The Effect of a Self-Management Program on Care Burden and Self-Efficacy in Family Caregivers of People With Multiple Sclerosis.

BACKGROUND: Family caregivers of patients with multiple sclerosis (MS) face many caring-related problems that increase their care burden and decrease their self-efficacy. Evidence-based self-management interventions may be used to improve care processes and resolve caregiver concerns. PURPOSE: The aim of this study was to investigate the effect of a self-management program on care burden and self-efficacy in family caregivers of people with MS. METHODS: This study was performed in Iran in 2018-2019. The participants were selected using convenience sampling and assigned to control and intervention groups of 35 participants each using stratified randomization by gender. The intervention group participated in an eight-session self-management program. Data were collected using the Zarit Burden Interview and Scherrer Self-efficacy Questionnaire. Data were analyzed using descriptive and inferential statistics in SPSS Version 16. RESULTS: No significant difference in care burden scores was found between the two groups at baseline ( p = .953). However, mean scores for care burden in the intervention group were significantly higher ( p < .001) both immediately after completion of the intervention (42.6 ± 3) and at 3 months after completion of the intervention (36 ± 3), with the most significant improvement found immediately after the intervention. Similarly, no significant difference in self-efficacy scores was found between the groups at baseline ( p = .976). However, mean scores for self-efficacy in the intervention group were significantly higher ( p < .001) both immediately after and at 3 months after completion of the intervention (60.6 ± 4.7 and 72.7 ± 4, respectively), with the most significant improvement found at 3 months postintervention. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Providing self-management programs to caregivers of people with MS is an effective approach to reducing their burden of care and increasing their self-efficacy. Enhancing self-management by learning adaptation skills, self-care skills, social support, and spiritual support promote improved self-efficacy and reduce the care burden of these caregivers.

A comparative study into the effects of topical hot salt and hot sand on patients' perception of low back pain.

BACGROUND: Low back pain (LBP) has been regarded as one of the musculoskeletal problems which is affecting more than three-quarters of individuals in their lifetime. Nowadays, various pharmacological and nonpharmacological therapies are employed for relieving and treating LBP. This study was conducted to compare the effects of topical hot salt and hot sand on patients' perception of LBP. MATERIALS AND METHODS: In this, quasi-experimental study patients with LBP referring to the orthopedic clinic of Shahrekord educational hospital were divided randomly into two interventions and one control group in 2020. All three groups were received naproxen cream and daily physiotherapy in the same manner, the interventional groups in addition either topical hot salt or topical hot sand. Data gathering tool for measuring patients' perception of LBP was the McGill Pain Short Form Questionnaire to be completed at the beginning, immediately at the end, and 2 months after the intervention. The data were analyzed using SPSS statistical software (version 21.0). RESULTS: Totally, 90 patients were randomized based on the table of random numbers (mean age 51.1 + 11.1), and finally, 87 patients completed the study. Patients' perception of LBP before the intervention was homogenous in hot salt, hot sand, and the control group The mean score of total pain experience before the intervention was 14.1 ± 11.3 for hot sand, 13.9 ± 10.7 for hot salt and 13.7 ± 10.1 for control group The mean scores of these three groups were not significant before the intervention (P > 0.05). The mean score of total pain experience immediately after the intervention was 6.7 ± 4.2 for hot sand, 5.2 ± 3.1 for hot salt and 13.9 ± 9.8 for control group. The mean scores of the hot sand group and the hot salt group were significantly decreased compared with control group (P > 0.05). The mean score of total pain experience two months after the intervention was 5.6 ± 3.27 for hot sand, 4.21 ± 2.14 for hot salt and 13.8 ± 10.4 for control group. Mean score of total pain experience in both intervention groups had significantly reduced two months after the intervention compared to control group (P ≤ 0.001); so that the effect of hot salt treatment on reducing total pain experience was larger than hot sand (P ≤ 0.001). The same trend was observed for VAS and Present pain intensity variables. CONCLUSIONS: The findings have revealed that the topical treatments with hot salt and hot sand could have a significant effect on the perception of LBP compared to those in the control group; whereas hot salt might be stronger effects than hot sand on reducing LBP.

The effect of situation, background, assessment, recommendation-based safety program on patient safety culture in intensive care unit nurses.

BACKGROUND: Patient safety culture is an integral part of patient care standards and a prerequisite for safe care. SBAR is an acronym for Situation, Background, Assessment, Recommendation; this communication model has gained popularity in health-care settings, especially among professions such as nursing. However, there is little evidence that nursing professional education can enhance patient safety culture. The aim of this study was to investigate the effect of a SBAR-based training program on patient safety culture in intensive care unit (ICU) nurses. MATERIALS AND METHODS: The quasi-experimental study was carried out in 2018-2019 at areas covered by Shahrekord University of Medical Sciences, Iran. This study was performed on 60 nurses working in ICU. The participants were randomly assigned to two experimental and control groups of 30 each. For the experimental group, five workshop sessions of SBAR-based program were held. For the control group, the patient delivery process was performed according to the ward routine. Data were collected using patient safety culture questionnaires before and 1 month after the intervention, and were analyzed using descriptive and analytical tests such as paired t-test, independent t-test, and Chi-square test by SPSS 22. RESULTS: The mean score of safety culture was 31 ± 23.5 and 55.2 ± 28.6 in frequency of reporting events, 32.8 ± 17.8 and 54.3 ± 19 in overall perception of patient safety, 23 ± 20.1 and 52.9 ± 26 in communication channel openness, and 35.2 ± 19.8 and 52.4 ± 18.8 in information exchange and conveyance before and after training intervention, respectively, so that they improved from poor level to neutral-moderate level. There was no strength in any dimensions of safety culture; however, the implementation of the SBAR-based program was significantly associated with patient safety culture (P < 0.001). CONCLUSIONS: Improving patient safety culture requires attention to patient safety models such as SBAR approach that provides an appropriate and reliable structure for quality improvement. SBAR-based program training is effective in promoting patient safety culture; therefore, it is recommended that managers use this technique to promote patient safety culture.

Effects of Aquatic Exercise on Dimensions of Quality of Life and Blood Indicators in Patients with Beta-Thalassemia Major.

BACKGROUND: Thalassemia is considered as a group of genetic blood disorders, characterized by anemia. The present research aimed at evaluating the effects of aquatic exercise on quality of life and blood indices in patients with beta-thalassemia major. METHODS: A clinical trial study involving 40 patients with thalassemia major, divided into two groups: experimental and control. The tools used to collect the data included demographic information questionnaire, blood indicators questionnaire, and SF-36 quality of life questionnaire. The experimental group performed exercise in water three times per week for 8 weeks in the pool after obtaining the consent. In this research, the quality of life questionnaire was filled out 24 h before the intervention, 24 h after the last session of the exercise program, and 2 months after the end of the exercise program. RESULTS: The current research revealed that exercise in water affected the quality of life, hemoglobin, hematocrit, iron and ferritin of serum such that the mean score of quality of life and blood indicators in the study showed a significant difference in the experimental group. CONCLUSIONS: The use of a regular exercise program combined with drug therapy and blood transfusion can be useful in the treatment of beta-thalassemia patients.

Identification of Concepts of Spiritual Care in Iranian Peoples with Multiple Sclerosis: A Qualitative Study.

Living with multiple sclerosis (MS) often needs attention combined with receiving the holistic care. Attention to spiritual care dimension is one of the most important aspects of care for these patients. This study aims at exploring and explaining dimensions of spiritual care for MS patients in care system of Iran. This study is conducted to explore the concept of spiritual care in care system of Iran during 2015-2016. Purposive sampling is done on 25 participants through unstructured interviews and observation of obtained data through conventional content analysis approach. Four themes of participants' experiences in spiritual care include restoration of identity essence and nature; disease as a factor for nearness to God; giving meaning to life; and disease as a facilitator for self-purification. Clear understanding of spiritual care dimensions and promoting knowledge in MS nurses as the caregivers play important roles in achieving the goals of health among patients in different cultures and religions. Given the results of this study, the themes such as the restoration of identity essence and nature, the disease as a factor for nearness to God, giving meaning to life and the disease as a facilitator for self-purification play important roles in explaining the concept of spiritual care in patients with MS. Therefore, the MS nurses and other health professionals need to effectively and successfully integrate the concept of spiritual care with their professional performance by deep understanding of this concept and try to provide holistic care to respond to MS patients' intertwined needs.

Effects of family-centered empowerment intervention on stress, anxiety, and depression among family caregivers of patients with epilepsy.

OBJECTIVES: Family caregivers face numerous challenges in taking care of their family members with epilepsy. The empowerment of this group of people, who can be described as forgotten patients, should always be considered through supportive interventions; therefore, this study investigated the effect of a family-centered intervention program on stress, anxiety, and depression among family caregivers of patients with epilepsy. METHODS: In 2017, a trial was conducted in Iran among subjects selected by the convenience sampling method and randomly assigned to two groups: intervention and control. After five sessions per week over a four-week period, the intervention- and control-group data were collected using the Depression Anxiety Stress Scale (DASS) in three stages: before, immediately after, and two months after the intervention. Data were analyzed with Statistical Package for the Social Sciences (SPSS) software using descriptive and analytical statistics, an independent t-test, and repeated measures Analysis of variance (ANOVA). RESULTS: In this study, the family caregivers included 61.3% women and 38.7% men, with a mean age of 37.5 years. The findings showed no significant differences in the mean scores of stress (p = 0.93), anxiety (p = 0.91), and depression (p = 0.56) before the interventional program between the intervention and control groups, but these differences were statistically significant in the mean score of stress (p = 0.003) in the immediately after the interventional program, whereas the mean scores of depression were not decreased significantly (p = 0.3). Two months after the interventional program the mean scores of stress (p = 0.001) and anxiety (p = 0.001) were significantly decreased in the intervention group, but the mean score of depression was not decreased significantly (p = 0.09). CONCLUSION: The results suggested that a family-centered intervention program reduced the stress, anxiety, and depression of caregivers because of feasibility, simplicity, and utility of intervention. This program was focused on psychological issues of caregivers, and an emphasis on their empowerment helped them in managing their problems in the caregiving situation and achieved greater psychological potency in the caring process.

Therapeutic effects of Ventolin versus hypertonic saline 3% for acute bronchiolitis in children.

BACKGROUND: Complications of Ventolin as the most common drug used for bronchiolitis are widely known. The present study was conducted to determine the efficacy of hypertonic saline 3%, compared with Ventolin, for treatment of acute bronchiolitis in children. METHODS: This double-blinded clinical trial study was conducted in Hajar Hospital, Shahrekord, Iran, from 2011 to 2012. A total of 70 patients under the age of two years with bronchiolitis were divided into two groups of 35 each. Ventolin nebulizer and hypertonic saline 3% nebulizer three times per day were administered in the first (Ventolin) and second (Hypersaline) group, respectively. The length of recovery was compared between the two groups. The data were analyzed by SPSS software (version 22) using chi-square, t-test, paired t-test, and Mann-Whitney. RESULTS: The mean±SD length of recovery was 4.14±0.9 and 3.06±0.6 in the Ventolin and hypersaline groups, respectively. The mean duration of recovery was significantly lower in the hypersaline group (p<0.001). CONCLUSION: Hypertonic saline 3% nebulizer has more pleasant therapeutic effects on acute bronchiolitis than Ventolin. Therefore, use of hypertonic saline 3% nebulizer is recommended for the treatment of acute bronchiolitis in children under two years old.

Family caregivers' experiences of caring for patients with heart failure: a descriptive, exploratory qualitative study.

BACKGROUND: Living with heart failure is a complex situation for family caregivers. Many studies addressing the challenges faced by heart failure family caregivers have already been conducted in Western societal settings. Sociocultural factors and perspectives influence the family caring experience and roles. The ethnic/culturally based differences in family caring behavior make this a subject worth further exploration and clarification. PURPOSE: This study explores the experiences of family caregivers in Iran of caring for patients with heart failure. METHODS: A descriptive, exploratory, and qualitative approach was applied to gain authentic insight into the experiences of participants. Purposive sampling was used to recruit 21 family caregivers from three educational hospitals in Isfahan, Iran. Data were collected using semistructured interviews and field notes. Interviews and field notes were transcribed verbatim and concurrently analyzed. RESULTS: Three major themes emerged from the analysis of the transcripts: caregiver uncertainty, lack of familial and organizational support, and Allah-centered caring. Participants believed that they did not have the basic knowledge related to their disease and drugs. In addition, they received little guidance from the healthcare team. Lack of support and insurance as well as financial issues were major problems faced by the caregivers. They accepted the providence of Allah and noted that Allah always helps them accomplish their caregiving responsibilities. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The care performed by the caregivers of patients with heart failure exceeds their individual capabilities. Nurses, other healthcare providers, and health policy makers may use the findings of this study to develop more effective programs to address these challenges and to provide more effective support.Sociocultural factors and perspectives were the primary factors affecting the caregiving experiences of participants in this study. Improved understanding of these factors and perspectives will help healthcare providers develop and implement suitable intervention programs for caregivers. Healthcare professionals should develop context-based intervention programs to promote caregiver capabilities and encourage caregivers to participate to facilitate the caregiving roles of caregivers.

Informational needs and related problems of family caregivers of heart failure patients: A qualitative study.

BACKGROUND: Heart failure is incurable disease and patients often have an ongoing decline once diagnosed. The symptoms of heart failure may impair the ability of patient to perform activities of daily living. As heart failure progresses, patients normally increase their reliance on family caregivers. AIMS: This paper explored the informational needs and related problems of family caregivers of heart failure patients as a part of the findings of a study exploring experiences of family caregivers in the caregiving situation. SETTING AND DESIGN: Using a qualitative design, 19 family caregivers from three educational hospitals in Isfahan, Iran, were recruited. MATERIALS AND METHODS: Participants were selected by purposive sampling. Data were collected through semi-structured interviews. Interviews were transcribed verbatim and analyzed concurrently. RESULTS: Four major themes were emerged from the analysis of the transcripts: "Lack of care-related knowledge", "Inaccessibility to responsible source of information", "Lack of guidance from healthcare team" and "caring with ambiguity due to unpredictable nature of the disease". Caregivers believed that they did not have the basic knowledge related to disease and medication administration. They received little guidance and support from the health care team on the caregiving roles. They experienced high level of ambiguity and stress in caregiving tasks due to lack of care-related knowledge and unpredictable nature of disease. CONCLUSION: The care, which was performed by the caregivers of HF patients, is beyond of their knowledge, capabilities, and resources. Nurses and other healthcare providers can use the findings of this study to develop effective educational and supportive programs to facilitate these needs.

The effectiveness of a supportive educative group intervention on family caregiver burden of patients with heart failure.

BACKGROUND: Living with heart failure patients is a complex situation for family caregivers. Few studies have been conducted to examine the effects of interventional programs to ease this condition. The purpose of this study was to determine the effectiveness of a supportive educative group intervention in reducing family caregivers' burden of caregiving. MATERIALS AND METHODS: This randomized clinical trail was conducted at a selective teaching hospital in Isfahan, Iran in 2012. The intervention consisted of four weekly multimedia training sessions of 2 h that included education and family support for 50 family caregivers. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Paired t-test, Student's t-tests, and repeated measures analysis of variance (ANOVA) were used to test for significant differences of the mean scores of burden between the intervention and control groups over a 3-month period. RESULTS: The intervention was successful in reducing caregiver burden over time both at the end of the intervention period (P = 0.000) and 3 months after the intervention (P = 0.000). CONCLUSIONS: Nurses and other healthcare providers can use the findings of this study in order to implement effective programs to reduce family caregivers' challenges and to provide them more support.

Caregiver burden among Iranian heart failure family caregivers: A descriptive, exploratory, qualitative study.

BACKGROUND: Living with patients of chronic diseases such as heart failure (HF) is a difficult situation for the caregivers. This study explored the Iranian family caregivers' burden of caregiving for patients with HF. MATERIALS AND METHODS: Eighteen family caregivers of the HF patients from two governmental medical training centers in Isfahan, Iran were recruited using purposive sampling. Data were collected through face-to-face semi-structured interviews. Each interview was transcribed verbatim and was thematically analyzed concurrently. RESULTS: FOUR MAJOR THEMES EMERGED FROM THE ANALYSIS OF THE TRANSCRIPTS: Lack of care-related knowledge, physical exhaustion, psychosocial exhaustion, and lack of support. Family caregivers believed that they have little knowledge about the patients' disease, drugs, and how to perform caregiving roles. They experienced negative physical and psychosocial consequences of full-time and highly extended caregiving roles, such as musculoskeletal disorder, fatigue, and sleep disturbance, and a high level of anxiety, stress, and social isolation. Caregivers believed that they receive little familial and organizational support on the emotional and financial dimensions of caregiving. CONCLUSIONS: The findings of this study can be used by healthcare providers, especially nurses, to provide more effective social, informational, and professional support for family caregivers.