Explaining the Nurses' Spiritual Needs in the Oncology Department: A Qualitative Study.

Background: It seems that improving the spiritual dimension of cancer patients can play an effective role in their mental and emotional peace. Meanwhile, oncology ward nurses are one of the most important healthcare providers that can help improve patients' relationship with God due to their more interaction and communication with patients. For this reason, this study aimed at explaining nurses' spiritual needs in an oncology ward. Materials and Methods: This study was conducted based on the qualitative content analysis method. The participants included 11 nurses from the oncology ward of Seyed Al Shahada Hospital in Isfahan from 2021 to 2022. A semi-structured interview was administered to determine nurses' spiritual needs. Results: Analysis of 11 interviews conducted with nurses revealed a total of four main codes, 13 sub-codes, and four sub-sub-codes. According to nurses' point of view, their spiritual needs can be classified into four dimensions as follows: communication with God, communication with oneself (intrapersonal communication), communication with others (interpersonal communication), and communication with environment. Administered interviews revealed the role of communication with God with six sub-codes as nurses' most important point of attention. Conclusions: According to nurses' point of view, nurses' spiritual needs were divided into the dimensions of communication with God, communication with oneself, communication with others, and communication with environment. Therefore, it is necessary to simultaneously pay attention to oncology nurses' personal and social aspects to increase their spirituality.

Comparison of the effectiveness of virtual reality-based education and conventional teaching methods in dental education: a systematic review.

BACKGROUND AND OBJECTIVES: Virtual reality dental simulators as an educational tool may create specific training conditions for dental students, allowing them to practice dental skills in a safe and controlled condition. This study aimed to investigate the effectiveness of virtual reality-based education in dental education compared to traditional education approaches. METHODS: In this systematic review, four databases (PubMed, Scopus, Web of Science, and Science Direct) were searched until 2023 following PRISMA guidelines. The Quality assessment and risk of bias were assessed by the Cochrane Collaboration Tool for RCTs and GRADE, respectively. Inclusion criteria were restricted to randomized or quasi-randomized trials about virtual reality efficacy in dental education. Two authors independently evaluated the data and reviewed the overall risk of bias for all selected studies. Study design, sample size, hardware, onset time of intervention, duration, and number of procedures performed were among the data extracted. RESULTS: From the 703 titles, 48 full texts were chosen for review, yielding 14 articles for final inclusion. The review of these articles indicated the effective role of virtual reality dental simulators in improving students' knowledge and practical skills. CONCLUSIONS: Based on our findings, adding haptic technology to virtual reality can improve students' practical skills, hand skills, theoretical knowledge, self-confidence, and learning environment. Although a fair amount of research needs to be done, notably on cost-effectiveness, student satisfaction, and other potentially adverse effects, virtual reality is a growing phenomenon with immense potential.

Development and implementation of an intraoperative documentation protocol for enhancing patient safety in the operating room: A mixed methods protocol study.

BACKGROUND: Documentation is an important part of the patient care process; however, there is no regular program for documenting intraoperative care in Iran. This study was conducted to design an intraoperative documentation for enhancing patient safety in the operating room (OR). MATERIALS AND METHODS: This exploratory, mixed-methods, qualitative-quantitative study (in 2021) consists of four phases. The first phase involves a conventional content analysis of healthcare providers in the OR to identify the needs, strategies, and content of a pertinent documentation. In this phase, purposeful sampling will be used to collect data through semi-structured interviews. In the second phase, a literature review will be carried out to extract the documentation procedures in the intraoperative period in many other countries. In the third phase, a panel of experts is recruited and the classic Delphi (RAND) technique is run to validate the initial draft of the designed program and, the protocol is then finalized. In the last phase, the designed protocol will be implemented through a quasi-experimental study in one group (before and after intervention), and the effectiveness of the intervention will be evaluated. DISCUSSION: To design a protocol for intraoperative documentation, healthcare providers' experiences during surgery in the Iranian healthcare setting, where the lack of documentation might forensically harm both the healthcare providers and the patients, will be explored. This information alongside some universal standards developed in other countries should help improve patients' safety in ORs.

The Effect of a Combined Exercise Program on the Fatigue Severity of Patients with Breast Cancer Undergoing Chemotherapy: A Randomized Clinical Trial Study.

Background: Breast Cancer (BC) is one of the most common cancers in the world, including in Iran. Chemotherapy as one of the basic treatments for BC leads to many side effects such as fatigue. This study aimed to examine the effect of a combined exercise program on the intensity of fatigue in patients with BC undergoing chemotherapy. Materials and Methods: This clinical trial study was conducted on 64 patients with BC undergoing chemotherapy referring to the Seyyed al-Shoada and the Al-Zahra clinics from January to April 2022. Eligible patients who met inclusion criteria were recruited by the convenience sampling and then assigned randomly to intervention and control groups. The combined exercise program in the intervention group was done for 8 weeks as three sessions a week (34 sessions) each for 35-40 min. Piper's Fatigue Scale was completed for both groups before and after the intervention. Data were analyzed using descriptive and inferential statistical methods. Results: The results showed that the mean score of fatigue intensity in both control and intervention groups had a statistically significant difference after the intervention (p = 0.004). The mean fatigue intensity score in the intervention group decreased significantly from mean (SD) 8.17 (1.88) to 5.56 (1.74). Conclusions: Based on the results, a combined exercise program can reduce fatigue in patients with BC. Therefore, nurses can utilize exercise programs and practices as a subset of complementary medicine alongside other treatment methods, which can effectively promote cancer patients' quality of life by reducing their fatigue.

Experiences of Nurses in Caring for Patients with COVID-19: A Qualitative Research.

Background: The Covid-19 disease was raised as a fundamental public health problem worldwide, and nurses were exposed to many problems and challenges at the front line of fighting this disease. Therefore, the present study aimed to explain the experiences of nurses who took care of Covid-19 patients. Materials and Methods: This study was a conventional content analysis qualitative study using Granheim and Lundman approach. The study participants included 20 nurses working in Corona referral hospitals in Isfahan, Iran. Participants were selected using purposive sampling and in-depth semi-structured interviews were conducted from September 2020 to March 2021. To assess the trustworthiness of the obtained data, credibility, dependability, confirmability, and transferability criteria were used. Results: Data analysis led to the production of 700 primary codes, 15 sub-sub-categories, 5 sub-categories and 2 main categories. These two main categories consisted ofpsychological reactions and organizational challenges. Negative emotional experiences and positive emotional experiences were placed in the category of psychological reactions and expectations from superiors, lack of facilities and resources and insufficient quality of care in the category of organizational challenges. Conclusions: The results of the present study showed that managers and policy- makers should prioritize the nursing empowerment to ensure effective epidemic fight and the psychological and financial support of Covid-19 ward nurses.

Development, implementation, and evaluation of a program to expand the nurse's roles in colorectal cancer prevention: A mixed-methods protocol study.

BACKGROUND: Nurses play an important role in cancer prevention. However, studies conducted on nurses' roles, in the field of cancer prevention in Iran, are very limited. This study will identify the role of nurses and designs, implements, and evaluates a program to expand their role in the prevention of colorectal cancer (CRC). MATERIALS AND METHODS: This exploratory mixed-methods study will be performed using quantitative-qualitative methods in three consecutive stages. In the first phase, a qualitative study will be conducted to identify the potential and actual roles of nurses in Iran using in-depth semi-structured interviews. Participants will be selected by purposive and snowball sampling, followed by a literature review; the actual and potential roles of nurses at the primary, secondary, and tertiary levels of CRC prevention in Iran and around the world will be extracted. And the actual role is determined. In the second phase, the roles of nurses will be prioritized using the modified Delphi method, and the program will be designed. In the third phase, the part of the program will be implemented as a quasi-experimental intervention, and the effect of the intervention will be evaluated. CONCLUSION: Developing a program can provide some evidence for promoting nurses' position in cancer prevention. Moreover, it is expected that this program promotes knowledge and empowerment and the position of nurses to provide primary, secondary, and tertiary cancer prevention. The entry of nurses into the field of cancer prevention leads to better quality care and more cost-effectiveness.

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.

Adaptation of Interdisciplinary Clinical Practice Guidelines to Palliative Care for Patients with Heart Failure in Iran: Application of Adapte Method.

Background: Clinical Practice Guidelines (CPGs) have been recommended to manage palliative care and take the best treatment measures and decisions. This study aimed to adapt the interdisciplinary CPG to provide palliative care for patients with Heart Failure (HF) in Iran based on the ADAPTE method. Materials and Methods: Guideline databases and websites were systematically searched up to April 2021 to determine appropriate publications related to the study topic. Followed by assessing the quality of the selected guidelines via the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II), those with appropriate standard scores were selected to be used in designing the initial draft of the adapted guideline. The developed draft contained 130 recommendations and was evaluated by a panel of interdisciplinary experts in terms of its relatedness, comprehensibility, usefulness, and feasibility in two phases of Delphi. Results: In the first phase of Delphi, the adapted guideline was derived from five guidelines and evaluated by 27 interdisciplinary pundits working in the universities of Tehran, Isfahan, and Yazd cities. After the assessment in Delphi Phase 2, four recommendation categories were removed because they did not receive the required scores. Finally, 126 recommendation items were included in the developed guideline, which were classified into three main categories of palliative care features, essentials, and organization. Conclusions: In the present study, an interprofessional guideline was designed to enhance palliative care information and practice in patients with HF. This guideline can be administered as a valid tool for interprofessional team members to provide palliative care to patients with HF.

Quality of Palliative Care Guidelines in Patients with Heart Failure: A Systematic Review of Quality Appraisal using AGREE II Instrument.

Objectives: While the principles for developing clinical practice guidelines (CPGs) are well established, the quality of published guidelines is very diverse. The present study was conducted to evaluate the quality of existing CPGs in palliative care for heart failure patients. Material and Methods: The study was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-analyses. A systematic search was conducted in the Excerpta Medica Database, MEDLINE/PubMed, CINAHL databases and Guideline internet sites: National Institute for Clinical Excellence, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, Guidelines International Network and National Health and Medical Research Council for CPGs published through April 2021. Criteria for including CPGs were: Containing palliative measures for patients with heart failure over 18 years old and preferably interprofessional guidelines that focus on only one dimension of palliative care or focus on diagnosis, definition and treatment were excluded from the study. After initial screening, five appraisers rated the quality of the final selection of CPGs using the Appraisal of Guidelines for Research and Evaluation, 2nd edition (AGREE II). Results: From 1501 records, seven guidelines were selected for analysis. The 'scope and purpose' and 'clarity of presentation' domains obtained the highest mean and 'rigor of development' and 'applicability' domains obtained the lowest mean scores. Three categories of recommendations were: (1) Strongly recommended (guidelines 1, 3, 6 and 7); (2) recommended with modifications (guideline 2) and (3) not recommended (guidelines 4 and 5). Conclusion: Clinical guidelines for palliative care in patients with heart failure were of moderate-to-high quality, with the main deficiencies occurring in the rigor of development and applicability domains. The results inform clinicians and guideline developers of the strengths and weaknesses of each CPG. To improve the quality of palliative care CPGs in the future, it is recommended that developers pay detailed attention to all domains of the AGREE II criteria. Funding agent: Isfahan University of Medical Sciences. (IR.MUI.NUREMA.REC.1400.123).

Patient education information material assessment criteria: A scoping review.

BACKGROUND: Patient education information material (PEIM) is an essential component of patient education programs in increasing patients' ability to cope with their diseases. Therefore, it is essential to consider the criteria that will be used to prepare and evaluate these resources. OBJECTIVE: This paper aims to identify these criteria and recognize the tools or methods used to evaluate them. METHODS: National and international databases and indexing banks, including PubMed, Scopus, Web of Science, ProQuest, the Cochrane Library, Magiran, SID and ISC, were searched for this review. Original or review articles, theses, short surveys, and conference papers published between January 1990 and June 2022 were included. RESULTS: Overall, 4688 documents were retrieved, of which 298 documents met the inclusion criteria. The criteria were grouped into 24 overarching criteria. The most frequently used criteria were readability, quality, suitability, comprehensibility and understandability. CONCLUSION: This review has provided empirical evidence to identify criteria, tools, techniques or methods for developing or evaluating a PEIM. The authors suggest that developing a comprehensive tool based on these findings is critical for evaluating the overall efficiency of PEIM using effective criteria.

Clinical Breast Cancer Registry of IR. Iran (CBCR-IR): Study Protocol and First Results.

BACKGROUND: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country. METHODS: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards. RESULTS: We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients. CONCLUSION: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.

Challanges of Meeting the Palliative Care Needs of Colorectal Cancer patients in Iran: A Qualitative Research.

Background: Despite the high prevalence of Colorectal Cancer (CRC) in Iran and the need to pay more attention to the Palliative Care (PC) needs of patients with this disease, a few studies have previously examined the PC needs of them by gaining the patients', family members', and treatment team's views. This study aimed to investigate the challenges in the way of meeting the PC needs of CRC patients. Materials and Methods: This study was a qualitative content analysis study conducted on 43 participants (including 15 patients, 20 health care providers, and eight family members) through purposive sampling and semi-structured individual interviews in Omid Educational and Medical Center and Iranian Cancer "Control Center (MACSA) in Isfahan from May 2020 to December 2021. Data analysis was performed simultaneously with data collection using conventional qualitative content analysis with the Graneheim and Lundman approach. In order to assess the trustworthiness of the obtained data, credibility, dependability, confirmability, and transferability criteria were used. Results: Data analysis led to the production of 615 primary codes, 16 sub-categories, and five main categories. These five main categories included "Lack of facilities and equipment", "Lack of quality of services provided by the treatment team", "Insufficient financial support to the patient and family", "Insufficient psychological and emotional support from the patient and family", and "Inefficiency of the patient and community awareness process". Conclusions: To improve the quality of care and increase patients' satisfaction with the provided services, it is recommended that policymakers should meet the challenges of the PC.

Competency assessment of the operating room staff and some related factors: A multi-center cross-sectional study.

Background: Operating Rooms (ORs) are complicated environments that necessitate the improvement of OR staff's knowledge and skills to remain clinically competent and secure patient safety. The aim of this study was to assess clinical competence of OR staff in accordance with some related factors. Materials and Methods: This descriptive analytical cross-sectional study was conducted on 227 OR staff in nine academic hospitals. Sampling was performed from the beginning to the end of May 2019 and the samples were selected by quota sampling. Data were collected using a researcher-made questionnaire encompassing six dimensions of competency including general knowledge, specialized knowledge, general practical skills, specific practical skills, personality, and motivation. Data analysis was performed using descriptive and interpretive statistics. Results: The mean (SD) total score of competence was 80.99, which was optimal (11.28). The lowest score was related to the dimension of general practical skills with the mean (SD) score of 53.32 (10.26). The mean score of specialized practical skills was significantly higher in single-specialty ORs (F = 21.53, p < 0.001). Based on multiple linear regression test, it was possible to predict clinical competency through the age and work experience (R-squared = 0.96, beta = 0.31, p = 0.022). Conclusions: Specialized training has overshadowed the general practical skills that are related to the observation of basic principles of patient safety apart from surgical specialization. Strengthening of competence in general practical skills need to be prioritized in empowerment programs. We need a fixed and permanent space for the continuation of educational programs designed to promote perioperative general practical skills.

The needs of colorectal cancer patients/survivors: A narrative review.

BACKGROUND: Identifying and addressing the needs of Colorectal cancer (CRC) patients/survivors' is important to improve patients/survivors' quality of life (QoL) and health. The present study aimed to review studies that have investigated CRC patients/survivors' needs. MATERIALS AND METHODS: In this narrative review, databases including PubMed, Scopus, Web of Science, Iranmedex, ISC, SID, and Magiran were searched during 2011-2021 using keywords included need, CRC, colon cancer, rectal cancer. RESULTS: The findings of the studies showed that the needs of the CRC patients/survivors' can be categorized into the 6 domains including informational, psychological, social, physical, financial, and spiritual needs. CONCLUSIONS: By identifying CRC patients/survivors' needs, healthcare providers particularly nurses can develop and design comprehensive care programs tailored to the needs and priorities of these patients/survivors to improve their QoL and health.

Nurse's Roles in Colorectal Cancer Prevention: A Narrative Review.

The objective of this paper is to investigate the different roles of nurses as members of healthcare teams at the primary, secondary, and tertiary levels of colorectal cancer prevention. The research team conducted a narrative review of studies involving the role of nurses at different levels of colorectal cancer prevention, which included a variety of quantitative, qualitative, and mixed-method studies. We searched PubMed, Scopus, Web of Science, Cochrane Reviews, Magiran, the Scientific Information Database (SID), Noormags, and the Islamic Science Citation (ISC) databases from ab initio until 2021. A total of 117 studies were reviewed. Nurses' roles were classified into three levels of prevention. At the primary level, the most important role related to educating people to prevent cancer and reduce risk factors. At the secondary level, the roles consisted of genetic counseling, stool testing, sigmoidoscopy and colonoscopy, biopsy and screening test follow-ups, and chemotherapy intervention, while at the tertiary level, their roles were made up of pre-and post-operative care to prevent further complications, rehabilitation, and palliative care. Nurses at various levels of prevention care also act as educators, coordinators, performers of screening tests, follow-up, and provision of palliative and end-of-life care. If these roles are not fulfilled at some levels of colorectal cancer, it is generally due to the lack of knowledge and competence of nurses or the lack of instruction and legal support for them. Nurses need sufficient clinical knowledge and experience to perform these roles at all levels.

Development, implementation and evaluation a palliative care program for colorectal cancer patients: a mixed methods protocol study.

INTRODUCTION: Colorectal cancer(CRC) patients are among the incurable groups who need comprehensive palliative care covering all aspects including physical, mental, social, and spiritual. The purpose of this study is to develop, implement, and evaluate a holistic palliative care program for CRC patients in order to improve quality of life of CRC patients. METHODS: This study is an exploratory mixed methods study which will be conducted using a sequential qualitative-quantitative design (QUAL quan) consists of four sequential steps using the approach proposed by Ewles & Sminett to develop the program. In the first phase, a qualitative study (semi-structured interview) will be conducted to discover the needs of CRC patients from the perspective of patients, family members and care providers. In the second phase, the literature review will be performed with the aim of confirming and completing the discovering new needs. In the third phase, in order to prioritize the identified needs and prepare a initial draft of the palliative care program will be done a panel of experts. In the fourth phase, the part of the developed program according to the opinions of the panel of experts, will be implemented as quasi-experimental intervention and the effect of intervention on quality of life will be evaluated. DISCUSSION: This results of this study are expected to meet the needs of CRC patients and their families through providing a holistic care and improve their quality of life in the socio-cultural context of Iran. This program can be useful in providing care, education, policy making and for future research.

The Effect of a Spiritual Care Program on the Self-Esteem of Patients with Cancer: A Quasi-Experimental Study.

Background: Despite the importance of self-esteem in cancer patients and the potential role of spiritual care programs in its promotion, no interventional study was found in this field in Iran. The aim of this study was therefore to investigate the effect of a spiritual care program on the self-esteem of patients with various types of cancer. Materials and Methods: This study was quasi-experimental with two groups using a before and after design which was conducted in 2019 in a selected hospital in Isfahan, Iran. A convenience sample of 64 patients randomly assigned into the experimental (n = 32) and the control group (n = 32). Data collection was conducted through a two-part questionnaire including Demographic characteristics and the Coopersmith Self-Esteem Inventory (SEI). The spiritual care program consisted of six sessions based on four domains including individuals' relationship with God, themselves, others, and with the environment. To analyze the data, Chi-square, Fisher's exact test, independent t test, and paired t test were performed. Results: The total self-esteem mean score and its domains were not significantly different between the two groups before the intervention (p > 0.05). However, after conducting the intervention, the total self-esteem mean score and its domains were significantly higher in the intervention group compared with the control group (p < 0.001). Conclusions: The spiritual care program used in this study was effective in promoting the self-esteem of patients with cancer. It is suggested that similar studies are conducted to provide fertile grounds for using such programs in the oncology clinical area.

Development, Psychometric Testing, and Use of a Disaster Nursing Competency Scale in Iran: A Mixed Methods Study.

Nurses play an important role during disaster response and recovery. Few tools are available to assess the relative competence of nurses in disaster. This study aimed to develop, test, and evaluate a disaster nursing competency scale. This was an exploratory mixed methods study. In the qualitative phase, 35 Iranian nurses and managers with experience in disaster relief were asked about the skills they need to respond effectively to a disaster event. From the qualitative data, a 50-item questionnaire was developed. In the quantitative phase, exploratory factor analysis was conducted with 400 samples followed by a test-retest reliability assessment with 30 nurses. The developed and validated instrument was applied to 200 nurses in Iran to assess their competency. From content analysis of the qualitative data, 5 main themes emerged. In the quantitative phase, exploratory factor analysis loaded 50 items into 4 domains named management, legal and ethical, specific personal, and technical competence. Use of the tool showed that nurses estimated their competence overall at 70.28%. Findings demonstrate the necessity for new domains in disaster nursing competencies; which may be applicable as a useful tool and guideline to improve nursing education and practice.