Lack of association between nuts and legumes consumption and metabolic syndrome in young Iranian nurses.

BACKGROUND: Most studies have investigated the association between dietary pattern and risk of metabolic syndrome. Limited studies have examined the association between nuts and legumes as a food group and metabolic syndrome. This study explored the association between nuts and legumes and components of metabolic syndrome in Iranian nurses. METHODS: This cross-sectional study included a representative sample of 420 female nurses of Isfahan who were randomly selected. Nuts and legumes consumption was assessed using a validated dish-based semi quantitative food frequency questionnaire (FFQ). Metabolic syndrome was defined by the National Cholesterol Education Program's Adult Treatment Panel III (ATP III). Linear and logistic regression tests were used to study the association between nuts and legumes consumption and metabolic syndrome and its components. RESULTS: Mean age of study participants was 35 years. The prevalence of the metabolic syndrome among study participants was 3.6%. Consumption of nuts and legumes was not associated with waist circumference either before (ß = -0.01, P = 0.24) or after adjusting for potential confounders (ß = -0.18, P = 0.41). The same findings were also observed for diastolic blood pressure (DBP) (ß = 0.001, P = 0.42), serum triglyceride (TG) (ß = 0.07, P = 0.32), high-density lipoprotein cholesterol (HDL-C) (ß = 0.008, P = 0.65) and fasting blood sugar (FBS) (ß = -0.001, P = 0.94). We failed to find a significant association between consumption of nuts and legumes and systolic blood pressure (SBP) after adjusting for confounders (ß = 0.002, P = 0.38). Individuals in the highest category of nuts and legume consumption did not had elevated odds for metabolic syndrome after adjusting for potential confounders (OR = 0.89, 95% CI = 0.08-9.80, P = 0.93). CONCLUSIONS: Nuts and legumes consumption was not associated with metabolic syndrome or its components. Prospective studies are needed to investigate further this association.

The relationship between ethical conflict and nurses' personal and organisational characteristics.

INTRODUCTION: Critical care nurses work in a complex and stressful environment with diverse norms, values, interactions, and relationships. Therefore, they inevitably experience some levels of ethical conflict. AIM: The aim of this study is to analyze the relationship of ethical conflict with personal and organizational characteristics among critical care nurses. METHODS: This descriptive-correlational study was conducted in 2017 on a random sample of 216 critical care nurses. Participants were recruited through stratified random sampling. Data collection tools were a demographic and professional characteristics questionnaire, the Ethical Conflict in Nursing Questionnaire-Critical Care Version, and the Organizational and Managerial Factors Questionnaire. The data were analyzed using the SPSS software (v. 22.0). ETHICAL CONSIDERATIONS: All participants were informed about the study's aim and were assured that participation in and withdrawal from the study would be voluntary. FINDINGS: The mean score of exposure to ethical conflict was 201.91 ± 80.38. The highest-scored conflict-inducing clinical situation was "working with professionally incompetent nurses or nurse assistants." Married nurses, nurses with official employment, nurses with master's degree, and nurses with the history of attending ethics education programs had significantly higher exposure to ethical conflict than the other nurses (p < 0.05). The significant predictors of exposure to ethical conflict were marital status, educational status, reward system, organizational culture, manager's conduct, and organizational structure and regulations (p < 0.05). These predictors accounted for 37.2% of the total variance of exposure to ethical conflict. CONCLUSION: Critical care nurses experience moderate levels of exposure to ethical conflict. A wide range of personal and organizational factors can contribute to such exposure, the most significant of which is the professional incompetence of nursing colleagues, nurse assistants, and physicians. Therefore, many improvements at personal and organizational levels are needed to reduce critical care nurses' exposure to ethical conflict.

The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. MATERIALS AND METHODS: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA), Chi-square, and independent t-test. RESULTS: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05). CONCLUSIONS: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

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.

Effect of using Richmond Agitation Sedation Scale on duration of mechanical ventilation, type and dosage of sedation on hospitalized patients in intensive care units.

BACKGROUND: Mechanical ventilation is one of the supporting treatments that are used for different reasons. To reduce patients' inconvenience caused due to using tracheal tube and ventilator, sedation is routinely used. Using scales for the sedation, for example, Richmond Agitation Sedation Scale (RASS), may reduce dose of sedation and length of mechanical ventilation. MATERIALS AND METHODS: This study is a randomized clinical trial on 64 patients selected from three intensive care units (ICUs) in Isfahan, Iran. Through random allocation, 32 patients were assigned to each of the study and control groups. In the control group, patients' level of consciousness and the amount of drug consumption in every shift, based on physician order, were recorded. In the study group, RASS score was recorded every hour and sedation was administered based on that. The purpose of the study was to investigate of application of RASS for drug consumption until weaning of the patient from the ventilator. Independent t-test with significance level of 0.05 was used. RESULTS: Results showed no significant difference in the mean consumption of midazolam and morphine after intervention, but there was a significant difference in fentanyl (P = 0.03) consumption (379 µg in the control group vs 75 µg in the study group) between groups after the intervention. The mean duration of being connected to the ventilator was significantly less in the study group (P = 0.03). CONCLUSIONS: Application of RASS by nurses leads to a decrease in sedation consumption, connection to ventilator, and length of stay in the hospital.

Adherence to the DASH diet and prevalence of the metabolic syndrome among Iranian women.

PURPOSE: Epidemiologic data linking adherence to the dietary approaches to stop hypertension (DASH) diet and metabolic abnormalities is sparse and inconsistent. The association between habitual intake of the DASH diet and metabolic syndrome (MetS) has not been investigated in the Middle East. We aimed to determine whether usual adherence to the DASH dietary pattern was associated with MetS in a group of Iranian women. METHODS: This cross-sectional study was conducted in 2012 among a representative sample of Isfahani female nurses. A validated, dish-based semiquantitative food frequency questionnaire was used for assessing usual dietary intakes. The DASH score was constructed based on 8 main foods and nutrients emphasized or minimized in the DASH diet. The MetS was defined according to the Joint Scientific Statement. RESULTS: After controlling for potential confounders, individuals in the highest tertile of the DASH diet score had 81% lower odds of MetS than those in the lowest category (OR 0.19; 95% CI 0.07-0.96). Further, adjustment for body mass index slightly weakened the association (OR 0.37; 95% CI 0.14-0.91). Participants with the greater adherence to the DASH diet were 54, 73, 78, and 80% less likely to have enlarged waist circumference, hyperglyceridemia, low HDL-C levels, and high blood pressure, respectively, compared with those in the lowest tertile. No significant association was seen between consumption of a DASH diet and abnormal fasting plasma glucose. CONCLUSIONS: Adherence to the DASH eating plan was inversely associated with the odds of MetS and most of its features among a group of Iranian women.

Comparison of the effects of two levels of negative pressure in open endotracheal tube suction on the physiological indices among patients in intensive care units.

BACKGROUND: Most of the patients admitted in the intensive care units (ICUs) require an endotracheal tube and mechanical ventilation. In order to clear and maintain patency of the airways, endotracheal suctioning is required. Therefore, the least detrimental way of endotracheal tube suctioning which can diminish the complications should be selected. The present study aimed to compare the effect of two levels of negative pressure (100 mmHg and 200 mmHg) in open endotracheal tube suction on the physiological indices among patients in the ICUs. MATERIALS AND METHODS: In this single-blind clinical trial, 60 patients meeting the inclusion criteria were selected by convenience sampling and randomly allocated in two groups. First group of patients were suctioned with negative pressure of 100 mmHg and the second group with 200 mmHg. Effects of two levels of suction pressure on oxygen saturation (SPO2) and heart rate (HR) values were measured and recorded at four time points. Repeated measure analysis of variance (ANOVA), Chi-square test, and independent t-test were adopted to analyze the data. RESULTS: In the two groups consisting of totally 60 subjects (30 in each group), 34 subjects were males and 26 were females, with a mean age of 60.63 years (minimum 18 years and maximum 75 years). Repeated measure ANOVA showed a significant difference in the mean SpO2 and HR before, during, and 5 and 20 min after suction within each group (P < 0.05), but not between the two groups (P > 0.05). CONCLUSIONS: The present study revealed that with regard to the detrimental effect of endotracheal tube suctioning on arterial oxygen saturation and HR, suctioning with negative pressure of 200 mmHg is considered to be a low-risk procedure compared to suctioning with negative pressure of 100 mmHg, if standard procedures in open suction system are followed.

The effect of earplugs and eye mask on patients' perceived sleep quality in intensive care unit.

BACKGROUND: Sleep is one of the basic human needs and sleep deprivation causes numerous undesirable effects on the human body and mind, especially in the intensive care unit (ICU) patients. It seems that noise and light are important environmental factors interrupting sleep in these patients. This study was carried out to determine the effect of earplugs and eye mask on Iranian patients' sleep quality in ICU. MATERIALS AND METHODS: In this cross-over clinical trial, 50 patients in the ICUs of Al-zahra Medical Center in Isfahan in 2012 were selected by convenient sampling method and randomly assigned to two groups. In group A, patients wore earplugs and eye mask in the first night during their sleep and slept without earplugs and eye mask in the second night, and the intervention was conversely conducted in group B. Verran and Snyder-Halpern Sleep Scales were used to measure the patients' sleep quality. The data were analyzed by paired t-test, independent t-test, one-sample t-test, and one-way analysis of variance (ANOVA) through SPSS version 18. RESULTS: Effect of the intervention on sleep effectiveness was positive, and there were significant differences (P < 0.001) between treatment night and control night, and also within each group (P < 0.001). Effect of the interventions on sleep disturbance was positive, and there was a significant difference at treatment night compared to the control night between groups and within each group (P < 0.001). Also, the mean scores for sleep supplementation were measured after the second night, and the results showed the scores significantly increased in the intervention group compared to the control group (P < 0.001, ER = 47, F = 22.1). In addition, carryover effects for sleep efficiency and sleep disturbance were positive, but periodic effects for sleep efficiency and sleep disturbance were negative and positive, respectively. CONCLUSIONS: : Although wearing earplugs and eye mask is a cost-effective and safe method and can improve perceived sleep quality in ICU patients, further research is needed to demonstrate the effect of this method.