Experiences and attitudes of clinical and academic nurses about infection prevention and control nursing curriculum and duties - a qualitative study.

BACKGROUND: Infectious diseases are becoming more widespread and re-emerging, causing psychological, social, economic, and health effects at both national and international levels. Specialist nurses can help prevent and control these infections. However, in Iran, there are currently no specialist infection prevention and control (IPC) nurses to manage and control infections. This study aims to explore clinical and academic nurses' attitudes toward IPC nursing curriculum and duties. METHODS: The study used a qualitative content analysis approach. Thirty-six participants, including clinical and academic nurses, were selected using a purposeful sampling method. Data was collected through seven focused group discussions. The accuracy and validity of the research tools were measured using the Four-Dimension Criteria developed by Lincoln and Guba. Data analysis was conducted using directed content analysis. RESULTS: The data analysis of the discussions held in the seven focus groups extracted 628 codes. Three themes were developed from the qualitative analysis: "Core characteristics of the curriculum", "Expected competencies and skills", and "Evaluation." These themes were derived from nine main categories and 25 subcategories. CONCLUSIONS: Specialist IPC nurses can play important roles in various positions and environments. Therefore, educational policymakers in Iran should consider establishing IPC nursing courses. It is also recommended that policymakers and decision-makers in the nursing field of other less developed countries should prioritize this issue.

Development and Psychometric Evaluation of the Clinical Nursing Cultural Competence Scale.

Background and Purpose: Cultural competence in clinical nurses can lead to comprehensive care for patients from different cultures. Currently, an appropriate instrument to assess cultural competence in clinical nurses is limited. This study aimed to design and determine the psychometric properties of the clinical nursing cultural competence scale (CNCCS). Methods: This methodological study was conducted in 2018-2019 in two phases. In the first phase, a literature review and semistructured interviews with 18 clinical nurses from Isfahan and Ahvaz were conducted, and the results were used for item generation. In the second phase, the face, content, construct validity, and reliability of the questionnaire were assessed. For construct validity assessment through exploratory factor analysis (EFA), 200 clinical nurses were purposefully recruited to fill out CNCCS. Results: In the first phase, 140 items were produced. In the second phase, the item number was reduced to 40 after the face and content validity assessment. In EFA for construct validity assessment, 13 more items were deleted, and the remaining 27 items were loaded on six factors. The Cronbach's alpha and the test-retest intraclass correlation coefficient were CNCCS 0.86 and 0.93, respectively. Conclusions: The CNCCS had acceptable psychometric characteristics in Iranian nurses and can be used for assessing cultural competence among clinical nurses. The use of this scale can help nursing policymakers and managers develop their understanding of nursing cultural competence and develop strategies for its improvement.

Psychometrics of the Persian version of the program in palliative care education and practice questionnaire (German revised - PPCEP-GR).

BACKGROUND: In order to improve the provision of palliative care by nurses, it is necessary to have a tool that measures different dimensions of palliative care and the knowledge and performance of nurses in this field. The Program in Palliative Care Education and Practice Questionnaire (German Revised) is psychometrically evaluated for the first time in Iran. METHODS: To measure the psychometric properties, 360 nursing students (BSc, MSc, PhD) and clinical nurses completed the questionnaire. Face and content (CVR and CVI) validity were checked by quantitative and qualitative approach. Construct validity was performed with exploratory and confirmatory factor analysis. The total variance explained was equal to 43%; the internal consistency reported a Cronbach's alpha of more than 0.7; and the composite reliability was greater than 0.7. RESULTS: After conducting construct validity and factor analysis, four factors (Knowledge and skill of managing patients' pain and symptoms, management of ethical and psychological issues in patients, communicating with patients and their families & management of patients' exposure to grief and attitudes towards death) were extracted. The total variance was equal to (%43) and coefficients of internal consistency were estimated more than 0.7. Also composite reliability was evaluated greater than 0.7. CONCLUSION: Persian version of the Program in Palliative Care Education and Practice Questionnaire (German Revised Version; PPCEP-GR) is a valid and reliable questionnaire that can be used to measure the knowledge and performance of nurses and nursing graduates in the field of palliative care.

The effect of an infection control guideline on the incidence of ventilator-associated pneumonia in patients admitted to the intensive care units.

BACKGROUND AND AIM: Standard airway care can reduce the incidence of ventilator-associated pneumonia (VAP). This study aimed to determine the effect of implementing infection control guidelines on the incidence of VAP in patients admitted to the intensive care unit (ICU). MATERIALS AND METHODS: In this clinical trial, 121 patients admitted to the intensive care units of Golestan and Imam Khomeini hospitals of Ahvaz, Iran who were under mechanical ventilation were assigned to two groups of control and intervention in non-randomly allocation. The study was conducted in two consecutive periods. In the intervention group, infection control guidelines were performed to prevent VAP and in the control group, routine care was performed. Data collection is done by used a three-part instrument. The first part included questions on the patients' demographics and clinical information. The second part was the modified clinical pulmonary infection scale (MCPIS) for the early detection of VAP. The third part of the data collection instrument was a developed checklist through literature review. The MCPIS was completed for all patients on admission and the 5th day of the study. RESULTS: The two groups were homogenous respecting their baseline characteristics (P > 0.05) including the mean MCPIS score (P > 0.05). However, the intervention group had lower body temperature (P < 0.001), lower white blood cell counts (P < 0.038), lower MCPIS score (P < 0.001), and higher PaO2/FIO2 (P < 0.013) at the end of the study. The incidence of VAP was significantly lower in the intervention group when compared to the control group (i.e. 30% vs. 65.6%, P < 0.001). CONCLUSIONS: The implementation of infection control guidelines could significantly reduce the incidence of VAP and its diagnostic indicators in patients admitted to the ICU. Nurses are advised to use these guidelines to prevent VAP in patients admitted to ICU.

Prediction of risk of coronary artery disease based on the Framingham risk score in association with shift work among nurses.

Objectives. This study aimed to determine the prediction of risk of coronary artery disease (CAD) based on the Framingham risk score (FRS) in association with shift work among nurses.Methods. This cross-sectional and descriptive-analytic study was conducted with nurses working in three hospitals located in Abadan, southwest Iran. The sample size was 120 participants, divided into 60 shift workers and 60 day workers (non-shift workers). Demographic data and medical and occupational history were collected through a checklist and interviews. CAD risk assessment tools used to estimate the 10-year cardiovascular disease (CVD) risk included the FRS. Data were analysed by Mann-Whitney U test, χ2 test and one-way analysis of variance (ANOVA) using SPSS version 22.0.Results. There were statistically significant differences between blood pressure (BP), total cholesterol (TC), body mass index (BMI) and shift work (p ≤ 0.001). There was a statistically significant difference between prevalence of CAD risk and shift work based on the FRS (p = 0.04).Conclusion. The study findings showed that shift work is a risk factor for CAD disturbances. Therefore, particular follow-up of shift workers should be recommended for screening and preventing CAD.

Experience of discomfort and its self-management strategies in ICU patients.

Introduction: Discomfort in patients admitted to the ICU occurs due to various reasons and leads to a stressful situation in these patients. Discomfort significantly affects the ability to cope psychologically, the process, and results of treatment. The aim of this study was to investigate the experiences of discomfort and its self-management strategies in patients admitted to the ICU. Methods: This qualitative study was conducted in the period of September 2019 to December 2020 through in-depth interviews with 13 patients admitted to the ICU who were selected by purposive sampling. Interviews continued until data saturation. All interviews were recorded, transcribed, and analyzed using MAXQDA18 software by the conventional Lundman and Graneheim content analysis method. Results: The two main themes including "hospitalization with anxiety" and "coping with the horror of ICU" emerged from the uncomfortable experiences of patients admitted to the intensive care unit. "Hospitalization with anxiety" included five subthemes: "fear of disability and possible death," "separation from family," "understanding ambiguity and contradiction in treatment," "environmental disruptors," and "painful and unfamiliar devices and treatments." "Coping with the horror of ICU" included three subthemes: "recourse to spirituality," "benefiting from psychosocial coping," and "information search."

The impact of critical thinking training using critical thinking cards on clinical decision-making of CCU nurses.

INTRODUCTION: Due to the complexity of the situation and rapid changes in patients' clinical status in intensive care units, it is necessary to teach decision-making skills to nurses, alongside critical thinking. The aim of this study was to evaluate critical thinking training by using critical thinking cards on clinical decision-making of nurses in cardiac care units (CCU). METHODS: In this quasi-experimental study, 74 CCU nurses from the selected hospitals affiliated to Ahvaz and Dezful Universities of Medical Sciences were selected based on the inclusion criteria and were assigned to either the intervention or the control group by using permuted block randomization. The data were entered into SPSS V22 and analyzed. RESULTS: There was no statistically significant difference between the demographic characteristics of the two groups (P < 0.05). The mean total score of nurses' clinical decision-making before training sessions in the intervention group was calculated to be 141.59 ± 10.76, which was lower compared to a score of 148.56 ± 10.95 in the control group (P = 0.011). Therefore, covariance analysis was used to modify the results. The mean total score of nurses' clinical decision-making after the training in the intervention group was calculated as 163.82 ± 8.83, indicating a significant increase compared to a score of 154.50 ± 11.25 in the control group (P < 0.001). CONCLUSION: The findings of the present study show that the education of critical thinking by using the critical card tool leads to improved clinical decision-making in CCU nurses.

The Effect of Pain Self-Management Education on Pain Severity and Quality of Life in Metastatic Cancer Patients.

OBJECTIVE: Proper pain control in cancer patients is one of the prime needs of metastatic cancer patients. It is, then, one of the essential objectives of health care workers. The present study aimed to pinpoint the impact of pain self-management education on the pain severity and the quality of life in patients with metastatic cancers using complementary medicine approaches. METHODS: This clinical trial study was performed in the Oncology Specialty Clinic of Ahvaz Golestan Hospital on 82 metastatic cancer patients picked based on inclusion criteria. They were randomly assigned to two groups: the intervention group and one as the control group. In the intervention group, pain self-management was taught in the three steps of providing information, skill development, and guidance. Self-management approaches were also practically taught face to face along with feedback. Furthermore, the quality of life was measured at 1-and 3-month follow-ups and the pain severity was measured during 7 weeks. In the control group, the quality of life questionnaire and the pain severity checklist were given to the participants to fill out. Finally, data were analyzed through SPSS version 22 in general and repeated-measures ANOVA and Friedman tests. RESULTS: It was observed that after the intervention, the trend of pain severity during weeks 1-7 was significantly different in the intervention and control groups (P < 0.0001). In addition, a significant difference was observed for the quality of life at 1 and 3 months after the intervention between the two studied groups (P < 0.0001). CONCLUSIONS: Findings of the present study indicate a positive impact of pain self-management on improving pain severity and the indicators of quality of life in metastatic cancer patients. Accordingly, the current study findings can help nurses, nursing students, and other team members improve pain control skills and subsequently increase the quality of life in patients with metastatic cancers.

The relationship between rotating shift work and blood pressure among nurses working in hospitals of Abadan, Iran.

Hypertension is a major risk factor for developing cardiovascular disease. Various factors such as occupational and environmental risk factors affect blood pressure. Shift work is considered to be an occupational stressor. The aim of this study was to determine the relationship between rotating shift work and blood pressure among nurses working in hospitals associated with faculty of medical science. This cross-sectional and descriptive-analytic study was conducted on nurses who worked in three hospitals associated with faculty of medical science, located in Abadan, southwest of Iran from September until December 2019. The sample size was 120 participants and divided into 60 rotating shift workers and 60 day workers (non-shift workers). The nurses were selected through the stratified random sampling technique. Demographic data, smoking status, and medical and occupational history were collected through a check list and interviews. Blood pressure was measured using a digital sphygmomanometer. Data were analyzed by the Mann-Whitney U, chi-square, Pearson's correlation coefficient and logistic regression by using SPSS software version 22. There was statistically significant difference in blood pressure between day workers and rotating shift workers (p ≤ 0.001). By logistic regression analyses, and even after adjusting for confounding variables, rotating shift work was associated with a higher prevalence of hypertension (OR: 1.76 [95%CI: 1.11-2.80]). The findings of this study showed that rotating shift workers have a higher incidence of hypertension than day workers. Therefore, a particular follow-up of rotating shift workers should be recommended to screen workers for hypertension.

Correction to: Determination of the effects of prone position on oxygenation in patients with acute respiratory failure under mechanical ventilation in ICU.

[This corrects the article on p. 274 in vol. 11, PMID: 30894882.].

Development and Psychometric Assessment of Nursing Student's Satisfaction with First Clinical Practical Education Questionnaire: Modified Version.

BACKGROUND: The present study aimed to develop an instrument for assessing nursing students' satisfaction with First Clinical Practical Education (SFCPE), and then to test the validity and reliability of the instrument. MATERIALS AND METHODS: In this methodological research, the views of a panel of 15 clinical professors, in terms of the clinical nursing principles and skills training, were used to develop the instrument. The content validity of the instrument was evaluated quantitatively and qualitatively based on the panel's views. The data was collected from the questionnaire completed by 380 second- and third-semester nursing students in 15 medical universities of Iran. The Exploratory Factor Analysis (EFA) was later performed to determine the construct validity of the instrument. The reliability of the instrument and stability analysis were evaluated using the internal consistency test by calculating Cronbach's alpha and by the test-retest method, respectively. RESULTS: Throughout the development phase, 16 items were added to the SFCPE instrument, and a 42-item instrument was later developed. During the qualitative and quantitative content validity reviews, the number of added items decreased to 38 items. Finally, a 37-item instrument consisting of seven factors was developed. The Cronbach's alpha coefficients of 0.95 and 0.75-0.9 were obtained for the whole instrument and the factors, respectively. Pearson's correlation coefficient was within the normal range (0.71-1). CONCLUSIONS: The developed SFCPE is a valid and reliable instrument that can be used for assessing the satisfaction of nursing students in terms of clinical nursing principles and skills.

Experience of Uncertainty in Patients with Thalassemia Major: A Qualitative Study.

Background: Uncertainty leads to a stressful situation in patients with thalassemia major that can dramatically affect their psychosocial coping ability, treatment process and disease outcomes, and reduce patients' quality of life. As one of the important factors affecting the health of thalassemia patients, understanding the concept of uncertainty is of major importance to health care providers especially nurses as the first line of exposure to these patients. The present study aimed to explore the experiences of uncertainty in patients with thalassemia major. Materials and Methods: The present qualitative study was conducted through in-depth face-to-face semi-structured interviews held with 18 patients with major thalassemia selected through purposive sampling. Interviews continued until saturation of data. All interviews were recorded, transcribed and analyzed with conventional content analysis method of Landman and Graneheim using MAXQDA10 software. Results: Two main themes, including 'living in the shadow of anxiety' and 'coping with uncertainty' emerged from patients' experiences of illness uncertainty of thalassemia. 'Living in the shadow of anxiety' included four categories of 'fear of complications', 'contradictory views on treatment', 'unknown future' and 'stigma'. 'Coping with uncertainty' included three categories of 'spiritual coping', 'psychosocial coping' and 'knowledge acquisition'. Conclusion: According to the results of this study, uncertainty is a major psychological stress in patients with thalassemia major. Healthcare providers should therefore consider the challenges and concerns faced by patients and, through utilizing appropriate training and communicational practices, plan interventions and strategies to empower patients for coping with uncertainty.

Investigation of Nursing Student Satisfaction with the First Clinical Education Experience in Universities of Medical Sciences in Iran.

Satisfaction with the experience gained in clinical settings is of great significance to nursing students and novice first-year students in particular and contributes significantly to developing basic clinical skills and competence. Accordingly, the present study aimed to examine nursing student satisfaction with the first clinical education experience. A total of 390 second- and third-semester nursing students gaining clinical experience in general surgery, internal medicine, gynecological surgery, orthopedics, emergency, obstetrics and gynecology, ophthalmology, andrological surgery, post-CCU, and otorhinolaryngology departments participated in this analytical cross-sectional study from March to June 2017. The research instrument included the "Assessment of nursing student's Satisfaction with First Clinical Practical Education Questionnaire: Modified Version", consisting of three parts: demographic characteristics, 37 items, and a 10-degree visual analog scale to assess student satisfaction. Descriptive statistics were used to hypothesis test in SPSS 22. The highest rate of student satisfaction was related to the third domain labeled "Instructor's behavior", and the lowest rate of student satisfaction was related to the fifth and seventh domains labeled "Emotional atmosphere and learning in the clinical setting" and "Creating appropriate learning opportunities", respectively. The results of statistical tests suggested a statistically significant relationship between the mean satisfaction score (based on the 10-degree scale) and gender (p=0.01). However, no statistically significant relationship was observed between the mean satisfaction score and other demographic characteristics such as age, grade point average (GPA), and university type. Student satisfaction rate varies in different domains of the questionnaire. Accordingly, it is recommended that schools of nursing and midwifery incorporate the findings of this study into their first clinical, educational experience planning and take into account the educational needs of students to bring greater satisfaction.

Determination of the Effects of Prone Position on Oxygenation in Patients with Acute Respiratory Failure Under Mechanical Ventilation in ICU.

Introduction: Patients under mechanical ventilation are usually in the supine position due to various arterial/venous tubes attached to them. Although many studies emphasize the advantages of prone position for oxygenation, some studies enumerate its disadvantages. Objective: The aim of the present research was to determine the effect of prone position on oxygenation of patients with Acute Respiratory Failure (ARF) under mechanical ventilation in the Intensive Care Unit (ICU). Methods: The present study is a single-group clinical trial (pretest-posttest), which was performed in 2017 in Ahvaz, Iran. The population of the study included 58 patients with ARF under Mechanical Ventilation (MV) in ICU in the Golestan Hospital of Ahvaz City. Patients were asked to lie in a supine position for 2 hours, and their physiological signs were measured twice at one-hour intervals. Arterial Blood Gas was tested at the end of the second interval. Afterward, they lied in the prone position and their physiological signs were again measured twice at one-hour intervals and Arterial Blood Gas (ABG) was tested at the end of the second interval. Collected data were statically analyzed by SPSS v.22. Findings: The prone position had a significant relation to Oxygen Arterial Blood (Sao2) and Pressure of Arterial Oxygen (pao2), (p-value<0.05). Also, on days one and two, there was no significant relationship between the prone position and physiological signs; however, this relation was significant on day three (p-value<0.05). Conclusions: Results showed that the prone position improves sao2 and pao2 without adverse effect on physiological signs.

The effect of nitric oxide releasing cream on healing pressure ulcers.

BACKGROUND: Pressure ulcer is one of the main concerns of nurses in medical centers around the world, which, if untreated, causes irreparable problems for patients. In recent years, nitric oxide (NO) has been proposed as an effective method for wound healing. This study was conducted to determine the effect of nitric oxide on pressure ulcer healing. MATERIALS AND METHODS: In this clinical trial, 58 patients with pressure ulcer at hospitals affiliated to Ahvaz Jundishapur University of Medical Sciences were homogenized and later divided randomly into two groups of treatment (nitric oxide cream; n = 29) and control (placebo cream; n = 29). In this research, the data collection tool was the Pressure Ulcer Scale for Healing (PUSH). At the outset of the study (before using the cream), the patients' ulcers were examined weekly in terms of size, amount of exudates, and tissue type using the PUSH tool for 3 weeks. By integrating these three factors, wound healing was determined. Data were analyzed using SPSS. RESULTS: Although no significant difference was found in terms of the mean of score size, the amount of exudates, and the tissue type between the two groups, the mean of total score (healing) between the two groups was statistically significant (P = 0.04). CONCLUSIONS: Nitric oxide cream seems to accelerate wound healing. Therefore, considering its easy availability and cost-effectiveness, it can be used for treating pressure ulcers in the future.

Design and Evaluation of Reform Plan for Local Academic Nursing Challenges Using Action Research.

PURPOSE: This study identifies challenges to the first nurse training program for undergraduate nursing students at a nursing and midwifery school in Iran using a collaborative approach in order to improve the program. METHODS: Action research was used as a research strategy with qualitative content analysis and quantitative evaluation. The participants were 148 individuals from nursing academic and clinical settings, including administrators, faculty members, students, and staff nurses. We obtained approval from the research deputy and ethics committee of Shahid Beheshti University of Medical Sciences in Tehran, Iran for this study. RESULTS: Lack of coherence in the educational program and implementation of the program, inadequate communication between management inside and outside the organization, insufficient understanding of situations by students, and improper control of inhibitors and use of facilitators in teaching and in practice were among the major challenges in the first training process in the context of this study. After classification of problems, the educational decision-making authorities of the school developed an operational program with stakeholder cooperation to plan initial reforms, implementation of reforms, reflection about the actions, and evaluation. Comparison of student satisfaction with the collaborative learning process versus the traditional method showed that except for the atmosphere in the clinical learning environment (p>.05), the mean differences for all dimensions were statistically significant. CONCLUSIONS: The results confirm the overall success of the revised partnership program, but stressed the need for further modification of some details for its implementation in future rounds.

Improvement of the First Training for Baccalaureate Nursing Students--A Mutual Approach.

BACKGROUND: Examination of problems and application of strategies appropriate for clinical education and learning, especially nursing clinical principles and skills internship can improve educational process and satisfaction of nursing students. The aim of the current study was to revise the current status of the fundamentals of nursing course and implement an improvement plan (2012-2014). PARTICIPANTS & METHODS: The present study reports the three rounds of a participatory action-research study with a mutual cooperation approach and focus group discussion, with participation of 104 stakeholders. Content analysis approach was used to analyze the data obtained in focus discussion interviews. In addition, evaluation and reflection were done during the operating rounds, with the participation of all members, including students, were involved. This research program was approved by Shahid Beheshti University of Medical Sciences in Tehran-capital of Iran, at the Research Deputy of Nursing and Midwifery School and ethics committee of the university. RESULTS: The findings of qualitative study detected Lack of consistency in planning and implementation of curriculum, inadequate intra/extra-organizational communication management, inadequate student understanding of situation, improper control of restrictors and improper use of facilitators in teaching and in clinical setting, were among major challenges in clinical skills and principles internship process in the context of this study. Educational decision-making authorities of the School developed an operational program within national curriculum framework through cooperation and reflection in clinical skills and principles training program. CONCLUSION: Planning Fundamentals of Nursing training in partnership with all those involved in practice and education, together with students involved can be effective in reducing educational failures, gap between theory and practice, and in students' accountability and satisfaction.