The inhibiting factors of adaptation to urinary incontinence in community-dwelling older adult women: A qualitative study.

Urinary incontinence affects the physical, psychological, social and well-being of older adult women and requires adaptation. This study aimed to explain the inhibiting factors of adaptation to urinary incontinence in community-dwelling older adult women. A qualitative content analysis approach was adopted. Participants were 15 older women with urinary incontinence, three family members, and three healthcare team members. Data were collected by individual, in-depth semistructured interviews and analysed using the Graneheim and Lundman approach. The data analysis yielded the theme of neglecting urinary incontinence and the older adult, with four categories of "s silence-inducing beliefs", "worthlessness for the family", "non-adaptation of urban spaces", and "deficiencies in the healthcare service structure". Elucidating the inhibiting factors for older women's adaptation to urinary incontinence will lead to a change in the attitude of social policymakers and healthcare officials. This changes will then facilitate the establishment and adjustment of the necessary infrastructure to overcome these barriers.

Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study.

INTRODUCTION: Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses. METHODS: The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test. RESULTS: The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15). CONCLUSIONS: There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units.

The experiences of patients with COVID-19 and their relatives from receiving professional home care nursing: a qualitative content analysis.

BACKGROUND: To overcome of patients with COVID-19 over the capacity of hospitals and mild to moderate severity of the disease in most cases, the World Health Organization and the Centers for Disease Control and Prevention in the United States, recommend home care for these patients. Receiving care at home will face challenges that can be context-based, especially in crises like the Coronavirus pandemic. The present study aimed to describe the experiences of patients with COVID-19 and their relatives from receiving professional home care nursing. METHODS: This study was conducted using a qualitative content analysis method. Nine participants with COVID-19 who were receiving home care nursing in Semnan participated in this study. The purposive sampling method was used. Sampling continued until no new categories appeared, meaning the category's theoretical saturation. Deep and semi-structured interviews were used to collect data based on the research question. Data was analyzed using the conventional content analysis method using Graneheim and Lundman's approach. RESULTS: After analyzing the interviews and comparing codes based on similarities and differences, three main themes, 11 categories, and 30 subcategories were identified. The main themes included "The value of home care" (personalization of care, being economical, providing intellectual security, and reducing the concern of family), "Comprehensive care" (professional commitment, empathy, mastery in care, and patronage), and "Care challenges" (cultural barriers, inadequate services, and lack of information about costs and conditions). CONCLUSION: The patients with COVID-19 who received professional nursing care at home mentioned some challenges, such as the caregiver not being of the same sex as the patient, delay in receiving the service, the inadequacy of the centers, the limitation of the right to choose the care provider, and insufficient information about the cost of services received before receiving each care.

Effect of propolis mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial.

OBJECTIVES: Ventilator-associated pneumonia (VAP) increases the length of hospitalization and mortality rate. This study aimed to determine the effect of propolis mouthwash on the incidence of VAP in intensive care unit (ICU) patients. MATERIALS AND METHODS: Triple-blind, comparative randomized, controlled clinical trial was conducted over one year, with 110 ICU patients at Imam-Hossein and Bahar hospitals (Shahroud) and Kowsar Hospital (Semnan) in Iran. The intervention group used 15 cc of 0.06% propolis mouthwash solution twice daily at 8 AM and 4 PM for seven days. The control group used 15 cc of 0.2% chlorhexidine mouthwash at the same times and duration. Data were collected using a demographic questionnaire, APACHE II, Beck Oral Assessment Scale, and Modified Clinical Pulmonary Infection Score (MCPIS). RESULTS: There was no significant difference in demographic information, disease severity, and oral health between the two groups before and after intervention (P > 0.05). The incidence of VAP in the intervention group compared to the control group was 10.9% vs. 30.9% on the third day (P = 0.0166, 95% CI: 0.53-0.83 and RR = 0.35), 23.6% vs. 43.6% on the fifth day (P = 0.0325 and 95% CI: 0.31-0.95 and RR = 0.54), and 25.5% vs. 47.3% on the seventh day (P = 0.0224, 95% CI: 0.32-0.92, and RR = 0.54). The Mann-Whitney indicated the incidence of VAP was significantly lower in the intervention group on the third, fifth, and seventh days. CONCLUSION: Propolis mouthwash can be considered as an alternative to chlorhexidine mouthwash for ICU patients. CLINICAL RELEVANCE: Propolis mouthwash serves as a simple, economical intervention to potentially reduce incidence of VAP. TRIAL REGISTRATION: (IRCT20110427006318N12, date 02.04.2019).

The Concerns of Community-Dwelling Older Women Living with Urinary Incontinence: Qualitative Research.

INTRODUCTION AND HYPOTHESIS: The world including Iran is facing population aging. Urinary incontinence (UI) is one of the most common health concerns of older women that can be accompanied by an increased sense of loneliness, social restrictions, and disruption in activities of daily living in addition to the regular challenges of old age. This study was aimed at explaining the concerns of community-dwelling older women living with UI. METHODS: This study used the conventional, qualitative, content analysis approach with purposive sampling. Twenty interviews were conducted with 18 participants, including 15 community-dwelling older women with UI and three family members (a husband and two daughters), over the span of 14 months (from August 2021 to October 2022). The data were collected via semi-structured, face-to-face interviews until data saturation was achieved, and were analyzed using Graneheim and Lundman's method. RESULTS: The findings revealed that the concerns of older women with UI include the impasse of UI, being powerless in life, distorted social identity, and marital frustration, which fell under the main theme of sense of inadequacy. CONCLUSIONS: Recognizing the concerns of older women with UI can make health care teams more sensitive to the importance of resolving these concerns and can offer some insight into how best to provide targeted training, support, and counseling services at individual, family, and society levels, to eventually resolve the older adult's sense of inadequacy.

Factors inhibiting adaptation to nursing care, the neglected loop in the mental health of intensive care unit nurses: A qualitative study.

BACKGROUND: As intensive care unit (ICU) nurses mainly care for critically ill patients, they face many professional challenges, including communicating with patients and working with various devices. Therefore, they need to adapt to the existing conditions, thereby providing high-quality care. Explaining factors inhibiting adaptation to nursing care among ICU nurses. MATERIAL AND METHODS: This is a qualitative study conducted using a conventional content analysis approach in a health center affiliated to Shahroud University of Medical Sciences, Iran. This hospital was equipped with an air ambulance and four ICUs and was also considered as the regional trauma center in the Northeast of Iran. Data were collected using semi-structured face-to-face interviews (from January 2020 to April 2021) and then analyzed using Graneheim and Lundman's (2004) qualitative content analysis method. RESULTS: It was shown that factors inhibiting adaptation to nursing care among ICU nurses consist of three main categories including "personal barriers to adaptation", "dominant management", and "educational concerns". CONCLUSION: To adapt more and as a result to improve the mental health of nurses, it is important to know the barriers to adaptation. Efficient management, paying attention to nurses' issues, and practical training constitute key elements affecting the adaptation to critical nursing care. Therefore, it is necessary to take measures to ensure adaptation in this group of health workers. Thus, an environmental approach of health promotion has social experience and organizational development.

The relationship between teamwork, moral sensitivity, and missed nursing care in intensive care unit nurses.

BACKGROUND: Teamwork, moral sensitivity, and missed nursing care are important healthcare challenges for Intensive Care Unit (ICU) nurses and the existence of a relationship between these variables can be useful for developing better care improvement strategies. This study aimed to determine the relationship between teamwork, moral sensitivity, and missed nursing care in ICU nurses. METHODS: This is a descriptive cross-sectional study conducted on a total of 200 ICU nurses working at teaching hospitals affiliated to Semnan and Shahroud Universities of Medical Sciences, Semnan, Iran in 2022. Sampling was conducted using the census method. Data collection was conducted using a demographic checklist, the TeamSTEPPS Team Perception Questionnaire (T-TPQ), Lützén Moral Sensitivity Questionnaire (L-MSQ), and Kalisch and Williams Missed Nursing Care (MISSCARE) Survey. The examination of the relationship between the three variables was conducted using Pearson's correlation coefficient and multiple regression analysis. RESULTS: The mean and standard deviation of teamwork, moral sensitivity, and missed nursing care was 3.47 ± 0.69, 64.19 ± 13.43, and 55.04 ± 34.10, respectively. The variable of teamwork had a significant positive relationship with moral sensitivity (p < .001) and a significant negative relationship with missed nursing care (p < .001). Teamwork was also a positive predictor of moral sensitivity (p < .001) and a negative predictor of missed nursing care (p < .001). The clinical experience of ICU nurses was a positive predictor of teamwork (p = .01) and a negative predictor of missed nursing care (p = .001). The age of ICU nurses was a positive predictor of moral sensitivity (p = .001) and a negative predictor of missed nursing care (p = .008). CONCLUSION: The findings showed that a higher level of teamwork was associated with increased moral sensitivity and reduced missed nursing care among ICU nurses. Therefore, focusing on planning interventions on teamwork improvement can lead ICU nurses to improve moral sensitivity, lower missed nursing care, and promote the quality of patient care.

Barriers and Facilitators of Palliative Care in Older Adults With Heart Failure: A Qualitative Content Analysis.

Objectives: The progressive and unpredictable course of heart failure (HF) has made the provision of palliative care (PC) services to older adults with HF a serious challenge. This study aimed to explain the barriers and facilitators of PC in older adults with HF. Methods: This qualitative study was conducted using the content analysis approach. A sample of 15 participants, including 6 patients, 2 family caregivers, and 7 healthcare team members (4 nurses, a psychiatric nurse, a nutritionist, and a PC physician) were selected by purposive sampling over 10 months (November 21, 2020 to September 1, 2021). The data were collected using semistructured in-person interviews until data saturation and analyzed with conventional qualitative content analysis. Results: The findings revealed the main category of "neglecting the provision of PC," with 4 subcategories of "weak organizational structure," "poor social support," "older adults' and healthcare teams' poor knowledge," and "limited financial resources" as the barriers of PC and the main category of "enjoying support potentials" with 3 subcategories of "the cooperation of the government, benefactors, and nongovernmental organizations," "empathy from the family and relatives," and "benefiting from the presence of healthcare workers" as PC facilitators. Conclusions: The findings of this study explained the barriers and facilitators of PC in older adults with HF. Removing the barriers and supporting the facilitators give older adults with HF better access to PC. Therefore, to expand PC centers for older adults with HF, health system officials, and policy-makers should pay attention to organizational infrastructures and remove the barriers at organizational, social, educational, and economic levels with the cooperation of governmental organizations, benefactors, and nongovernmental organizations.

A qualitative quantitative mixed methods study of domestic violence against women.

BACKGROUND: Violence against women is one of the most widespread, persistent and detrimental violations of human rights in today's world, which has not been reported in most cases due to impunity, silence, stigma and shame, even in the age of social communication. Domestic violence against women harms individuals, families, and society. The objective of this study was to investigate the prevalence and experiences of domestic violence against women in Semnan. METHODS: This study was conducted as mixed research (cross-sectional descriptive and phenomenological qualitative methods) to investigate domestic violence against women, and some related factors (quantitative) and experiences of such violence (qualitative) simultaneously in Semnan. In quantitative study, cluster sampling was conducted based on the areas covered by health centers from married women living in Semnan since March 2021 to March 2022 using Domestic Violence Questionnaire. Then, the obtained data were analyzed by descriptive and inferential statistics. In qualitative study by phenomenological approach and purposive sampling until data saturation, 9 women were selected who had referred to the counseling units of Semnan health centers due to domestic violence, since March 2021 to March 2022 and in-depth and semi-structured interviews were conducted. The conducted interviews were analyzed using Colaizzi's 7-step method. RESULTS: In qualitative study, seven themes were found including "Facilitators", "Role failure", "Repressors", "Efforts to preserve the family", "Inappropriate solving of family conflicts", "Consequences", and "Inefficient supportive systems". In quantitative study, the variables of age, age difference and number of years of marriage had a positive and significant relationship, and the variable of the number of children had a negative and significant relationship with the total score and all fields of the questionnaire (p < 0.05). Also, increasing the level of female education and income both independently showed a significant relationship with increasing the score of violence. CONCLUSIONS: Some of the variables of violence against women are known and the need for prevention and plans to take action before their occurrence is well felt. Also, supportive mechanisms with objective and taboo-breaking results should be implemented to minimize harm to women, and their children and families seriously.

Academic resilience, moral perfectionism, and self-compassion among undergraduate nursing students: A cross-sectional, multi-center study.

BACKGROUND: Academic resilience has been identified as a coping method for nursing students' educational and practice challenges. Despite the importance of academic resilience, knowledge on how to enhance academic resilience is under-researched. To suggest suitable approaches, relationships between academic resilience and other constructs need to be appraised. OBJECTIVES: This study aims to evaluate predictors of academic resilience, examining its relationships with other essential constructs: self-compassion and moral perfectionism, in undergraduate nursing students in Iran. DESIGN: This descriptive cross-sectional study was conducted in 2022. PARTICIPANTS: A convenience sample of 250 undergraduate nursing students at three universities in Iran participated in this study by completing self-report measures. METHODS: Data collection tools were Nursing Student Academic Resilience Inventory, Moral Perfectionism scale, and Self-Compassion Scale-Short Form. Correlation and regression analyses were conducted. RESULTS: The mean and standard deviation of academic resilience were 57.57 ± 23.69; moral perfectionism 50.24 ± 9.97, and self-compassion 37.19 ± 5.02. Self-compassion had significantly related to moral perfectionism (r = 0.23, p < 0.001). Academic resilience had no statistically significant relationship with moral perfectionism (r = -0.05, p = 0.41) and self-compassion (r = -0.06, p = 0.35), but significantly affect age (r = 0.14, p = 0.03), Grade point average (r = 0.18, p < 0.001) and university of study (r = 0.56, p < 0.001). The grade point average and the university of the study predicted 33 % of the changes in academic resilience, and the greatest impact was related to the university (r = 0.56, p < 0.001). CONCLUSION: Adopting appropriate educational strategies and supporting the students will help improve nursing students' academic resilience and performance. Promoting self-compassion will lead to the development of nursing students' moral perfectionism.

Effect of clove mouthwash on the incidence of ventilator-associated pneumonia in intensive care unit patients: a comparative randomized triple-blind clinical trial.

OBJECTIVES: Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in intensive care units (ICUs), and the use of mouthwash is the most widely used method to prevent its incidence. The aim of this study was to investigate effect of clove mouthwash on the incidence of VAP in the ICU. MATERIALS AND METHODS: This comparative, randomized, triple-blind, clinical trial was conducted on 168 eligible ICU patients at Kosar Hospital in Semnan, Iran, during 2021-2022, who were divided into intervention and control groups using random blocks. The intervention group received clove extract mouthwash at 6.66% concentration, and the control group received chlorhexidine 0.2% twice a day for 5 days (routine care). Data were collected using a demographic questionnaire, and disease severity was measured based on the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, oral health status was examined using the Beck Oral Assessment Scale (BOAS), and VAP diagnosis was made based on the Modified Clinical Pulmonary Infection Score (MCPIS). RESULTS: Before the intervention, there was no significant difference in disease severity (p = 0.412) and oral health status (p = 0.239) between the patients in the two groups. After the intervention, 20.2% of the patients in the intervention group and 41.7% of those in the control group acquired VAP. The risk of VAP was 2.06 times higher in the control group than in the intervention group (p = 0.005, 95% CI: 1.26-3.37, RR = 2.06), but the severity of VAP did not differ significantly between the patients in the two groups (p = 0.557). CONCLUSION: The findings showed that clove mouthwash reduces the incidence of VAP significantly. CLINICAL RELEVANCE: Clove mouthwash can be used as a simple and low-cost method to prevent VAP in ICU patients.

The impact of Propolis on catheter exit site infection and peritonitis in peritoneal Dialysis patients: a clinical trial.

BACKGROUND: Peritonitis is one of the major complications of peritoneal dialysis. The most common cause of peritonitis is infection at the catheter exit site. This study aimed to determine the effect of propolis on the incidence of catheter exit site infection and peritonitis in peritoneal dialysis patients. METHOD: This study was a double-blind clinical trial (2019-2020) with peritoneal dialysis patients. Ninety peritoneal dialysis patients were allocated to three groups (placebo, control, intervention) using block randomization method. Catheter exit site was washed with 0.9% normal saline and dressing was done every other day after the morning peritoneal dialysis exchange by use of normal saline in placebo, mupirocin in control, and propolis in intervention group, for 6 months. DISCUSSION: 10% of the patients in the placebo and 6.7% in the control group developed catheter Exit Site Infection, but none patient in the intervention group developed this infection (P = 0.469). Whereas 6.7% in both the placebo and control groups developed peritonitis, but none patient in the intervention group contracted peritonitis (P = 0.997). No significant differences in the incidence of catheter exit site infection and peritonitis among the three groups were observed. Considering that mupirocin is of chemical origin and may lead to drug resistance whereas propolis is of plant origin and does not produce drug resistance, the use of propolis is recommended. TRIAL REGISTRATION: Iranian Registry of Clinical Trials [ IRCT20110427006318N10 ] (17/01/2019).

Predicting moral intelligence in nursing students and its relationships with self-compassion, and cultural competence: a cross-sectional study.

BACKGROUND: In the recent era, nursing needs employees with moral intelligence, cultural competence, and self-compassion skills more than ever. This study aimed to determine the predictors of moral intelligence and its relationship with self-compassion and cultural competence in nursing students. METHODS: This cross-sectional and multi-center descriptive study was conducted in 2022. With convenience sampling, 250 nursing students from three Iranian universities participated in this study. Data gathering included the Moral Intelligence Questionnaire, Self-Compassion Scale (short form), and Cultural Competency Questionnaire. The data were analyzed using descriptive statistics, the correlation between variables, and hierarchical regression. RESULTS: The results showed that nursing students had good moral intelligence (72.63 ± 11.38), moderate self-compassion (37.19 ± 5.02), and poor cultural competence (50.06 ± 13.15). No statistically significant relationship was observed between self-compassion and cultural competence (r = 0.11, p = 0.07). Moral intelligence with marital status (r = 0.16, p = 0.01), academic year (r = 0.14, p = 0.03) and self-compassion (r = 0.33, p < 0.001) had a significant relationship in such a way that these variables explained 15% of moral intelligence and self-compassion had the highest impact (p < 0.001). CONCLUSION: Considering the moderate level of self-compassion and the poor level of cultural competence reported in the undergraduate nursing students, and also that self-compassion was known to be a predictive factor for moral intelligence, planners and educators must pay more attention to promoting self-compassion and cultural competency in the curriculum and conduct studies to find ways to improve them.

Effect of chamomile oil on the intensity of nonspecific low back pain in prehospital emergency technicians.

INTRODUCTION: Low back pain (LBP) are prevalent in prehospital emergency (PE) technicians. This study aimed to investigate effect of chamomile oil on the intensity of LBP in PE technicians. METHODS: In this three-blind randomized clinical trial study, 90 PE technicians with LBP were randomly assigned to three groups: intervention, placebo and control. Intervention and placebo used 1.5 cc oil of chamomile and paraffin respectively, in lumbar region, three times a day for three weeks. Control group did not receive any intervention. Pain intensity and its interference with daily activities were measured by brief pain inventory (BPI), before intervention and end of first, second, and third weeks. RESULTS: Intervention group showed a significant drop in pain intensity and pain interference with daily activities at end of first, second, and third week (p < 0.001). At the end of first and second weeks, the mean pain reduction in intervention was significantly higher than that in placebo and control (p < 0.001), but at end of third week, there was no significant difference between three groups in this respect (p > 0.05). CONCLUSION: Topical chamomile oil application can reduce the intensity of LBP in PE technicians and its impact on their daily activities for a period of two weeks.

Novice nurses' experiences from teamwork in the emergency department: A qualitative content analysis.

BACKGROUND AND AIM: Teamwork is assumed crucial in nursing. Nevertheless, nursing shortages in medical centers have thus far compelled nurse managers to use novice nurses. The present study aimd to explaining the challenges and experiences of novice nurses regarding teamwork in emergency departments. MATERIALS AND METHODS: Using qualitative content analysis, 11 novice nurses working at emergency department, participated in this study. Data were collected with semi structured interview and analyzed by Graneheim and Lundman. RESULTS: The data analysis led to the emergence of four themes of "essential teamwork skills development", "contradictory relationships between team members", "unpleasant feelings and experiences", and, "personal growth and maturation during teamwork". CONCLUSION: Fostering different personal aspects as prerequisites for teamwork, novice nurses will be able to deal with unpleasant feelings and experiences as well as contradictory relationships between team members in an effective manner. This challenging experience will thus give rise to personal growth and maturation during teamwork among them in emergency department.

The protective role of professional self-concept and job embeddedness on nurses' burnout: structural equation modeling.

BACKGROUND: Job embeddedness and professional self-concept are among the important nursing components, the existence of which help decrease occupational burnout among nurses. This study aimed to determine the protective role of Professional Self-concept and Job embeddedness on nurses'burnout. METHODS: This descriptive, correlational study had a predictive design and was conducted on nurses working in training and healthcare centers of Babol University of Medical Sciences in 2019. In total, 308 nurses participated in this study and were selected by stratified random sampling. In addition, data were collected using demographic characteristics questionnaire, Professional Self-concept questionnaire, Job embeddedness scale and nurses' burnout questionnaire. Moreover, data analysis was performed in SPSS version 25 and Smart PLS version 3.3 using correlational statistics and structural equation modeling. RESULTS: Both the variables of professional self-concept and job embeddedness, had a significant effect on nurses' burnout at 99% confidence level (P < 0.001) and the negative beta value for these two variables shows the inverse relationship between both professional self-concept and job embeddedness with nurses' burnout. The value of the coefficient of determination for burnout indicates that both the variables of professional self-concept and job embeddedness, together explain 78% of the changes in the variable of burnout. The beta coefficient for professional self-concept (- 0.50) is higher than the same coefficient for job embeddedness (- 0.42). As a result, the role of professional self-concept in predicting burnout of clinical nurses has been more than the role of job embeddedness. The indirect effect of professional self-concept on burnout of clinical nurses mediated by job embeddedness has been equal to - 0.347. As a result, it can be said that nurses' professional self-concept has a significant effect on nurses' burnout through mediation of job embeddedness. CONCLUSION: According to the results of the study, Professional Self-concept had an effective role in nurses' burnout. In other words, the higher the Professional Self-concept of nurses, the lower their burnout. Therefore, it is suggested that effective interventional strategies be designed by nursing managers through better planning and a supportive workplace be established to improve Professional Self-concept among nurses and decrease their burnout.

Moral intelligence, clinical placement experience and professional behaviors among Iranian undergraduate nursing students in a baccalaureate nursing program: A descriptive correlational study.

AIMS: This study was intended to examine the relationship of both moral intelligence (MI) and Clinical Placement Experience (CPE) with the level of nursing students' professional behaviors (PB). BACKGROUND: The foundation of belief, belonging and ethical values develop PB as a meaningful attribute during the period students and caring for patients. DESIGN: A descriptive correlational study was conducted. METHODS: Descriptive data were derived from the Belongingness Scale-Clinical Placement Experience (BES-CPE), the Moral Intelligence Questionnaire (MIQ) and the Nursing Students Professional Behaviors Scale (NSPBS) including 200 students (response rate 94.5%). RESULTS: We found a statistically strong positive correlation between NSPB, MI and CPE. The regression model accounted for 57.8% of the variance in NSPB; CPE and MI were significant explanatory variables of NSPB. Moreover, the non-employed dormitory students had a significant statistical difference in the scores of all three variables. Female students had significantly higher CPE and MI (p˂0.05). CONCLUSIONS: According to our findings, preventive and mediation endeavors for nursing students can explicitly target their behavioral skills to reduce perceived rejection and improve morality. As a result, an optimal plan to improve the quality of professional training courses for students should be designed based on the comprehension of clinical belonging and moral intelligence.

The Effects of Valerian on Sleep Quality, Depression, and State Anxiety in Hemodialysis Patients: A Randomized, Double-blind, Crossover Clinical Trial.

OBJECTIVES: Our study sought to determine the effects of valerian on sleep quality, depression, and state anxiety in hemodialysis (HD) patients. METHODS: This randomized, double-blind, placebo-controlled, crossover clinical trial was conducted on 39 patients undergoing HD allocated into a valerian and placebo group. In the first phase of the study, group A (n = 19) received valerian and group B (n = 20) received a placebo one hour before sleep every night for a total of one month. Sleep quality, state anxiety, and depression were assessed in the patients at the beginning and end of the intervention using the Pittsburgh Sleep Quality Index, the Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory. In the second phase, the two groups' treatment regimen was swapped. After a one-month washout period, the same process was repeated on the crossover groups (i.e., group A received placebo and group B received valerian). RESULTS: In the first phase, the mean sleep quality, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly higher in group A compared to group B (7.6 vs. 3.2, p< 0.001; 6.5 vs. 2.3, p =0.013; 14.6 vs. 7.3, p =0.003, respectively). In the second phase, the mean sleep disorder, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly lower in group A compared to group B (1.4 vs. 4.6, p< 0.001; 1.2 vs. 3.8, p =0.002; 1.5 vs. 6.2, p< 0.001, respectively). CONCLUSIONS: Valerian significantly improved sleep quality, the symptoms of state anxiety, and depression in HD patients.

Effect of reminiscence on cognitive impairment and depression in haemodialysis patients.

BACKGROUND: Cognitive impairment and depression are common problems in haemodialysis patients. AIM: The present study was carried out to determine the impact of reminiscence on cognitive impairment and depression in haemodialysis patients. DESIGN: This clinical trial (2016) was conducted with a pretest-posttest design on the haemodialysis patients of hospitals in Shahrud, Iran. PARTICIPANTS AND MEASUREMENTS: Block random sampling was used to investigate the patients' cognitive status and Beck's Depression Scale were administered among 75 patients divided into intervention (given 12 sessions of Stinson's group reminiscence), control (group discussions), and sham (without any intervention) groups before, immediately and 30 days after the intervention. RESULTS: Immediately and 30 days after the intervention, the cognitive score was significantly higher in the reminiscence group than the control (p < 0.001) and sham (p < 0.001) groups. Immediately after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.011) and sham (p < 0.001) groups. Also, immediately and 30 days after the intervention, the depression score was significantly lower in the reminiscence group than the control (p = 0.031) and sham (p < 0.001) groups. CONCLUSIONS: The findings showed that reminiscence increased the cognitive health score and improved depression in haemodialysis patients. Therefore, reminiscence protocols can be utilized as an independent routine nursing care measure for improving cognitive status and depression in haemodialysis patients.

Effect of foot reflexology on chest pain and anxiety in patients with acute myocardial infarction: A double blind randomized clinical trial.

BACKGROUND AND PURPOSE: The aim of this study was to determine the effect of foot reflexology on chest pain and anxiety in patients with AMI. MATERIALS AND METHODS: This study was a double blind randomized clinical trial. Stratified random sampling was carried out on 90 patients with AMI in the three groups of treatment, placebo and control. Foot reflexology was done for three consecutive days, each time for 20 min. Chest pain and anxiety were evaluated with Visual Analogue Scale before, immediately and 20 min later. RESULTS: 20 min after the intervention, severity of chest pain in treatment group was significantly lower than control group (p < 0.001) and placebo group (p = 0.002). Severity of anxiety between groups and at different times was not significant. CONCLUSIONS: Foot reflexology was effective in attenuating chest pain, had the most effect in 20 min after intervention, and can be used to relieve chest pain in patients with AMI.