Death Anxiety in Patients with a History of Coronary Artery Bypass Graft Surgery During the COVID-19 Pandemic: The Role of Spiritual Well-Being and Coping Strategies.

Patients who have previously undergone coronary artery bypass surgery (CABG) were prone to death anxiety during the COVID-19 pandemic. It appears that spiritual well-being and appropriate coping strategies may mitigate the harmful effects of death anxiety. Therefore, this study aimed to determine the level of death anxiety in patients with CABG during the COVID-19 pandemic and investigate the relationship between spiritual well-being, coping strategies and death anxiety.This cross-sectional study was conducted on 100 patients with CABG history in Tehran from June 2021 to February 2022. The face-to-face questionnaire, containing questions on demographics, Templer's death anxiety scale, the spiritual well-being questionnaire, and the ways of coping questionnaire was administered to collect data. Statistical analysis was performed using descriptive-analytical statistics, correlation tests, and logistic regression models.Participants' mean age was 55.59 ± 12.78 years. The mean death anxiety score was 10.00 ± 2.16, with 87% of participants reporting high levels and 13% reporting low levels of death anxiety. Based on the results, there was a significant negative correlation between death anxiety and coping strategies, as well as subscales of distancing, seeking social support, accepting responsibility, and planful problem-solving. Logistic regression showed that with the increase in the score of spiritual well-being, the odds of having high levels of death anxiety decreased (p < 0.05). Furthermore, increasing the total score of coping strategies, and the score of self-controlling, seeking social support, accepting responsibility, and planful problem-solving, significantly reduced the odds of high levels of death anxiety (p < 0.05).The study showed that patients with a CABG history experienced high death anxiety during the COVID-19 pandemic. According to the findings, spiritual well-being and coping strategies, especially self-controlling, seeking social support, accepting responsibility, and planful problem-solving, may reduce the odds of severe death anxiety. These should be considered as effective targets for psychological intervention in these patients.

Barriers and facilitators to fulfilling the teaching assistant role from nursing students' perspective: a qualitative study.

BACKGROUND: Employing postgraduate students as Teaching Assistants (TA) has become a common practice in many higher education institutions and is part of a growing international trend for professional practice. OBJECTIVE: This study aimed to determine the barriers and facilitators to fulfilling the teaching assistant role from nursing students' perspective. METHODOLOGY: This qualitative-descriptive study was conducted in 2022 on teaching assistants in the Faculty of Nursing and Midwifery of Tehran University of Medical Sciences. 13 teaching assistants were selected by targeted sampling method with maximum variation. The inclusion criteria were 2nd-semester postgraduate nursing students and above, having experience as a teaching assistant, and willing to participate in the research. Data were collected through semi-structured individual interviews for 45 to 60 min until saturation was reached. Data analysis was done manually and using the framework analysis method with steps: Familiarization, Identifying a thematic framework, indexing, Charting, data synthesis, mapping, and interpretation. The trustworthiness of the study data was determined with the Lincoln and Guba criteria. RESULTS: Barriers to fulfilling the TAs' role were divided into three main categories with nine subcategories: (1) Not accepting the teaching assistant as a clinical instructor (2) not being prepared to accept the TA role, and (3) improper planning of the TA plan. Facilitators are divided into two main categories with five subcategories: (1) internal motivation, and (2) empowering TAs. CONCLUSION: To facilitate management processes in the field of education and to achieve educational goals, including improving the quality of education and better learning, planning and compiling instructions to create written job descriptions for teacher assistants should be done, also, with careful planning, steps should be taken to scientifically employ capable teacher assistants as young and motivated forces in education processes.

The impact of an integrated early palliative care telehealth intervention on the quality of life of heart failure patients: a randomized controlled feasibility study.

BACKGROUND: While palliative care for patients with heart failure has gained global attention, in Iran most palliative care interventions have focused only on cancer patients. The purpose of this study is to determine the feasibility and acceptability of a telehealth palliative care intervention to improve the quality of life in patients with heart failure in Iran. METHODS: This single-site, pilot randomized controlled trial of a telehealth palliative care intervention versus usual care was conducted on patients with New York Heart Association class II/III heart failure recruited from a heart failure clinic in Iran. Under the supervision of a nurse interventionist, intervention participants received 6 weekly educational webinars and concurrent WhatsApp® group activities, with 6 weeks of follow-up. Feasibility was assessed by measuring recruitment, attrition, and questionnaire completion rates; acceptability was assessed via telephone interviews asking about satisfaction and attitudes. Secondary outcomes measured at baseline and 6 weeks included quality of life (PKCCQ and FACIT-Pal-14), anxiety and depression (HADS), and emergency department visits. RESULTS: We recruited and randomized 50 patients (mean age 47.5 years, 60% men). Among those approached for consent, 66% of patients agreed to participate and total study attrition was 10%. Also 68% of patients successfully completed at least 4 out of the 6 webinar sessions. Acceptability: 78% of patient participants expressed willingness to participate in the present study again or recommend other patients to participate. There was a trend towards improvement in anxiety and depression scores in the intervention group though the study was not powered to detect a statistical difference. CONCLUSION: This nurse-led, early telehealth-palliative care intervention demonstrated evidence of feasibility, acceptability, and potential improvement on quality of life in patients with heart failure in Iran. TRIAL REGISTRATION: The study was registered at the Iranian Registry of Clinical Trials (IRCT) at 14 November, 2021, and can be found on the Iranian Registry of Clinical Trials Platform. IRCT registration number: IRCT20100725004443N29.

Effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission of patients with heart failure: protocol for a randomised controlled trial.

INTRODUCTION: Heart failure (HF) as a long-term clinical syndrome is associated with inadequate self-care behaviours, a feeling of uncertainty and frequent hospitalisation. In recent years, empowerment has evolved for improving chronic disease management. Nevertheless, there is a lack of studies investigating remote care interventions such as a tele-empowerment programme in patients with HF. Therefore, this protocol proposes a randomised controlled trial which aims to evaluate the effectiveness of a comprehensive tele-empowerment programme on self-care behaviours, uncertainty and readmission in patients with HF. METHODS AND ANALYSIS: The study is a double-arm and parallel-group randomised controlled trial in which a 10-week intervention, including 6 weeks of a comprehensive tele-empowerment programme and 4 weeks of follow-up, will be compared with usual care. A total of 96 eligible patients with HF will be recruited and randomly assigned to the intervention or control group. The patients in the intervention group will join virtual groups and receive the five-step tele-empowerment programme through the internet. The primary outcomes include self-care behaviours and uncertainty which will be measured with valid instruments at baseline and 10th week. The secondary outcome is the number of patients' hospital readmissions and will be assessed at the end of the study. Descriptive statistics will be used to describe variables. According to the types of variables, appropriate statistical tests including two-sample t-tests, Χ2, analysis of covariance or linear regression will be performed. In addition, standardised intervention effect sizes will be calculated for each outcome. ETHICS AND DISSEMINATION: The trial has been approved by the Research Ethics Committee of School of Nursing and Midwifery & Rehabilitation at Tehran University of Medical Sciences. In this study, written consent will be obtained from all participants. The results will be presented to representative groups and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: Iranian Registry of Clinical Trials (IRCT20100725004443N30).

The feasibility and acceptability of an early tele-palliative care intervention to improve quality of life in heart failure patients in Iran: A protocol for a randomized controlled trial.

Background: Heart failure (HF) has become a global health problem that has affected the quality of life of millions of people. One approach to improving patients' quality of life (QoL) with chronic diseases such as HF is palliative care. In Iran, the bulk of palliative care research is directed to patients with cancer, with the primary focus on the physical aspect rather than the psychosocial and spiritual aspects of palliative care. To address this gap, this study aims to determine the feasibility and acceptability of this early tele-palliative care intervention to improve quality of life in heart failure patients in Iran. Methods: The early tele-palliative care versus usual care study is designed as a single-centre, randomised, feasibility trial of 50 patients with heart failure aged 18 to 65 and clinician-determined New York Heart Association class II/III or American College of Cardiology stage B/C HF, recruited in Imam Khomeini Hospital Complex, Tehran, Iran. This intervention contains 6 weekly educational webinars and concurrent WhatsApp® group activities. Program feasibility and acceptability will be assessed by measuring the recruitment, attrition, and questionnaire completion rates; satisfaction and attitudes about the intervention will be measured via a telephone-based interviews. Secondary outcomes of Qol, mood status and number of emergency department visits will be measured with validated instruments. Participants in both groups will be followed up for 6 weeks, and the measures will be re-administered. Appropriate statistical tests will be used to analyse the data. Conclusion: This is the first early tele-palliative care intervention designed for heart failure patients in Iran. The intervention has been developed by a multidisciplinary team of academic and clinical professionals with patient stakeholder input to create a rigorous and culturally responsive approach for palliative care delivery for heart failure patients in Iran. Trial registration: IRCT registration number - IRCT20100725004443N29.

Anticipatory grief during COVID-19: a commentary.

The diagnosis of potentially fatal diseases, such as COVID-19, may cause many critical reactions in dying patients and their relatives. Grief and fear of anticipatory death are natural, especially in the case of COVID-19. Although several studies have been conducted on anticipatory grief (AG) caused by cancer and dementia, the outbreak of COVID-19 could potentially intensify the AG rate among dying patients, their families and healthcare professionals. Therefore, mental health support, palliative and psychiatric care, and similar strategies should be taken into account when planning the treatment process and allocating resources during the COVID-19 pandemic. This commentary highlights the importance of addressing anticipatory grief during the COVID-19 pandemic and provides some recommendations for grief management for healthcare professionals.

A Resilient Care of the Patient With COVID-19: A Phenomenological Study.

This study a utilized phenomenological hermeneutic design. Fourteen Iranian family caregivers of patients with COVID-19 who were isolated at home were included in the study using purposive sampling. In-depth unstructured interviews were conducted via WhatsApp. Sampling continued until data saturation. Interviews were transcribed and analyzed using Van Manen's approach. Three primary themes and eight subthemes emerged. The primary themes included: "captured in a whirlpool of time", "resilient care' and "feeling helpless". It seems that the families of patients with COVID-19 attempt to resist the pressures of this disease with religious practices and problem solving. However, due to the nature of the disease and its severity, they sometimes feel ashamed or lonely and are afraid of losing their loved ones. It is recommended that psychiatric nurses should develop programs in the form of comprehensive spiritual care packages or psychological support and utilize multiple media channels to deliver these.