Barriers and facilitators of readiness for hospital discharge in patients with myocardial infarction: a qualitative study: quality improvement study.

Background: Readiness for hospital discharge (RHD) in patients with myocardial infarction (MI) is a key concept in the discharge process. This study was conducted to explain the barriers and facilitators of preparation for discharge in patients with MI. Materials and methods: A qualitative study was conducted using conventional content analysis from April 2021 to 2022. Data collection was done in a targeted manner through semi-structured interviews until the data saturation stage. Nineteen participants (11 patients, 3 family members, and 5 healthcare team) were interviewed. Data analysis was done in eight steps according to the suggested steps of Graneheim and Lundman. MAXQDA18 software was used for coding. Results: From the interviews, 348 primary codes, 11 sub-categories, and 5 categories were extracted. Finally, after continuous analysis and comparison of interviews, codes, and categories, two themes including "supporting platform" and "caring atmosphere" were extracted, which were the result of the participants' experience and understanding of the barriers and facilitators of RHD. The supporting platform included "family support" and "social support" and the caring atmosphere included "care gaps" and "professional healthcare team performance". Conclusion: The results of this study indicate several factors affecting RHD in heart attack patients. According to the results of the study, the participation of the patient, family, healthcare team, and community in creating RHD is recommended. It is also suggested to pay attention to these factors in care and treatment planning to help improve health and control complications and prevent re-hospitalization in these patients.

Core components of end-of-life care in nursing education programs: a scoping review.

BACKGROUND: So far, there have been many studies on end-of-life nursing care education around the world, and in many cases, according to the cultural, social, and spiritual contexts of each country, the results have been different. The present study intends to gain general insight into the main components of end-of-life care in nursing education programs by reviewing scientific texts and the results of investigations. METHODS: This study was a scoping review conducted with the Arksey and O'Malley methodology updated by Peters et al. First, a search was made in Wos, ProQuest, Scopus, PubMed, Science Direct, Research Gate, and Google Scholar databases to find studies about end-of-life care education programs. Then, the screening of the found studies was done in four stages, and the final articles were selected based on the inclusion and exclusion criteria of the studies. Due to the nature of the research, editorials, letters, and commentaries were excluded. The screening steps are shown in the PRISMA-ScR diagram. RESULTS: 23 articles related to end-of-life care education programs were reviewed. The studies included eleven descriptive and cross-sectional studies, two qualitative studies, eight interventional studies, one concept analysis article, and one longitudinal study. By summarizing the data from the studies, six themes were obtained as the main components of end-of-life care education: principles of end-of-life care, communication skills, physical considerations, psychosocial and spiritual considerations, ethical considerations, and after-death care. CONCLUSION: End-of-life care is one of the most challenging nursing care in the world. Since many nurses are not prepared to provide such care, the information obtained from this review can help nursing education and treatment managers develop more comprehensive training programs to improve the quality of end-of-life care.

The Relationship Between Spirituality and Religiosity with Death Anxiety Among Cancer Patients: A Systematic Review.

This systematic review aimed to summarize the evidence regarding the relationship between spirituality and religiosity with death anxiety (DA) among cancer patients. This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) checklist. An extensive search was conducted on electronic databases such as Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) via keywords extracted from Medical Subject Headings from the earliest to February 9, 2022. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Fifteen studies were selected for inclusion in this systematic review. Nine and six studies assessed the relationship between spirituality and religiosity with DA in cancer patients, respectively. Most studies had a negative relationship between spirituality (n = 8) and religiosity (n = 4) with DA. In sum, most studies showed that religion and spirituality are negatively related to DA in patients with cancer.

Effect of family-centered care on the anxiety levels among family members of patients undergoing cardiac surgery: a randomized controlled trial.

Background: The present study aims to determine the effect of family-centered care on anxiety levels among family members of patients undergoing cardiac surgery. Materials and methods: This study was a randomized clinical trial study that was conducted on the families of Iranian cardiac surgery patients. In the intervention group, family-centered care was implemented, and the content of the intervention included providing informational and emotional support to the family member and the family member's participation in patient care according to the set framework. Results: A total of 144 family members of patients undergoing cardiac surgery were included in this study. Among the 144 family members, 71 were in the intervention group, and 73 were in the control group. The changes in the state anxiety score before and after the intervention were significant between the two groups, and the changes were higher in the control group (P=0.043). Also, there was no significant difference in the changes in trait anxiety before and after the intervention between the two groups (P>0.05). Conclusion: In general, the high prevalence of anxiety in patients' families has negative functional consequences on both patients and their families. To reduce the level of anxiety, special attention should be paid to knowing the effective factors and appropriate coping methods. Nevertheless, it is important to note that additional research is warranted to delve deeper into this matter in future studies.

The effect of serious game and problem-based learning on nursing students' knowledge and clinical decision-making skill regarding the application of transfusion medicine in pediatric nursing.

PURPOSE: Comparing the effect of serious game and problem-based learning on nursing students' knowledge and clinical decision-making skill regarding the application of transfusion medicine in pediatric nursing. DESIGN AND METHODS: In this quasi-experimental study, 76 undergraduate nursing students were enrolled through a convenience sampling method, and were allocated to one of the three groups of serious game, problem-based learning, and control through the block randomization method. Data were collected using a valid and reliable 3-part researcher-made tool, completed before and two weeks after the intervention. Statistical analysis was performed using paired t-test, analysis of covariance, and Bonferroni post hoc test. A significance level of <0.05 was considered. RESULTS: After the intervention, mean scores of both knowledge and clinical decision-making skill increased significantly in both intervention groups (p < 0.05). Mean post-test scores of both knowledge and clinical decision-making skill in the serious game group, and only clinical decision-making skill in the problem-based learning group were significantly higher than the control group (p < 0.05). However, no significant difference was observed regarding mean post-test scores of both knowledge and clinical decision-making skill between the intervention groups (p > 0.05). CONCLUSIONS: Both serious game and problem-based learning are proven to be effective in improving nursing students' knowledge and clinical decision-making skill regarding the application of transfusion medicine in pediatric nursing. PRACTICE IMPLICATIONS: Since learning now occurs beyond classrooms and the new generation of students spend most of their time in virtual places, utilizing technology-based teaching methods like serious games can benefit both educators and students by providing continuous education, saving their time and expenses, etc.

Psychometric evaluation of the heart failure somatic perception scale in Iranian heart failure patients: a cross-sectional study.

Background: This study aimed to evaluate the psychometric evaluation of heart failure somatic perception scale (HFSPS) in Iranian heart failure patients. Materials and methods: A total of 220 heart failure (HF) patients were enroled in the study. Data gathering was conducted via consecutive sampling from August 2022 to April 2023. Face validity, content validity, construct validity, and internal consistency were used to evaluate the validity and reliability of the Persian version of the HFSPS. Construct validity was done through confirmatory factor analysis and convergent validity. Convergent validity between HFSPS and symptom status questionnaire-heart failure was measured using Pearson's correlation coefficient. Cronbach's alpha and Macdonald's omega coefficient were used to evaluate the reliability of instruments. Results: A total of 220 HF patients participated in this study. Their mean age was 66.46 (SD=11.40). Among the participants, 70% were men. The results of the confirmatory factor analysis evaluation showed the goodness of fit indices of the final HFSPS model after modification was within an acceptable range (χ2=306.18 P<0.001, Minimum Discrepancy Function Divided by Degrees of Freedom=2.47, Comparative of Fit Index=0.91, Tucker-Lewis index=0.90, Adjusted goodness of fit index=0.81, Parsimonious norm fit index=0.70, root mean square error of approximation=0.082). Convergent validity between HFSPS and symptom status questionnaire-heart failure indicated a positive and significant correlation. Cronbach's alpha coefficient in the HFSPS was 0.868, and McDonald's omega coefficient in the HFSPS was 0.832. Conclusion: Overall, the Persian version of the HFSPS was determined to be a reliable and valid scale among Iranians with HF.

Clinical Decision Making in Forensic Nursing: A Cross-Sectional Study From an Emergency Nursing Perspective.

BACKGROUND: Appropriate clinical decision making (CDM) is very important for emergency nurses when working with forensic patients with violence-related injuries and can improve patient outcomes. Therefore, it is essential for emergency nurses to have the basic skills to make the right clinical decisions when working with forensic patients. AIM: The aim of this study was to evaluate the CDM of emergency nurses when caring for forensic patients. METHODS: This study was conducted using a cross-sectional design. Nurses working in the seven emergency departments of Rasht hospitals, Guilan Province, Iran, were recruited to take part in the study. Data collection was performed via census sampling from September to November 2019. Data were collected via a two-part questionnaire developed by the researcher(s) that addressed (a) demographic characteristics and (b) simulated scenarios that assessed their CDM in caring for forensic patients. FINDINGS: One hundred ninety-two emergency nurses participated in this study. The mean score of CDM in forensic nursing was moderate (56.46; 95% CI [54.49, 58.43]). Of the participants, 60.42% of the emergency nurses had moderate CDM knowledge related to forensic nursing, whereas only 2.8% had desirable knowledge of CDM. There was a statistically significant relationship between CDM in forensic nursing and the history of encountering forensic patients ( p = 0.008). CONCLUSION: CDM scores regarding emergency nurses' knowledge of forensic nursing were moderate. Knowledge of and CDM in forensic nursing is very important and provides high-quality safe care for forensic patients. IMPLICATIONS FOR CLINICAL FORENSIC NURSING PRACTICE: This study highlights the importance of additional education and professional development in forensic nursing, for emergency nurses, and should be considered further by nursing administrators and nursing educators.

Prevention of central line-associated bloodstream infections: ICU nurses' knowledge and barriers.

BACKGROUND: Central line-associated bloodstream infections (CLABSI) have been a significant challenge in care, increasing healthcare costs and leading to adverse outcomes, including mortality. AIM: The present study aimed to assess the knowledge of intensive care unit (ICU) nurses on the prevention of CLABSI and the implementation barriers of evidence-based guidelines in practice. DESIGN: A cross-sectional study. METHODS: Data were collected from adult, paediatric, and neonatal ICU nurses working in seven hospitals in Iran, using census sampling from April to July 2020. RESULTS: A number 209 out of 220 ICU nurses participated in the present study (response rate of 95%). The median score of knowledge of ICU nurses towards the prevention of CLABSI was 3.00 out of 11. 50.72% of ICU nurses had insufficient knowledge. The most critical implementation barriers of evidence-based guidelines were high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops. CONCLUSIONS: Overall, the knowledge of ICU nurses towards the prevention of CLABSI was insufficient. Study findings suggest that the knowledge of ICU nurses may be improved by reducing the workload, increasing the number of nursing staff in the ICU, having an adequate supply of equipment needed to ensure safe practice in the ICU, and providing regular related educational workshops for nurses working in the ICU. RELEVANCE TO CLINICAL PRACTICE: The present study's findings suggest that regular training programs should be developed to improve the knowledge of ICU nurses in the care and prevention of CLABSI. Nursing policymakers and managers need to identify and address implementation barriers of evidence-based guidelines to improve nursing, such as high workload, shortage of necessary equipment, and lack of CLABSI prevention workshops.

Effect of Topical Sesame Oil on the Severity of Pain in Patients With Limb Trauma: A Randomized Controlled Trial.

Objective: The purpose of this study was to investigate the effect of topical use of sesame oil on pain severity in patients with limb trauma. Methods: A placebo-controlled randomized controlled trial was conducted on 120 patients with nonpenetrating upper and lower limb traumas admitted to the trauma emergency department. The patients were allocated to either the sesame oil group or the placebo group using the stratified random sampling technique based on trauma size and age. Depending on the trauma area, sesame or placebo oil were poured on the trauma site and massaged for 5 to 7 minutes. The intervention was repeated twice a day for 3 days at home. Pain severity was measured using the numeric pain scale before intervention on the first day and 30 minutes after each intervention for 3 days, twice a day. Data were analyzed using descriptive and analytical tests including the independent t test, χ2 test, Fisher exact test, Mann-Whitney U test, Friedman test, and multiple linear regression analysis. The significance level was set at 0.05. Results: The decreasing trend of pain was significant in both the intervention and placebo groups (P < .001). Comparison of the trend of changes in pain scores between the 2 groups showed that the mean changes of pain severity were higher in the intervention group compared with the placebo group in all assessments. There was a significant difference in the rate of analgesic consumption in the intervention group compared with the placebo group (P < .001). However, there was no significant difference between the 2 groups regarding pain severity. Pain reduction was negatively associated with body mass index (b = -0.091, P = .003), amount of received pain medication (b = -0.001, P = .039), and area of trauma (b = -0.002, P = .039). Pain reduction was greater in male patients than female patients (b = 0.676, P = .015). The effect of sesame oil on pain changes was not significant. No adverse side effects were reported. Conclusion: This study showed that despite less use of analgesics in the intervention group than in the placebo group, sesame oil did not have any statistically significant effects on the severity of limb trauma pain. Further research is needed regarding the effect of topical sesame oil application on pain as a safe and uncomplicated intervention.

Effect of a forensic nursing virtual education course on knowledge and clinical decision-making of master's nursing students in Iran: a non-equivalent control group pre- and post-test study

PURPOSE: Forensic nursing is a specialty in the nursing profession based on legal procedures. This study aimed to assess the effect of a forensic nursing virtual education course on knowledge and clinical decision-making among master's nursing students. METHODS: In a quasi-experimental study with a pre- and post-test, 106 master's nursing students at Guilan (n=65) and Mazandaran (n=41) Universities of Medical Sciences, Iran were enrolled. Data were collected using census sampling from March to April 2021. Participants in the intervention group received a forensic nursing virtual education course in three 90-minute sessions for 2 days. RESULTS: A total of 88 out of 106 master's nursing students were enrolled in this study. The mean post-education score for knowledge in the intervention group was significantly higher than in the control group (12.52 vs. 7.67, P<0.001). The mean post-education score for clinical decision-making in the intervention group was significantly higher than in the control group (16.96 vs. 13.64, P<0.001). CONCLUSION: The level of knowledge and clinical decision-making of master's nursing students regarding forensic evidence improved after the forensic nursing virtual education course in the intervention group compared to the control group. Nursing managers and policymakers can develop appropriate strategies to improve the knowledge and clinical decision-making of nursing students by using forensic nursing education courses in the curricula of nursing programs, especially in postgraduate education as an elective or mandatory course.

Adherence to Referral Criteria for Burn Patients; a Systematic Review.

Introduction: Burn injuries are under-appreciated trauma, associated with substantial morbidity and mortality. It is necessary to refer patients in need of specialized care to more specialized centers for treatment and rehabilitation of burn injuries. This systematic review aimed to assess the adherence to referral criteria for burn patients. Methods: An extensive search was conducted on Scopus, PubMed, and Web of Science online databases using the relevant keywords from the earliest to October 7, 2021. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Results: Among a total of 7,455 burn patients included in the nine studies, 60.95% were male. The most frequently burned areas were the hands (n=3) and the face (n=2). The most and least common burn mechanisms were scalds (62.76%) and electrical or chemical (2.88%), respectively. 51.88% of burn patients had met ≥ 1 referral criteria. The overall adherence to the referral criteria for burn patients was 58.28% (17.37 to 93.39%). The highest and lowest adherence rates were related to Western Cape Provincial (WCP) (26.70%) and National Burn Care Review (NBCR) (4.97%) criteria, respectively. Conclusion: The overall adherence to the referral criteria for burn patients was relatively desirable. Therefore, well-designed future studies are suggested in order to uncover approaches to improve adherence to referral criteria for burn patients.

The effect of clinical guideline education on the knowledge and practice of nurses for peripheral intravenous catheter placement based on short message service: A quasi-experimental study.

BACKGROUND: Peripheral intravenous catheter (PIVC) placement is the most common invasive clinical procedure, often performed by nurses in hospitals worldwide. This study aimed to assess the effect of clinical guideline education on the knowledge and practice of nurses for PIVC placement based on short message service (SMS). METHODS: In a quasi-experimental study with parallel groups, 66 nurses working in two general university hospitals in Iran were enrolled. Data was collected from 2017 to 2018. PIVC placement was assessed before, immediately, and 4 weeks after educational intervention based on SMS (twice a day for 10 days). RESULTS: Nurses' knowledge score immediately after intervention versus before intervention was higher in the intervention group than in the control group (4.48 vs -0.70; p < 0.001). Nurses' knowledge score in 4 weeks after intervention versus immediately after intervention was lower in the intervention group than in the control group (0.03 vs 0.42; p = 0.014). Nurses' knowledge scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (4.52 vs -0.27; p < 0.001). Nurses' practice score immediately after intervention versus before intervention was higher in the intervention group than in the control group (0.57 vs -0.18; p = 0.174). Nurses' practice score 4 weeks after intervention vs immediately after intervention was higher in the intervention group than in the control group (-0.10 vs -0.38; p = 0.046). Nurses' practice scores 4 weeks after intervention versus before intervention was higher in the intervention group than in the control group (0.47 vs -0.56; p = 0.001). CONCLUSION: Educational intervention by SMS had a significant effect on increasing the knowledge and practice of nurses toward clinical guidelines for PIVC placement. Therefore, it is suggested that educational intervention by SMS be conducted to improve nurses' knowledge as an effective educational method.

Comparison of Nurses' and Patients' Readiness for Hospital Discharge: A Multicenter Study.

Decision to discharge is often based solely on clinical criteria but readiness for discharge is multifactorial and perceived differently by patients, families, nurses, and physicians. This is an analytical cross-sectional study aimed to compare perceptions of readiness to discharge 452 patients and their assigned nurses on the day of hospital discharge. To compare perceptions of readiness to discharge patients and their assigned nurses on the day of hospital discharge via readiness for hospital discharge (RHD) self-reported questionnaire. The biggest difference between nurses and patients' perception scores was in the knowledge subscale. The results of linear regression model showed that patients' gender, education, occupation, ward, nurse's age, and marital status predict the difference between nurses and patients' perception of readiness. Hospitalization in ear, nose, and throat (ENT) department with increasing difference and the older age of nurses is associated with a decrease in the difference between the perception. Assessment of nurse's self-readiness can help with the development of care and education planning tailored to patients' needs before discharge.

Knowledge, attitude, and practice of Iranian critical care nurses related to prevention of pressure ulcers: A multicenter cross-sectional study.

INTRODUCTION: Pressure ulcers (PU) are a major, but preventable health problem in all health settings, but especially in intensive care units (ICUs). This study aimed to investigate the knowledge, attitude, and practice (KAP) of Iranian ICU nurses related to the prevention of PU. METHODS: In a cross-sectional study, data obtained from 183 ICU nurses working in four hospitals affiliated to Mazandaran University of Medical Sciences, Sari, Iran were evaluated. The study was conducted from July to October 2020. Data were collected using a four-part questionnaire including demographic characteristics, Pieker Pressure Ulcer Knowledge Test (PPUKT), Attitude toward Pressure Ulcer Prevention (APUP) tool, and the practice of nurses related to the prevention of PU. FINDINGS: The mean scores of KAP of ICU nurses toward PU prevention were 70.57 (SD = 13.51), 52.82 (SD = 6.16), and 22.44 (SD = 5.20), respectively. There was a positive correlation between nurses' attitude and practice (r = 0.232, P = 0.002), and a negative correlation between knowledge and attitude (r = -0.156, P = 0.035) of nurses regarding PU prevention. Additionally, a positive correlation was found between nurses' years of working experience in ICU and their knowledge regarding PU prevention (r = 0.159, P = 0.032). CONCLUSION: According to the results of the present study, the level of KAP of Iranian ICU nurses related to PU prevention were desirable, positive, and relatively desirable. Therefore, nurse managers and policymakers should try to eliminate the main barriers such as heavy workload, inadequate nurse staffing, and lack of appropriate guidelines for PU prevention which consequently affect the practice of ICU nurses in the prevention of PU.

Development and psychometric testing of nurses' professional commitment inventory.

Background: Promotion of nurses' professional commitment is one of the strategies for retaining nurses and preventing their turnover. The aim of this study was the development and psychometric testing of the Nurses' Professional Commitment Inventory. Methods: This mixed method study was performed in an item generation and a psychometric testing phase. In the first phase, a 34-item inventory was developed based on the results of a grounded theory and the existing literature. Search date was 2010 to May 2018. In the second phase, we recruited 272 clinical nurses and tested the psychometric properties of the inventory. Construct validity was tested via the exploratory factor analysis. Reliability testing was performed through test-retest stability and internal consistency testing. SPSS version 21.0 (SPPS Corp) was used for statistical analysis. Significance level was set at p<0.05. Results: In the first phase, a 74-item pull was extracted. After reviewing, the primary version of the Nurses' Professional Commitment Inventory (NPCI) with 34 items was developed. Eight items were deleted during psychometric testing. In factor analysis, the remaining 26 items were loaded on 3 factors, namely professional attachment, professional performance, and internalization of the profession. These factors explained 53.92% of the total variance of professional commitment. The Cronbach's alpha and mean test-retest intraclass correlation coefficient for NPCI were 0.92 and 0.88, respectively. Conclusion: The Nurses' Professional Commitment Inventory has acceptable validity and reliability. This inventory includes dimensions that indicate the formation of professional commitment. The items of the scale can reveal nurses' strengths and weaknesses related to professional commitment.

Comparing the effects of traditional lecture and flipped classroom on nursing students' critical thinking disposition: A quasi-experimental study.

BACKGROUND: One of the most principal key aims of nursing education is to promote nursing students' and nurses' critical thinking. Therefore, nursing education needs to develop an appropriate curriculum and use effective instructional strategies for critical thinking promotion. Flipped classroom is a teaching method which substitutes individual learning for group learning in a dynamic, interactive environment where the teacher guides students to understand and use concepts. OBJECTIVES: The present study aimed to compare the effects of traditional lecture and flipped classroom on Iranian nursing students' critical thinking disposition. METHODS: This nonequivalent control group pretest-posttest quasi-experimental study was done in 2016 on 85 second-year bachelor's nursing students who had signed up for the Musculoskeletal Medical-Surgical Nursing theoretical training course. Because of their large number, students had been divided at the beginning of the first semester of their four-year program into two 42- and 43-student groups and attended separate theoretical training classes. These two classes were randomly allocated to either a traditional lecture or a flipped classroom group. The instructional strategies in these groups were the traditional lecture and the flipped class strategies, respectively. A demographic questionnaire and Ricketts' Critical Thinking Disposition Inventory were used for data collection. RESULTS: After the intervention, the mean scores of critical thinking disposition and its engagement domain in the flipped class group were significantly higher than the traditional lecture group (P < 0.0001). CONCLUSIONS: This study shows the positive effects of flipped classroom on nursing students' critical thinking disposition. It is recommended that future studies assess the effects of flipped classroom on other nursing education outcomes.

Quality assessment of diabetic foot ulcer clinical practice guidelines.

OBJECTIVE: Nurses play an effective role in diabetic foot care and they should know the best evidence. In this way, implementations according evidence-based clinical practice guidelines have positive effects on nurses' practice and patient outcomes. The objective of this study was quality assessment of diabetic foot ulcer clinical practice guidelines. METHODS: Evidence about nursing care in diabetic foot ulcer in last 5 years was searched and categorized based on nursing diagnosis (ND) and evidence levels and was finally designed as a guideline. Quality appraisal of guideline was evaluated with AGREEII tool by an expert panel. AGREEII consists of 23 items, grouped in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence. Applicability of the guideline in clinical was assessed with a checklist by the nursing group. Data analysis was carried out with SPSS v.18 (descriptive statistics and binomial test). RESULTS: Of the 114 studies, evidence of 19 studies was selected. The guidelines had three parts: introduction, nursing recommendation, and appendix. Evidence was categorized according to 8 NDs. According to AGREEII, the guideline had the highest score in the "scope and purpose" (92.7%) and the lowest in "applicability" (76.2%) domains. Also, nurses reported the positive effect of implementation of guideline recommendations and lack of needed equipment for its implementation. CONCLUSIONS: Guidelines received acceptable scores in all the domains of AGREEII. Based on nurses' opinion, recommendations of guidelines will play an effective role in prevention, treatment, reduction of complication among diabetic foot patients. Therefore, adaptation, implementation, and evaluation of the guidelines were recommended.