The Effects of White Noise on Preprocedural Anxiety and Vital Signs Among Older Adults Undergoing Colonoscopy.

PURPOSE: A significant portion of individuals undergoing colonoscopy report stress and anxiety before the procedure. The efficacy of white noise as a nonpharmacological intervention on state anxiety and vital signs of individuals waiting for colonoscopy has not been investigated in previous studies. The current study aimed to analyze the effect of white noise on preprocedural anxiety and vital signs among older adults undergoing colonoscopy. DESIGN: A pre-test/post-test quasi-experimental study. METHODS: Subjects (N = 60) were older adults in the colonoscopy unit and divided into experimental (n = 30) and control groups (n = 30). The subjects in the experimental group listened to the white noise via binaural headphones for 20 minutes, while the control group received routine pre-endoscopic care. State anxiety and vital signs were assessed before and after intervention using the State-Trait Anxiety Inventory and vital signs monitor, respectively. The data were analyzed using SPSS-25 software. FINDINGS: No statistically significant differences were found between the two groups on demographic characteristics, state-anxiety, systolic and diastolic blood pressure, pulse rate, and respiratory rate before the intervention (P > .05). A significant difference was found between the experimental and control groups in terms of state-anxiety (P = .00) and pulse rate (P = .003) after the intervention. No significant differences were found between the two groups in terms of systolic blood pressure (P = .69), diastolic blood pressure (.59), and respiratory rate (P = .164) after the intervention. CONCLUSIONS: This study provides preliminary evidence supporting the use of white noise in older adults undergoing colonoscopy to reduce anxiety. The authors recommend that this intervention, as a nonpharmacological and easily administered approach, is adopted to reduce precolonoscopy anxiety. Continued investigation into the effect of white noise on vital signs is recommended.

Barriers to providing quality care for patients with substance use disorders from the perspective of baccalaureate nursing students: A descriptive qualitative study.

BACKGROUND: With Iran facing an epidemic in substance use disorders, nursing students are increasingly encountering people impacted by substance misuse. Providing care for this group brings with it many barriers and challenges. These serious barriers have not been a priority in Iranian nurse education. OBJECTIVES: To describe barriers to providing quality care for people with substance use disorders from the perspective of nursing students. DESIGN: A descriptive qualitative study, using content analysis was used to address the study aim. SETTING AND PARTICIPANTS: Purposive sampling was used to recruit participants. Participants were 34 baccalaureate nursing students from different academic semesters studying at two medical sciences universities in Iran. METHODS: Data were collected using semi-structured interviews from July 2022 to October 2022. Granheim & Lundman's method for qualitative content analysis was used to analyze data. RESULTS: The barriers to providing quality care for people with substance use disorders were described through the major theme: "lack of communication skills and difficulty finding language for therapeutic communication with people with substance use disorders". Based on nursing student perspectives, a lack of communication and language for therapeutic communication was described through the three barriers of: 1. "possessing or witnessing prejudiced attitudes and stereotypes", 2 "negative role models", and 3. "Knowledge deficit in self or others". CONCLUSION: The result of this study showed that nursing students interact with people with substance use disorders through prejudiced attitudes, negative stereotypes, and knowledge deficits. Academic education should include practical techniques to reduce negative stereotypes and moral distress among nursing students as well as strategies to manage tough ethical situations and decrease prejudiced attitudes. Nurses and clinical educators must be attentive to their power to influence nursing students and should model appropriate unbiased behavior and language.

Perceived stress and quality of life among frontline nurses fighting against COVID-19: A web-based cross-sectional study.

BACKGROUND: The coronavirus disease-2019 (COVID-19) crisis has changed many aspects of frontline nurses' lives. Nurses caring for patients with COVID-19 reported experiencing significant psychological distress and work-related anxiety. This study aimed to assess the perceived stress and quality of life among frontline nurses fighting against COVID-19. MATERIALS AND METHODS: This web-based cross-sectional study was conducted on 322 frontline nurses fighting against COVID-19 in hospitals affiliated to Mazandaran University of Medical Sciences. Data were collected using the two following online questionnaires: the Perceived Stress Scale and World Health Organization Quality of Life-Brief. Data were compiled from October 23, 2020, to November 25, 2020. Data were analyzed using the independent sample t-test, Pearson's correlation test, and regression analysis test in the SPSS-21. RESULTS: Average perceived stress scores was 30.27 (standard deviation [SD] = 7.01). Average quality of life subscale scores consist of physical health, psychological health, social relationships, and environment were 57.71 (SD = 12.74), 44.3 (SD = 15.58), 45.61 (SD = 16.99), and 47.6 (SD = 18.11), respectively. There was an inverse significant association between all the subscales of quality of life and perceived stress (P = 0.008). Based on the multiple linear regression analysis, the variables of age, gender, marital status, and perceived stress were the significant predictors of quality of life subscales. CONCLUSIONS: Paying serious attention to addressing the concerns of frontline nurses, especially those who are at high risk, is necessary. It is recommended to take action as soon as possible to reduce the perceived stress and improve quality of life on nurses who care for patients with COVID-19.

Immunomodulatory Microgels Support Proregenerative Macrophage Activation and Attenuate Fibroblast Collagen Synthesis.

Scars composed of fibrous connective tissues are natural consequences of injury upon incisional wound healing in soft tissues.  Hydrogels that feature a sustained presentation of immunomodulatory cytokines are known to modulate wound healing. However, existing immunomodulatory hydrogels lack interconnected micropores to promote cell ingrowth. Other limitations include invasive delivery procedures and harsh synthesis conditions that are incompatible with drug molecules. Here, hybrid nanocomposite microgels containing interleukin-10 (IL-10) are reported to modulate tissue macrophage phenotype during wound healing. The intercalation of laponite nanoparticles in the polymer network yields microgels with tissue-mimetic elasticity (Young's modulus in the range of 2-6 kPa) and allows the sustained release of IL-10 to promote the differentiation of macrophages toward proregenerative phenotypes. The porous interstitial spaces between microgels promote fibroblast proliferation and fast trafficking (an average speed of ≈14.4 µm h-1 ). The incorporation of hyaluronic acid further enhances macrophage infiltration. The coculture of macrophages and fibroblasts treated with transforming growth factor-beta 1 resulted in a twofold reduction in collagen-I production for microgels releasing IL-10 compared to the IL-10 free group. The new microgels show potential toward regenerative healing by harnessing the antifibrotic behavior of host macrophages.

Changes in Preventive Behavior During the First 3 Months of the COVID-19 Outbreak in Iran.

OBJECTIVES: Iran is facing a big challenge controlling the coronavirus disease 2019 (COVID-19) outbreak, and it is unclear to how individuals are engaging in preventive behaviors. This study aimed to investigate changes in preventive behaviors during the first 3 mo of the COVID-19 outbreak in Iran. METHOD: This cross-sectional survey was conducted on 1477 adults aged 18 y and older in 31 provinces of Iran. Data were collected by an anonymous online questionnaire. RESULT: Overall, engagement in preventive behaviors was relatively acceptable, and more than 45% of subjects always carried out all preventive behaviors. Engaging in all preventive behaviors had a peak in the second month and obviously declined during third month. Engagement in some preventive behaviors, such as "wearing a face mask" and "keeping a safe distance from others," was observed less than other behaviors. There was a statistically significant difference in the engagement in preventive behaviors by gender and occupation (P < 0.001). CONCLUSIONS: Although engagement in preventive behaviors was relatively acceptable for the first 2 mo of the outbreak, it has declined gradually. This is a warning for public health decision makers. COVID-19 is still a crucial issue in Iran, and it is necessary that government decision be based on the fact that Iranian people must live with a coronavirus for months, with full caution and compliance toward all preventive care protocols.

Injectable, Pore-Forming, Perfusable Double-Network Hydrogels Resilient to Extreme Biomechanical Stimulations.

Biological tissues hinge on blood perfusion and mechanical toughness to function. Injectable hydrogels that possess both high permeability and toughness have profound impacts on regenerative medicine but remain a long-standing challenge. To address this issue, injectable, pore-forming double-network hydrogels are fabricated by orchestrating stepwise gelation and phase separation processes. The interconnected pores of the resulting hydrogels enable direct medium perfusion through organ-sized matrices. The hydrogels are amenable to cell encapsulation and delivery while promoting cell proliferation and spreading. They are also pore insensitive, tough, and fatigue resistant. When tested in biomimetic perfusion bioreactors, the hydrogels maintain physical integrity under prolonged, high-frequency biomechanical stimulations (>6000 000 cycles at 120 Hz). The excellent biomechanical performance suggests the great potential of the new injectable hydrogel technology for repairing mechanically dynamic tissues, such as vocal folds, and other applications, such as tissue engineering, biofabrication, organs-on-chips, drug delivery, and disease modeling.

Shedding light on the causes of academic procrastination among nursing students: A qualitative descriptive study.

BACKGROUND: Academic procrastination is a complex phenomenon and a common behavior among nursing students. Due to procrastinating behaviors, students cannot show their real performances in learning processes. In order to stop this behavior, it is crucial to know the most common causes of procrastination in the first place. The aim of this study was to identify a variety of different possible factors influencing academic procrastination among nursing students. MATERIALS AND METHOD: A qualitative study method with the content analysis approach was conducted from October 2019 to March 2020. Participants were 67 nursing students and 8 nursing educators from 3 nursing schools in Iran. Face-to-face semi-structured interviews and focus group discussions were used for data gathering. An inductive approach to content analysis was used for data analysis. RESULTS: Five categories and 24 subcategories emerged from the data analysis: "student-related factors," "educator-related factor," "assignment characteristic-related factors," "institution-related factors," and "nursing work-related factors." CONCLUSIONS: The present study showed that nursing students' academic procrastination can have a wide range of causes and a comprehensive effort is needed to address the problems. The result of our study will be useful to nursing students, educators, and nursing administrators in relation to what constitutes nursing students' academic procrastination, as well as how nursing education can play an effective role in decreasing tendency to procrastination.

Effect of a Breathing Exercise on Respiratory Function and 6-Minute Walking Distance in Patients Under Hemodialysis: A Randomized Controlled Trial.

BACKGROUND: Pulmonary disorders and poor functional capacity are common complications in patients under hemodialysis. Although breathing exercise is frequently prescribed to improve respiratory function, its efficacy in this patient community is not well established. PURPOSE: Our study was designed to determine the effectiveness of a breathing exercise on respiratory function and 6-minute walk (6MW) distance in patients under hemodialysis. METHODS: A randomized controlled trial approach was used. The sample consisted of 52 patients under hemodialysis from a university teaching hospital in Iran. The experimental group (n = 26) received the breathing exercise program and was encouraged to perform incentive spirometry for 2 months. The control group (n = 26) received only routine hospital care. The respiratory function test and 6MW test were performed at baseline and at 2 months after the intervention (posttest). RESULTS: The two groups were homogeneous in terms of respiratory function parameters, 6MW distance, and demographic characteristics at baseline. Forced expiratory volume in 1 second and forced vital capacity were significantly better in the experimental group compared with the control group at 2 months after intervention. No significant difference was found in 6MW distance between the groups at the 2-month posttest. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The 2-month breathing exercise effectively improved pulmonary function parameters (forced vital capacity, forced expiratory volume in 1 second) in patients under hemodialysis but did not affect 6MW distance. Hemodialysis nurses should strengthen their clinical health education and apply breathing exercise programs to reduce the pulmonary complications experienced by patients under hemodialysis.

The relationship between anxiety, depression and risk behaviors in adolescents.

Aim Adolescence is a developmental period often associated with high-risk behaviors. While some risk-taking behavior is considered normative in adolescents, research has indicated an association between risky behaviors and mental ill-health. The current research aimed to examine the relationship between anxiety and depression with the occurrence of high-risk behaviors in adolescents and also determine the predictive factors of these main variables. Methods A descriptive, cross-sectional, correlational design was used to collect data from 399 adolescents between the ages of 14 and 19 residing in Qazvin, Iran using the Revised Child Anxiety and Depression Scale (RCADS) and the Iranian Adolescents Risk-taking Scale (IARS) between the period of October and November 2015. Data analysis included descriptive and inferential statistics powered by SPSS (v. 23). Results Mean scores for anxiety, depression and risky behaviors were 37.70 ± 21.11 and 80.76 ± 31.30, respectively. Participants' frequency of suicidal thoughts (ß = 0.126, p < 0.05) positively predicted anxiety and depression, while age (ß = -0.126, p < 0.01) and self-confidence (ß = -0.307, p < 0.001) negatively predicted anxiety and depression. Moreover, having friends that smoke (ß = 0.366, p < 0.001), suicidal thoughts (ß = 0.127, p < 0.01), and the strength of suicidal thoughts (ß = 0.100, p < 0.05) were positive predictors of occurrence of risky behaviors. Furthermore, religious belief (ß = -0.204, p < 0.001) negatively predicted occurrence of risky behaviors in Iranian adolescents. Male respondents were more likely to have higher level of occurrence of risky behaviors than females (ß = -0.193, p < 0.001). Conclusion Findings of the present study suggest that anxiety and depression positively and significantly predict the occurrence of risky behaviors in addition to having friends that smoke, suicidal thoughts, and strong suicidal thinking. The implications of these findings have relevance for screening, prevention, and treatment interventions targeting mental health in adolescents.

Exploring the Dominant Discourse of Baccalaureate Nursing Education in Iran.

INTRODUCTION: Understanding how academic dominant discourse is implicated in the shaping of nursing identity, professional aspirations and socialization of nursing students is useful as it can lead to strategies that promote nursing profession. MATERIALS AND METHODS: This is a qualitative research conducted through discourse analysis approach. Semi-structured interviews, focus group, and direct observation of undergraduate theoretical and clinical courses were used to collect the data. Participants were 71 nursing students, 20 nursing educators, and 5 nursing board staffs from five universities in Iran. RESULTS: Data analysis resulted in the development of four main themes that represent essential discourses of nursing education. The discourses explored are theoretical and scientific nursing, domination of biomedical paradigm, caring as an empty signifier, and more than expected role of research in nursing education discourse. CONCLUSIONS: The results indicated that academics attempt to define itself based on "scientific knowledge" and faculties seek to socialize students by emphasizing the scientific/theoretical basis of nursing and research, with the dominance of biomedical discourse. It fails to conceptually grasp the reality of nursing practice, and the result is an untested and impoverished theoretical discourse. The analysis highlights the need for the formation of a strong and new discourse, which contains articulation of signifiers extracted from the nature of the profession.

Discourse analysis: A useful methodology for health-care system researches.

Discourse analysis (DA) is an interdisciplinary field of inquiry and becoming an increasingly popular research strategy for researchers in various disciplines which has been little employed by health-care researchers. The methodology involves a focus on the sociocultural and political context in which text and talk occur. DA adds a linguistic approach to an understanding of the relationship between language and ideology, exploring the way in which theories of reality and relations of power are encoded in such aspects as the syntax, style, and rhetorical devices used in texts. DA is a useful and productive qualitative methodology but has been underutilized within health-care system research. Without a clear understanding of discourse theory and DA it is difficult to comprehend important research findings and impossible to use DA as a research strategy. To redress this deficiency, in this article, represents an introduction to concepts of discourse and DA, DA history, Philosophical background, DA types and analysis strategy. Finally, we discuss how affect to the ideological dimension of such phenomena discourse in health-care system, health beliefs and intra-disciplinary relationship in health-care system.

Structure, Properties, and In Vitro Behavior of Heat-Treated Calcium Sulfate Scaffolds Fabricated by 3D Printing.

The ability of inkjet-based 3D printing (3DP) to fabricate biocompatible ceramics has made it one of the most favorable techniques to generate bone tissue engineering (BTE) scaffolds. Calcium sulfates exhibit various beneficial characteristics, and they can be used as a promising biomaterial in BTE. However, low mechanical performance caused by the brittle character of ceramic materials is the main weakness of 3DP calcium sulfate scaffolds. Moreover, the presence of certain organic matters in the starting powder and binder solution causes products to have high toxicity levels. A post-processing treatment is usually employed to improve the physical, chemical, and biological behaviors of the printed scaffolds. In this study, the effects of heat treatment on the structural, mechanical, and physical characteristics of 3DP calcium sulfate prototypes were investigated. Different microscopy and spectroscopy methods were employed to characterize the printed prototypes. The in vitro cytotoxicity of the specimens was also evaluated before and after heat treatment. Results showed that the as-printed scaffolds and specimens heat treated at 300°C exhibited severe toxicity in vitro but had almost adequate strength. By contrast, the specimens heat treated in the 500°C-1000°C temperature range, although non-toxic, had insufficient mechanical strength, which was mainly attributed to the exit of the organic binder before 500°C and the absence of sufficient densification below 1000°C. The sintering process was accelerated at temperatures higher than 1000°C, resulting in higher compressive strength and less cytotoxicity. An anhydrous form of calcium sulfate was the only crystalline phase existing in the samples heated at 500°C-1150°C. The formation of calcium oxide caused by partial decomposition of calcium sulfate was observed in the specimens heat treated at temperatures higher than 1200°C. Although considerable improvements in cell viability of heat-treated scaffolds were observed in this study, the mechanical properties were not significantly improved, requiring further investigations. However, the findings of this study give a better insight into the complex nature of the problem in the fabrication of synthetic bone grafts and scaffolds via post-fabrication treatment of 3DP calcium sulfate prototypes.

Exploring the environment of clinical baccalaureate nursing students' education in Iran; A qualitative descriptive study.

INTRODUCTION: Today's students are the nurses of tomorrow. They need appropriate clinical learning opportunities in order to shape their professional identity, attitudes and values. Despite undeniable progresses of nursing education in Iran, the quality of the clinical education in Iran is not favorable. There is a need to explore the environment of clinical baccalaureate nursing students' education for developing, maintaining and enhancing the quality of clinical program. METHOD: This is a qualitative study and was conducted based on content analysis multimethod design. Data were collected by individual interviews, focus groups and direct observations. 54 nursing students and 8 clinical educators from the four geographically diverse universities in the Iran composed the study sample. A purposive sampling was used. RESULT: Five themes were emerged from data analysis including; ambiguity in the nursing care role, routine-based nursing care, uncritical and dependent thinking climate, incompetency of clinical educators and patient education as important component of nursing. CONCLUSIONS: The findings of this study describe a clearer understanding of the real environment of the clinical education in Iran. All of themes that emerged from the study play an important role in student learning and nursing education. It is crucial to pay more attention to reconsider care concept as an operational component of nursing, maximize meaningful learning opportunities, reevaluate clinical instructor as role models and prepare effective operational plan to combine theoretical and evidence based knowledge with clinical practice.

Investigating the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens.

UNLABELLED: Abstract Background: Stroke survivors have residual neurological impairment, which requires long-term support and care. In this situation family involvement in care process is necessary. However, as the family caregivers of stroke survivors are not necessarily supported by the health-care professionals, and they often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. AIM: The aim of this study was to investigate the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens. METHODS: This is a posttest-only randomized controlled trial study, conducted on stroke patients and their family caregivers. The control group (N = 30) received only routine hospital services and the experimental group (N = 30) received routine hospital services plus a family-centered care program consisting of four steps; need assessment, educating families based on patients' needs, follow-ups by short phone interviews, and referral service. The data were collected via a demographic data form and 'Adherence to the Therapeutic Regimens (ATR)' questionnaire between July 2011 and March 2012 and lasted 2 months for each subject. Data were assessed and analyzed with SPSS version 18. FINDINGS: Study findings showed that the levels of adherence to the different components of the therapeutic regimens, including rehabilitations, medications and dietary regimen are significantly higher in the experimental group compared to the control group (P < 0.001). CONCLUSION: By empowering patients' families and improving their ATRs, family-centered care programs will be able to play an important role in management of physical and mental health of stroke patients.

Investigating the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens.

Abstract Background: Stroke survivors have residual neurological impairment, which requires long-term support and care. In this situation family involvement in care process is necessary. However, as the family caregivers of stroke survivors are not necessarily supported by the health-care professionals, and they often feel inadequately prepared to deal with the physical, cognitive and emotional needs of the stroke survivors. Aim: The aim of this study was to investigate the effects of a family-centered care program on stroke patients' adherence to their therapeutic regimens. Methods: This is a posttest-only randomized controlled trial study, conducted on stroke patients and their family care-givers. The control group (n = 30) received only routine hospital services and the experimental group (n = 30) received routine hospital services plus a family-centered care program consisting of four steps; need assessment, educating families based on patients' needs, follow-ups by short phone interviews, and referral service. The data were collected via a demographic data form and "Adherence to the therapeutic regimens" Questionnaire between July 2011 to March 2012 and lasted two months for each subject. Data were assessed and analyzed with SPSS version 18. Findings: Study findings showed that the levels of adherence to the different components of the therapeutic regimens, including rehabilitations, medications and dietary regimen are significantly higher in the experimental group compared to the control group (P value< 0.001). Conclusion: By empowering patients' families and improving their adherence to the therapeutic regimens, family-centered care programs will be able to play an important role in management of physical and mental health of stroke patients.