Effect of protocol-based family visitation on physiological indicators in ICU patients: a randomized controlled trial.

BACKGROUND: Intensive care unit (ICU) patients often experience significant physiological stress. This study evaluated the effect of a defined family visitation protocol on physiological responses in the ICU. METHODS: A randomized, block-randomized clinical trial was conducted on 78 ICU patients at Imam Reza Hospital between February 8, 2017, and August 8, 2017. The intervention group received protocol-based visits, and the control group continued with standard visitation. Block randomization was utilized for group assignments. The primary outcome was the measurement of physiological signs using designated monitoring devices. Data were analyzed using SPSS version 22, employing independent t-tests, Mann-Whitney U test, repeated measures analysis, and Friedman's test. RESULTS: The results showed no significant differences in systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and arterial blood oxygen levels between the two groups. However, heart rate in the intervention group was significantly lower in three stages before, during, and after the meaningful visiting (P = 0.008). CONCLUSION: Protocol-based scheduled family visits in the ICU may reduce physiological stress, as evidenced by a decrease in patients' heart rate. Implementing tailored visitation protocols sensitive to patient preferences and clinical contexts is advisable, suggesting the integration of family visits into standard care practices for enhanced patient outcomes. TRIAL REGISTRATION: IRCT20161229031654N2; 25/01/2018; Iranian Registry of Clinical Trials ( https://en.irct.ir ).

The Effect of Self-Care Nurturance Based on Erickson's Modeling and Role-Modeling Theory on Quality of Life of Patients With Upper Gastrointestinal Cancer: A Randomized Clinical Trial.

Patients with upper gastrointestinal cancer undergo a diverse variety of needs that influence their quality of life (QoL). The present study aimed to investigate the effect of self-care nurturance on the QoL of patients with upper gastrointestinal cancers. This randomized, 2-group clinical trial was conducted at Qaem Hospital during 2019-2020, in Mashhad, Iran. A total of 46 patients were allocated into 2 groups randomly. At the time of hospitalization, the intervention group received care based on the modeling and role-modeling theory for at least 3 sessions individually. Participants were given 3 telephone counseling sessions each week for up to 2 months. In the control group, patients received educational pamphlets. The demographic and general QoL (EORTC QLQ-C30) questionnaires were utilized to collect data. Data were analyzed with SPSS 25. The results showed that the intervention and control groups were homogenous in all demographic characteristics (P > .05). The data revealed the total QoL significantly improved 1 month (P = .002) and 2 months (P < .001) after the intervention in the intervention compared with the control group. Self-care nurturance would empower patients to achieve new living experiences by enhancing their QoL.

The Effect of Self-Care Nurturance Using the Theory of Modeling and Role-Modeling on Self-Efficacy in Stroke Patients: A Randomized Controlled Trial.

The disability after a stroke results in reduced self-care capacity and lower levels of self-efficacy in survivors. Exploiting a holistic self-care plan to strengthen internal resources in clients can be thus deemed as an effective solution. This study aimed to determine the effect of self-care nurturance using the Theory of Modeling/Role-Modeling (TMRM) on self-efficacy in stroke clients. A randomized controlled trial was conducted at Qaem Hospital, Mashhad, Iran, in 2020. For this purpose, 70 clients were randomly assigned to 2 groups. Then, the experimental group received self-care nurturance based on the TMRM, all through 4 to 6 individual sessions of 30 to 45 minutes in the hospital, and subsequently 2 sessions of telephone counseling up to 8 weeks after the discharge. With reference to patient evaluation in terms of self-care resources, knowledge, and actions, the researcher also tried to strengthen such factors based on the individual needs of each client. The control group received routine care. The data were collected through completing a demographic/disease information form at the onset and the Stroke Self-Efficacy Questionnaire (SSEQ) before the intervention, 4 and 8 weeks after it. The results revealed that the self-efficacy mean scores of the experimental group, in the course of 3 measurement stages, had significantly improved, compared with that in the control group (P = .018). It was concluded that applying the TMRM could strengthen internal and external resources and self-care knowledge in stroke patients, develop their self-care actions, and improve their levels of self-efficacy.

Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy.

BACKGROUND: Fear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC). AIM: The present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC. METHOD: This randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire. RESULTS: The results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001). CONCLUSIONS: As evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.

The effects of abdominal "I LOV U" massage along with lifestyle training on constipation and distension in the elderly with stroke.

INTRODUCTION: Constipation and distension are dominant gastrointestinal problems after stroke in the elderly. Always they are treated by the use of laxatives and fibers. Abdominal massage along with a healthy lifestyle can be a solution. PURPOSE: This study aimed to investigate the effect of abdominal massage and lifestyle training on constipation and distention of the elderly with stroke. METHOD: This study was a randomized clinical trial that was conducted on elderly patients with stroke at Qaem hospital of Mashhad, Iran. 68 patients were randomly allocated into control (n = 34) and intervention (n = 34) groups in 2017-2018. Finally 29 elderly in the intervention and 34 in the control group completed the study. Intervention included the abdominal massage by using "I LOV U" method along with lifestyle education. Each abdominal massage lasted for 15 min, twice daily for ten days that was performed at first session by the researcher and then continued by the key care giver. Data were collected by the demographic form, constipation assessment score (CAS), distension measurement tool (meter), and food tolerance evaluation checklist. RESULTS: The results indicated that both groups were homogeneous in demographic variables (P > 0.05). The repeated ANOVA showed a more significant decrease in abdominal circumference of the intervention group during the 10- days study (P = 0.029).The Friedman test showed a significant difference in frequency of defecation in two groups in 10- day study (P < 0.0001). Therefore the CAS Score was significantly decreased in intervention group more than the control group (0.30 < 0.98 < 1.59, P = 0.001, EF = 0.44). The food tolerance frequencies through Gavage (P = 0.20), and also orally (P < 0.001) were significantly improved in the intervention group. CONCLUSION: According to results, the abdominal massage along with lifestyle training could improve constipation and distension and also increase food intake tolerance in the elderly patients with stroke.

Effect of Guided Imagery Along With Breathing Relaxation on Sleep Quality of the Elderly Patients Under Abdominal Surgery: A Randomized Clinical Trial.

Elderly patients undergoing surgery often suffer from sleep disorder. Holistic therapies might help them sleep better. The aim of this research was to determine the effect of guided imagery along with breathing relaxation on sleep quality in elderly patients undergoing abdominal surgery. A double-blind randomized clinical trial was conducted on 90 elderly patients undergoing abdominal surgery in 2 educational hospitals in 2018, Mashhad, Iran. The elderly patients with different abdominal surgical procedures were distributed to the wardrooms and then the rooms were randomly assigned into 2 groups. In the intervention group, the patients learned breathing relaxation the day before surgery and then an audiotape was provided to perform the guided imagery from the day before surgery for 5 days (twice) along with breathing relaxation. St Mary's Hospital Sleep Inventory was completed the night before, 48 hours and 96 hours after the surgery. Data analysis was done using SPSS 21 through analytical tests. Results of the test indicated that the score of sleep quality was significantly higher in the intervention group the night before surgery (P = .001). The total scores of sleep quality in the intervention group 48 and 96 hours after the surgery were significantly higher (P < .001). Based on results of generalized estimating equation model, the score of sleep quality for patients was 8.76 units higher in the intervention group than in the control group by controlling for the effects of time. Guided imagery along with breathing relaxation improved the sleep quality of the elderly patients undergoing abdominal surgery.Trial registration: IRCT20180731040652N1.

Nurse-led Care Program with Patients with Heart Failure Using Johnson's Behavioral System Model: A Randomized Controlled Trial.

Patients with heart failure experience system imbalance and have multiple symptoms. A nurse-led care program based on Johnson's behavioral system model was used to improve the balance of the behavioral system of heart failure patients. One hundred and fifty patients were randomly assigned into two groups. In the experimental group, the patient's status was evaluated by a behavioral subsystem assessment tool related to the level of imbalance. The patients in the intervention group received care individually based on their worst subsystem scores over a period of 2 weeks. The results showed significant improvement in restorative, ingestive, eliminative, aggressive/protective, dependency, and achievement (p < .05) subsystems in the experimental group. However, no significant difference was seen in sexual and affiliative (p > .05) subsystems.

The Effect of Self-Care Program Based on Modeling and Role Modeling Theory on Body Image Nurturance in Patients With Colorectal Cancer: A Randomized Clinical Trial.

One of the most critical disorders among patients with colorectal cancer is a change in their body image. This study aimed to examine the effect of a self-care program based on the modeling and role-modeling theory on nurturing body image of patients with colorectal cancer. In 2018, a 2-group randomized clinical trial was conducted in Mashhad, Iran. According to the modeling and role-modeling theory, 27 patients allocated in the experimental group received five 30- to 45-minute sessions at the hospital and 4 sessions of phone counseling within 2 weeks. Twenty-seven patients randomly allocated in the control group received the routine care. Data were collected by demographic and body image scales 3 times with the patients. The mean age of the patients in experimental and control groups was not significantly different (P = .46). The mean scores of the body image at the admission time were 26.8 ± 2.6 in the experimental and 27.9 ± 3.1 in control groups (P = .12). However, the mean scores of body image of the experimental group were 24.3 ± 4.6 at the discharge time and 28.1 ± 2.1 during the follow-up phase. In the control group, the body image scores were 21.0 ± 5.6 at discharge time and 22.9 ± 6.1 during the follow-up phase. Repeated-measures analysis of variance revealed significant differences between the 2 groups (P ≤ .001). Application of the self-care program based on the modeling and role-modeling theory can play a critical role in nurturing the body image of patients with colorectal cancer.

Effectiveness of Nurse's Intentional Presence as a Holistic Modality on Depression, Anxiety, and Stress of Cardiac Surgery Patients.

One of the important aspects of recovering after bypass surgery is mental disorders of patients. Despite the importance of intentional presence in interpersonal interactive space in holistic nursing, a few experimental and clinical trial studies are conducted on this subject. This study determines the effect of intentional presence of a holistic nurse on anxiety, stress, and depression in patients undergoing coronary artery bypass graft surgery. The study used a randomized clinical trial conducted on 80 patients referred to heart surgery department from March 2016 to June 2017, who were allocated to the control and intervention groups randomly. DASS 21 (Depression, Anxiety, Stress scale) questionnaire and a checklist to determine stressor resources were used to measure the variables. Four 30- to 45-minute sessions of nursing intentional presence were conducted for each patient individually in the intervention group. The results showed homogeneity between 2 groups in demographic variables (P > .05). But there was heterogeneity between 2 groups (P < .05) for some stressors. By using analysis of covariance and excluding the effect of stressors and the first scores before the intervention, statistics represented a significant decrease in stress, anxiety, and depression scores in the intervention group compared with the control group (P < .0001). The results of this study indicated that the intentional presence of a nurse as an effective nursing procedure can reduce the depression, stress, and anxiety of the patients undergoing coronary artery bypass surgery.

Faculty-Student Caring Interaction in Nursing Education: An Integrative Review.

Introduction: Faculty- student caring relationship in nursing education has been offered as enhancing students' learning experiences to care , desire to care for others and self-actu-alization. This review therefore was carried out to analyze faculty-student caring interactions in nursing education. Methods: This concept analysis of caring in the nursing education was conducted based on Broom methodology of integrative review. The literature was consisted of two books from two known theorists, and 47 relevant articles. They retrieved from English data bases including MEDLINE, CINAHL, ERIC, SCOPUS, and SID, with based on the keywords of caring and "nursing education", during the period 2005-2014. Results: Caring in nursing education refers to faculty-student interaction based on ethical and human values. The development of values and moral principles in education, flexibility in educational processes, application of objective patterns in learning, and dynamism in educational processes are identified as caring concept attributes in teaching-learning process. This requires environmental support, constant human relationship, and knowing. Internalization of values, achieving self-esteem, peace, and towards human evolution were the main achievements of the concept of caring in nursing education. Conclusion: The details obtained from the dimensions of "caring" concept in this study could be utilized by nursing education researchers and designers in order to develop content and structure for educational programs.

Developing the concept of caring in nursing education.

BACKGROUND: Caring is a value-based concept in the nursing field and in education. Exact understanding of caring in education and developing this concept in nursing will result in the evolution of the position of nursing science and profession. AIM: The aim of this study was to attempt to develop the concept of caring in nursing education. METHODS: This qualitative study was conducted in 2016 using directed content analysis. Participants were thirteen subjects (6 instructors and 7 senior and junior nursing students) who were selected using purposeful sampling method. Research environment was the Faculty of Nursing and Midwifery in Mashhad. Data collection method was semi-structured interviews for thirty to ninety minutes and sampling continued until data saturation. Interviews were conducted in Persian language and they were immediately transcribed and analyzed using MAXDA10 software. The text of interviews was reviewed several times. First, open codes were extracted, and after several reviews based on similarity in meaning, they were classified into subcategories and finally, similar subcategories were placed in main classes based on meaning. RESULTS: Results of this study led to the identification of four themes: 1, ethical and religious commitment, 2, development of knowing and cultural sensitivity, 3, soft assertion, 4, clear describing of objectives, expectations, and educational rules for students. CONCLUSION: Results of this study showed that the cultural and religious background of instructors affects their interaction with students. Instructors' commitment and compliance to values in interacting with students and other educational colleagues has an origin beyond ethical and human subjects and it is originated from their religious education and training.

Principle-based concept analysis: Caring in nursing education.

INTRODUCTION: The aim of this principle-based concept analysis was to analyze caring in nursing education and to explain the current state of the science based on epistemologic, pragmatic, linguistic, and logical philosophical principles. METHODS: A principle-based concept analysis method was used to analyze the nursing literature. The dataset included 46 English language studies, published from 2005 to 2014, and they were retrieved through PROQUEST, MEDLINE, CINAHL, ERIC, SCOPUS, and SID scientific databases. The key dimensions of the data were collected using a validated data-extraction sheet. The four principles of assessing pragmatic utility were used to analyze the data. The data were managed by using MAXQDA 10 software. RESULTS: The scientific literature that deals with caring in nursing education relies on implied meaning. Caring in nursing education refers to student-teacher interactions that are formed on the basis of human values and focused on the unique needs of the students (epistemological principle). The result of student-teacher interactions is the development of both the students and the teachers. Numerous applications of the concept of caring in nursing education are available in the literature (pragmatic principle). There is consistency in the meaning of the concept, as a central value of the faculty-student interaction (linguistic principle). Compared with other related concepts, such as "caring pedagogy," "value-based education," and "teaching excellence," caring in nursing education does not have exact and clear conceptual boundaries (logic principle). CONCLUSION: Caring in nursing education was identified as an approach to teaching and learning, and it is formed based on teacher-student interactions and sustainable human values. A greater understanding of the conceptual basis of caring in nursing education will improve the caring behaviors of teachers, create teaching-learning environments, and help experts in curriculum development.

Principle-based concept analysis: intentionality in holistic nursing theories.

PURPOSE: This is a report of a principle-based concept analysis of intentionality in holistic nursing theories. METHOD: A principle-based concept analysis method was used to analyze seven holistic theories. The data included eight books and 31 articles (1998-2011), which were retrieved through MEDLINE and CINAHL. FINDINGS: Erickson, Kriger, Parse, Watson, and Zahourek define intentionality as a capacity, a focused consciousness, and a pattern of human being. Rogers and Newman do not explicitly mention intentionality; however, they do explain pattern and consciousness (epistemology). Intentionality has been operationalized as a core concept of nurse-client relationships (pragmatic). The theories are consistent on intentionality as a noun and as an attribute of the person-intentionality is different from intent and intention (linguistic). There is ambiguity concerning the boundaries between intentionality and consciousness (logic). Theoretically, intentionality is an evolutionary capacity to integrate human awareness and experience. Because intentionality is an individualized concept, we introduced it as "a matrix of continuous known changes" that emerges in two forms: as a capacity of human being and as a capacity of transpersonal caring. CONCLUSION: This study has produced a theoretical definition of intentionality and provides a foundation for future research to further investigate intentionality to better delineate its boundaries.