perceptions of workplace bullying. RESULTS: The mean score of moral distress, burnout, and the Negative Acts Questionnaire-Revised Scale among the participants were 91.02 ± 35.26, 79.9 ± 18.27, and 45.4 ± 15.39, respectively. The results confirmed our hypothesized model. All the latent variables of study were significantly correlated in the predicted directions. The moral distress and bullying were significant predictors of burnout. Perception of bullying partially mediated the relationship between moral distress and burnout. The mediating role of the bullying suggests that moral distress increases burnout, directly and indirectly. CONCLUSION: Nursing administrators should be conscious of the role of moral distress and bullying in the nursing workplace in increasing burnout.

Can theoretical intervention improve hand hygiene behavior among nurses?

BACKGROUND: Hand washing is the best strategy to prevent known nosocomial infections but the nurses' hand hygiene is estimated to be poor in Iran. OBJECTIVE: This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education. METHODS: This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control) in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann-Whitney, chi-square, and Fisher's exact tests. The significance level was considered P<0.05. RESULTS: The mean age was 38.4±8.1 years for the intervention group and 40.2±8.0 years for the control group. There was no significant difference between the two groups for any demographic variables. Also, before the intervention, there was no significant difference between the two groups for any components of the BASNEF model. Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P<0.001), but hand hygiene behavior did not show any significant change in the intervention group (P=0.16). CONCLUSION: Despite the improving attitudes and intention, the intervention had no significant effect on hand hygiene behavior among the studied nurses.