Effectiveness of Family-oriented Education on Self-care behaviors of Patients with Acute Myocardial Infarction: A Randomized Clinical Trial.

Background: Proper self-care practices play a crucial role in the well being and longevity of patients with cardiovascular disease. To effectively engage in self-care, it is imperative for patients to receive adequate education and training on the self-care process. This study was conducted to determine the effect of family-oriented education (FOE) on the self-care behaviors of patients with acute myocardial infarction (AMI). Methods: In this randomized clinical trial study, 70 patients hospitalized in two hospitals in Shiraz during November 2021-April 2022 participated after the first AMI. Patients were randomly assigned into control (N=35) and intervention groups (N=35) based on random allocation. In the intervention group, an educational program was conducted for patients and active family members during three sessions of 45 to 60 minutes. The control group received routine care. Demographic information form and Self-Care Agency scale was completed by the patients before the educational intervention, one month, and two months after the educational intervention. Data analysis was done through SPSS 22 using Chi-square test, independent t-test, Fisher's exact, and Friedman test. P˂0.05 was considered as the statistical significance level. Results: There was no significant difference in self-care behaviors between the two groups before the intervention (P=0.71). The mean score of self-care behaviors in patients one month (P<0.001) and two months (P<0.001) after FOE in the intervention group showed a statistically significant difference with the control group. Also, the mean score of self-care behaviors two months after the education in the intervention group was significantly higher than before and one month after the intervention (P<0.001). Conclusion: Given the positive effect of FOE on self-care behaviors of patients with AMI, it is recommended that educational interventions related to the treatment plan of these patients with the participation of families should be conducted.Trial Registration Number: IRCT20211116053078N.

Relationship between resilience and death anxiety of the older adults during the coronavirus disease 2019 (COVID-19) pandemic.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19) caused an increase in the incidence of physical and psychological problems, particularly in the older adult. Considering the special physical and mental health conditions of the older adult, they were more exposed to psychological problems associated with the pandemic, such as death anxiety. Therefore, assessing the psychological status of this group is necessary in order to implement appropriate interventions. The present study aimed to investigate the relationship between resilience and death anxiety in the older adult during the COVID-19 pandemic. METHODS: This descriptive-analytical study was conducted on 283 older adult people over the age of 60 years. The older adult population was selected from 11 municipal districts of Shiraz, Iran, using the cluster sampling method. The resilience and death anxiety scales were used for data collection. Data analysis was performed in SPSS version 22, using Chi-square test, t-test, and Pearson's correlation coefficient test. A P-value less than 0.05 was considered statistically significant. RESULTS: The mean and standard deviation of the older adult's resilience and death anxiety scores were 64.16 ± 9.59 and 6.3 ± 2.95, respectively. There was a significant correlation between resilience and death anxiety scores (P < 0.01, r=-0.290). Also, sex (P = 0.00) and employment status (P = 0.00) were significantly associated with the older adult's resilience. Besides, sex (P = 0.010) and employment status (P = 0.004) were significantly related to death anxiety. CONCLUSIONS: Our findings showcase levels of resilience and death anxiety in older adults during the covid-19 pandemic and suggest that resilience and death anxiety are inversely linked. This has implications on policy planning for future major health events.

Vascular outcomes of early deflation of radial artery band following coronary angiography: A controlled clinical trial.

The present study aimed to investigate the effect of early deflation of the transradial (TR) band on the vascular outcomes of patients who have undergone coronary angiography through transradial access (TRA). The present controlled clinical trial included all patients who had undergone elective coronary angiography through TRA. The participants (n=70) met the inclusion criteria and were selected using convenient sampling. Then, they were randomly assigned to the intervention and control groups, using block randomization. Data collection tools included a questionnaire on demographic and related clinical data, including the history of diabetes, hypertension, hypercholesterolemia, heart failure and vascular disease, and the checklist of post-angiographic complications, including duration of the procedure, systolic and diastolic blood pressures measured before and after the procedure, and assessments of radial artery occlusion (RAO), hematoma and pain. The intervention group had their TR band on the artery for 1.5 hours after the procedure. Then, the cuff of the band was deflated at a speed of 5 cc every 15 minutes, using a syringe. However, the TR band was kept in place for 2 hours in the control group, followed by the deflation with the same speed. The pressure application time was recorded in both groups from the removal of sheaths until complete hemostasis. The patients with early deflation of the TR band experienced less pain compared to those with typical deflation (P=0.003). However, the variables of hematoma development (P=0.062) and RAO (P=0.371) were not significantly different between the patients with typical and early deflation of the TR band. The present study concluded that the patients with early deflation of the TR band experienced less pain compared to those with typical deflation. Therefore, deflating the TR band after cardiac angiography at 1,5 hours has similar efficacy and safety compare to 2 hours and associated with less reported pain score.

From disobedience to struggle for adaptation: ​​nursing students' experiences of attending the clinical learning environment during Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic has affected the clinical education of nursing students all over the world. Considering the importance of clinical education and clinical learning environment (CLE) in the education of nursing students, identifying the challenges and problems faced by these students during the covid-19 pandemic helps to plan more effectively in this regard. The aim of this study was to investigate the experiences of nursing students in CLEs during the Covid-19 pandemic. METHODS: A descriptive qualitative research was conducted, which used a purposive sampling technique to recruit 15 undergraduate nursing students from Shiraz University of Medical Sciences between July 2021 and September 2022. Data were collected through in-depth semi-structured interviews. For data analysis, conventional qualitative content analysis based on Graneheim and Lundman approach was used. RESULTS: The data analysis led to emergence of two themes of "disobedience " and "struggle for adaptation". The disobedience theme consists of two categories: "objection to attend CLE" and "patient marginalization". The theme of struggle for adaptation includes two categories: "using support sources" and "applying problem-oriented strategies". CONCLUSION: At the beginning of the pandemic, the students were unfamiliar due to the disease, as well as fear of contracting themselves and infecting others, so they tried not to be in the clinical environment. However, they gradually tried to adapt to the existing conditions by applying support resources and using problem-oriented strategies. Policymakers and educational planners can use the results of this study to plan for solving the challenges of students during future pandemics and improve the condition of CLE.

Facilitators and barriers to collaboration between pre-hospital emergency and emergency department in traffic accidents: a qualitative study.

BACKGROUND: Death caused by traffic accidents is one of the major problems of health systems in low- and middle-income countries. Rapid handover of the traffic accident victims and proper collaboration between the pre-hospital and emergency departments (EDs) play a critical role in improving the treatment process and decreasing the number of accidental deaths. Considering the importance of the collaboration between pre-hospital and emergency departments, this study was designed to investigate the facilitators and barriers of collaboration between pre-hospital and emergency departments in traffic accidents. METHOD: This research is a qualitative study using content analysis. In order to collect data, semi-structured interviews were used. Seventeen subjects (including pre-hospital and emergency department personnel, emergency medicine specialists, and hospital managers) were selected through purposive sampling and were interviewed. After transcribing and reviewing interviews, data analysis was performed with the qualitative content analysis approach. RESULTS: The participants consisted of 17 individuals (15 persons in pre-hospital and emergency departments with at least three years of work experience, one emergency medicine specialist and one hospital manager) who were selected by purposive sampling. The interviews were analyzed and three main categories and seven sub-categories were extracted. The main categories included "individual capabilities", "development of mutual understanding", and "infrastructures and processes". DISCUSSION: Proper and practical planning and policymaking to strengthen facilitators and eliminate barriers to collaborate between pre-hospital and emergency departments are key points in promoting collaboration between these two important sectors of health system and reducing the traffic accident casualties in Iran.

Comparison of the Quality of Life and Depression in the Elderly with and without a History of COVID-19 Infection in Shiraz, Iran.

Background: COVID-19 causes many physical and mental complications. The elderly, as one of the vulnerable groups, were more exposed to the problems caused by this pandemic. The aim of this study was to compare the quality of life and depression in the elderly with and without a history of COVID-19 infection. Method: This is a cross-sectional descriptive study conducted on 404 elderly people (202 from the affected group and 202 from the nonaffected group) aged over 60 years old in Shiraz city. The elderly participants were selected based on simple random sampling from the elderly list. In order to collect information, the quality of life questionnaire of the World Health Organization and Beck's depression questionnaire were used. Data analysis was done through SPSS software version 22 using statistical tests of chi-square, t-test, analysis of variance, and Pearson's correlation coefficient. An alpha level under 0.05 was considered the significant level. Results: The average score of depression in the elderly with a history of COVID-19 (14.66 ± 13.17) was significantly higher than that of the elderly without a history of COVID-19 (9.71 ± 10.12) (p < 0.001). The average score of the quality of life in the elderly with a history of COVID-19 (80.15 ± 14.85) was significantly lower than that of the elderly without a history of COVID-19 (85.25 ± 14.09) (p < 0.001). Conclusion: Elderly people with a history of COVID-19 had more depression and lower quality of life compared to people without a history of COVID-19. It is suggested that planners and health policymakers should pay special attention to the use of effective psychological interventions in order to reduce the problems of the elderly.

Evaluation of the Moral Distress Intensity and Its Relationship with the Quality of Work Life among Nurses Working in Oncology Wards in Shiraz, Southwest of Iran.

Background: Moral distress defined as an incident that prevents the appropriate functioning of individuals in spite of having the required knowledge. Nurses are commonly exposed to moral distress while doing their professional roles, which can influence the quality of their work life. The present study aimed to assess the relationship between the moral distress intensity and work life quality amongst nurses. Methods: In this descriptive-correlational study, 180 nurses working in oncology wards were selected through census based on inclusion criteria (associate or higher degrees, having at least six months of clinical work experience, and not suffering from anxiety disorders). The data were collected using Corley's questionnaire (2001) and Brooks' investigation of work life quality of nurses (2001). Then, the data were entered into the SPSS 22 software and were analyzed using the Independent Sample t-test, One-way ANOVA, and Pearson's correlation coefficient. Results: The nurses' mean scores of moral distress and work life quality were 136.63 ± 27.39 and 133.83 ± 25.40, respectively. The results revealed a negative significant relationship between the nurses' moral distress and work life quality (P < 0.001) (r = -0.53). There was also a significant difference between the nurses' sex and work life quality (P < 0.05). Conclusion: Identifying the moral distress intensity and work life quality of nurses and proper planning from the authorities can improve job satisfaction in nurses and resulting to higher quality of care.

A Study of the Relationship between Professional Communication and Professional Commitment in Operating Room Nurses.

Background: Operating rooms are among the most complex clinical environments in hospitals where teamwork and professional communication play a very important part. Professional commitment is an influential factor in the personnel's professional communication and can affect the outcomes of healthcare services. Objective: The present study aims to investigate the relationship between professional communication and professional commitment in the operating room nurses in teaching hospitals. Study Design. The present study used a descriptive-correlational design. Participants were selected via census sampling from hospitals in Shiraz over a period of three months. The participants were 350 operating room nurses who met the inclusion criteria. Data were collected using professional communication and a professional commitment questionnaire. The collected data were analyzed using the descriptive and inferential statistics in SPSS vv. 22. Findings. The operating room nurses' mean scores for professional communication (136.81 ± 13.77) and professional commitment (71.42 ± 11.62) were found to be high. The results of the Pearson correlation coefficient test showed that there was a statistically significant linear relationship between professional communication and professional commitment (p < 0.001, r = 0.235). The results also showed that there was a significant relationship between professional commitment on the one hand and gender (p=0.042), marital status (p=0.047), and interest in work (p=0/000) on the other hand. There was also a significant relationship between professional communication and interest in work (p=0/000). Conclusion: Given the significance of professional communication and professional commitment in the operating rooms, it is recommended that healthcare administrators and policymakers take steps to improve these areas. It is suggested that measures should be taken to increase the personnel's awareness of the principles of professional communication and the significance of professional commitment through regular workshops.

Comparison of the Effects of Abdominal Massage and Oral Administration of Sweet Almond Oil on Constipation and Quality of Life among Elderly Individuals: A Single-Blind Clinical Trial.

Background: Constipation is a common digestive disorder in the elderly population, which has a considerable impact on various aspects of their lives. Traditional and complementary medicines are two common treatments for constipation. This study was aimed at comparing the effects of abdominal massage and oral administration of sweet almond oil on constipation and quality of life among elderly people. Methods: In this single-blind study, 90 eligible elderly people were randomly selected according to ROME IV diagnostic criteria from October 2020 to May 2021 and were divided into three groups using block randomization (n = 30). In the oral consumption group, 126 ml sweet almond oil was administered during seven sessions held over two weeks (18 ml every other day). The abdominal massage group was provided with abdominal massage with the same amount of sweet almond oil during seven sessions in two weeks. Finally, the third group (i.e., the control group) received no interventions. Constipation was measured using the Constipation Assessment Scale (CAS) and the Bristol Stool Form Scale (BSFS) at baseline and on the 15th day of the intervention. Patient Assessment of Constipation-Quality of Life (PAC-QOL) was also applied before and after the intervention (day 15). The data were entered in to the SPSS 22 software and were analyzed using chi-square t-test, paired t-test, independent t-test, and ANOVA. p ≤ 0.05 was considered statistically significant. Results: The results revealed a significant decrease in the CAS score in the oral consumption group (i.e., oral administration of sweet almond oil; from 7.81 ± 2.62 to 1.15 ± 1.08, p < 0.0003) compared to the abdominal massage group (i.e., abdominal massage; from 8 ± 2.57 to 2.26 ± 1.81, p < 0.0002) and the control group (from 7.73 ± 2.53 to 6 ± 2.74, p < 0.0002). Additionally, the stool consistency score in BSFS was significantly higher in the oral consumption group in comparison to the two other groups (p < 0.0003) before and after the intervention. Furthermore, the quality of life score decreased more significantly in the oral consumption group (from 75.04 ± 7.66 to 28.15 ± 3.30, p < 0.0003) than in the abdominal massage group (from 81.15 ± 5.15 to 43.26 ± 4.13, p < 0.0001) and the control group (from 79.62 ± 4.76 to 62.31 ± 6.40, p < 0.0008). Conclusion: Since the oral administration of sweet almond oil and abdominal massage was highly influential in the participants' constipation scores and quality of life, these cost-effective methods with low complication rates are recommended to be used alongside other treatments in managing constipation among older adults.

The Effect of Using Peer on Self-Care, Quality of Life, and Adherence in Elderly People with Coronary Artery Disease.

INTRODUCTION: Coronary artery disease is one of the most common diseases and the cause of death among elderly people. Due to the chronic nature of this disease, regular follow-up, lifestyle changes, and adherence to recommendations can reduce the complications and improve the quality of life among elderly individuals. Given the importance of using educational methods that are based on the patient's age and disease stage, the present study aimed to investigate the effect of using a peer group on self-care, adherence, and quality of life in elderly people. METHOD: This single-blind clinical trial was conducted on 30 old patients with coronary artery disease aged 60 years in Shiraz from March to June 2021. The patients were selected using simple random sampling and were then randomly assigned to the peer education and control groups (15 participants in each group) via permuted block randomization. The patients in the peer education group received the necessary education about medications, lifestyle, daily activities, self-care, and adherence through three educational clips by educated peer. The patients in the control group received routine education using two clips by the ward nurses. The levels of self-care, adherence, and quality of life were assessed in the intervention and control groups before and one month after the intervention. Data analysis was performed by SPSS 20 software using an independent t-test, paired sample t-test, and chi-square test. P < 0.05 was considered statistically significant. Findings. The results showed no statistically significant difference between the two groups with respect to the mean scores of self-care and quality of life before the intervention (P > 0.05). Following the educational intervention, however, a statistically significant difference was found between the two groups concerning the mean scores of self-care and adherence (P < 0.05). Moreover, the mean differences between the two groups regarding the three variables were statistically significant before and after the intervention (P < 0.05). CONCLUSION: Education based on multimedia clips by peer was effective in increasing the mean scores of self-care, adherence, and quality of life among the elderly people with coronary artery disease. Given the low cost, high effectiveness, and decrease in the nurses' workload, this method is recommended to be used alongside other methods in order to educate elderly individuals suffering from coronary artery disease.

The Effect of Abdominal Massage with Extra-Virgin Olive Oil on Constipation among Elderly Individuals: A Randomized Controlled Clinical Trial.

BACKGROUND: Constipation is one of the most prevalent problems during old age. Abdominal massage is a complementary method in controlling constipation. This study is conducted with the aim of determining the effect of abdominal massage with extra-virgin olive oil on constipation among the elderly. METHODS: In this single-blind randomized controlled clinical trial, 54 old individuals in Shiraz nursing homes during November 2018-March 2019 were selected randomly and then allocated to three groups of 18, based on block randomization. The first group underwent abdominal massage with olive oil for five consecutive days (each day one time for 15 minutes). The second group underwent abdominal massage with water similar to the first group. No specific intervention was applied to the control group. All three groups received their medical treatment. The constipation scores were examined using constipation assessment scale (CAS) before the intervention and on the sixth day. Data analysis was done through SPSS 22 using Chi-square, paired t-test, and ANOVA. P<0.05 was considered as the level of statistical significance. RESULTS: There were no statistically significant differences among the three groups before the intervention. The results demonstrated that the mean score of constipation further decreased in the olive oil group (5.62±1.89 to 2.06±0.99) (P≤0.001) than the massage with water (5.05±1.25 to 3.11±0.99) (P=0.02), and the control group (4.44±1.38 to 5.22±1.35) (P=0.006). CONCLUSION: Due to the greater effectiveness of abdominal massage with extra-virgin olive oil, the use of this method is recommended in treatment of constipation among the elderly. TRIAL REGISTRATION NUMBER: IRCT20180923041101N.

The Relationship between Spiritual Well-Being and Resilience in Patients with Psoriasis.

Psoriasis skin disease affects the patients' health and quality of life to a great extent. Given the chronic nature of the disease, identifying the factors affecting adaptation to the disease can provide guidelines required for helping these patients deal with their problems. This study was conducted with the purpose of investigating the relationship between spiritual well-being and resilience in patients suffering from psoriasis. The present study is a descriptive-analytical work conducted in the largest city in the south of Iran in 2019. 150 patients diagnosed with psoriasis completed Ellison and Paloutzian's Spiritual Well-Being Scale and Connor and Davidson's Resiliency Scale. Data were analyzed using SPSS v. 20, descriptive (frequency distribution, mean, and standard deviation) and inferential statistics (Pearson, regression, and t-test). The significance level was set at 0.05. The obtained mean scores were 54.84 ± 13.25 for resilience and 73.22 ± 11.13 for spiritual health. Spiritual health predicted 43% of the variance of resilience, and all resilience-related factors had a significant positive relationship with spiritual well-being-related factors (P > 0.05). An analysis of the relationship between demographic variables on the one hand and resilience and spiritual well-being on the other indicated that an increase in the patients' academic status, duration of the disease, and age correlated with an increase in their resilience and spiritual well-being. Also, male patients and married patients were found to possess higher levels of resilience and spiritual well-being. According to the findings of the present study, spiritual well-being correlates with resilience in patients with psoriasis. Considering the chronic nature of the disease, it is recommended that more attention be paid to promoting spiritual health in the care plans of these patients.

The Effect of Acupressure on Fasting Blood Glucose and Glycosylated Hemoglobin Levels in Diabetic Patients: A Randomized Controlled Trial.

BACKGROUND: Diabetes is the most common endocrine disorder. Non-pharmacological methods can be used for treatment of these patients. The present study aimed to investigate the effect of acupressure point on fasting blood glucose and glycosylated levels of diabetic patients. METHODS: This clinical trial was conducted on 102 patients who referred to Motahari Clinic of Shiraz during May-June in 2018. The participants were selected based on simple random sampling and divided into three groups via permuted block randomization. The control group only received the pharmacological treatments. The intervention group received acupressure at ST36 point in addition to medications. The placebo group also received medications and acupressure at a fake point. The intervention was carried out for six minutes (three minutes for each lower extremity), three sessions a week for 12 weeks. Fasting blood glucose and glycosylated hemoglobin levels were checked in all patients immediately after the intervention. The data were analyzed using Chi-square, paired t-test, and ANOVA by the SPSS statistical software, version 21, and P<0.05 was considered statistically significant. RESULTS: The results showed no significant differences among the three groups' blood glucose mean levels before (P=0.89) and after the intervention (P=0.36). However, a significant difference was observed in the intervention group's glycosylated hemoglobin mean levels before (8.61±1.96) and after the intervention (8.1±1.62) (P=0.02). CONCLUSION: In sum, the study indicated that acupressure could only be effective in reducing the glycosylated hemoglobin in the intervention group. Thus, further larger studies are recommended to evaluate the effectiveness of this technique. Trial Registration Number: IRCT20111224008505N47.

The Effectiveness of Peer Group-Based Training on the Outcomes of Patients Undergoing Transradial Coronary Angiography.

INTRODUCTION: Coronary artery angiography using radial artery is one of the methods used for diagnosis of coronary artery disease, which causes physical and psychological problems in patients despite its precise and definite diagnosis. The present study is aimed at investigating the effect of peer group-based education on physical and psychological outcomes of patients undergoing coronary artery angiography through the radial artery. Methodology. The present clinical study was conducted on 60 patients undergoing coronary angiography through the radial artery in Vali-e-Asr educational hospital of Fasa during 2018 to 2019. The participants were divided into peer training and control groups (n = 30 in each group) using permutated block randomization. In the peer training group, the patients received the necessary precare training through peer training during and after angiography care. In the control group, the patients received the routine care by the nurse of the related ward. The peer group's stress, anxiety, and depression levels were evaluated before and after the training. Indeed, their comfort, tolerance, satisfaction, and pain levels were measured by a nurse after angiography at the time of entering the ward. Findings. The results indicated no significant difference between the two groups regarding the mean scores of stress, anxiety, and depression before the intervention (p > 0.05). After the intervention, however, there was a significant difference between the two groups concerning the mean score of anxiety (p < 0.05). Nonetheless, no significant difference was found between the two groups in terms of tolerance, comfort, satisfaction, and pain levels (p > 0.05). Finally, the level of pain decreased in both groups over time (p < 0.001). CONCLUSION: Peer group-based training was effective in decreasing the mean score of anxiety in the patients undergoing coronary angiography. Thus, this method is recommended to be utilized alongside other methods to train patients before coronary angiography due to its inexpensiveness and lack of side effects as well as not increasing the nurses' workload.

Efficacy of complementary interventions for management of anxiety in patients undergoing coronary angiography: A rapid systematic review.

Coronary angiography (CAG) is an invasive and anxiety-provoking procedure for many patients. Psychological problems, especially anxiety, are the main concern of nurses taking care of these patients before the procedure. This rapid systematic review aimed to assess the efficacy of interventions for management of anxiety in patients undergoing CAG. In this study, all published, peer-reviewed, English-language interventional studies from 2009 to 2018 were identified in a search of Scopus, PubMed, and Google Scholar databases. The relevant studies were assessed using a quality assessment checklist. All included studies were assessed by 2 researchers. Finally, 15 studies with 1,312 participants that evaluated the effects of complementary methods on management of anxiety in patients undergoing CAG were included. The findings of this rapid systematic review suggested that complementary and nonpharmacological methods, such as music therapy, reflexology, Benson's relaxation technique, aromatherapy, guided imagery, and yoga, could be used effectively for management of anxiety in patients undergoing CAG.

A model to explain self-medication by Iranian people: a qualitative grounded theory study.

BACKGROUND: Self-medication (SM) is a common and global health problem. The process of attempting SM is still unclear. Exploration of SM and its contributing factors would help policymakers design and develop preventive programs. This qualitative study aimed to explore the process of attempting SM among Iranian people. METHODS: This grounded theory (GT) study was conducted among people with the experience of attempting SM (n = 17) and medical staff (n = 9) in Iran selected via semi-structured interviews. The recorded and transcribed interviews were analyzed using open, axial, and selective coding based on Strauss and Corbin's (1998) approach. RESULTS: The study results revealed that people sought to deal as simply and quickly as possible with their illnesses/symptoms according to their attitudes towards and perceptions of illnesses/symptoms as well as their economic and social problems. This simple and quick approach was the participants' main concern, resulting in taking decision-making strategies as SM facilitators. SM, in turn, provided short-term improvement and temporary satisfaction as a predominant outcome. Overall, "to avoid being trapped in the vortex of illness" was the central category, which covered and connected all the other categories developed in this study. CONCLUSIONS: The elements of this model could be used as a guide for healthcare policymakers to design preventive programs and to plan for increasing people's knowledge about the complications and consequences of SM. In addition, identification of barriers to referral to physicians and treatment of illnesses through the right way as well as reducing the health system's problems would help reduce SM.

How do nursing students experience the clinical learning environment and respond to their experiences? A qualitative study.

INTRODUCTION: On entry into the clinical environment, nursing students are confronted with many challenges. It is a common problem throughout the world, including Iran. Although many studies have been conducted on the problems of nursing students in the clinical environment, limited information is available on nursing students' experiences of the clinical learning environment and the way they respond to these experiences. Identifying nursing students' experiences is essential to develop interventions to reduce challenges. OBJECTIVE: This study aimed to explore nursing students' experiences in a clinical learning environment and the way they responded to these experiences. DESIGN: The present study was conducted based on the qualitative research design of the grounded theory methodology. SETTING: This study was conducted at schools of nursing in academic settings in Iran. PARTICIPANTS: The participants included 19 nursing students, 4 nursing instructors and 3 clinical nurses. METHODS: The data were collected using semistructured interviews, field notes and observation, and were analysed using Strauss and Corbin's approach. RESULTS: Students, as a result of the inadequacy of the educational environment, were faced with 'confusion of identity', stating this as their main concern. When confronted with this concern, they employed specific strategies, some of which prevented them from getting into unpleasant conditions. These strategies did not help students solve their problems and also prevented them from accepting their professional roles and responsibilities. Conversely, some other strategies led them to advanced professional development and enabled them to accept their role and the clinical environment. CONCLUSION: According to the results of this study, educational policymakers should focus on improving the clinical environment. Identifying professional models and increasing their influence on management, education and clinical education, as well as teaching positive and constructive strategies, will promote positive strategies in coping with inadequate educational contexts. This is necessary for the professional development of nursing students.

Challenges of Cooperation between the Pre-hospital and In-hospital Emergency services in the handover of victims of road traffic accidents: A Qualitative Study.

OBJECTIVES: To take a deep look at the challenges of cooperation between the pre-hospital and in-hospital emergency services in the handover of victims of road traffic accidents. METHODS: This is a qualitative study and the method used is of content analysis type. Semi-structured interviews were used to collect the data. Through purposive sampling, fifteen employees from ambulance personnel and hospital emergency staff were selected and interviewed. They expressed their experiences of cooperation between these two teams in the handover of traffic accident casualties. The interviews were transcribed verbatim and content analysis method was used to explain and interpret the content of the interviews. RESULTS: Three major categories were derived from the analysis of interviews: Shortage of infrastructure resources (Shortage of equipment, Shortage of physical space, and Shortage of manpower); Inefficient and unscientific management (Shaky accountability, Out-of-date information based activities, Poor motivation, and Manpower low productivity); and Non-common language (Difference in understanding and empathy, and Difference in training and experience). CONCLUSIONS: The obtained results of this study suggest that the careful planning of resources, the promotion of managerial practices as well as empowerment program of the staff, healthcare managers and policymakers can take a pace forward in order to enter into a hearty coordination between these two services for the attention of victims of road traffic accidents.

The efficacy of interventions for back pain in patients after transfemoral coronary angiography: A rapid systematic review.

Coronary angiography is a gold standard tool for diagnosis of coronary artery disease. After this test, patients are restricted in bed to prevent vascular complications. Immobilization and bed rest can cause back pain in these patients. The objective of this rapid systematic review is to assess the efficacy of interventions for reducing back pain after transfemoral coronary angiography. All published, peer-reviewed, English-language interventional studies from 1990 to 2017 were identified in a search of Scopus, PubMed, and CINAHL databases. Relevant studies were surveyed with experimental and quasiexperimental designs that assessed the interventions for reducing back pain after coronary angiography. Data were extracted from studies and assessed. Totally 9 studies with 1062 participants which evaluated the interventions for reducing back pain after coronary angiography were included. The findings of these studies suggest that early ambulation and modified positioning were effective to reduce back pain in patients undergoing coronary angiography. The use of early ambulation 2-4 hours after angiography and changing the patients' position along with modified positioning cause a reduction in the back pain of the patients.

Challenges of Cooperation between the Pre-hospital and In-hospital Emergency services in the handover of victims of road traffic accidents: A Qualitative Study

Objective. To take a deep look at the challenges of cooperation between the pre-hospital and in-hospital emergency services in the handover of victims of road traffic accidents. Methods. This is a qualitative study and the method used is of content analysis type. Semistructured interviews were used to collect the data. Through purposive sampling, fifteen employees from ambulance personnel and hospital emergency staff were selected and interviewed. They expressed their experiences of cooperation between these two teams in the handover of traffic accident casualties. The interviews were transcribed verbatim and content analysis method was used to explain and interpret the content of the interviews. Results. Three major categories were derived from the analysis of interviews: Shortage of infrastructureresources (Shortage of equipment, Shortage of physical space, and Shortage of manpower); Inefficient and unscientific management (Shaky accountability, Out-ofdate information based activities, Poor motivation, and Manpower low productivity); and Non-common language (Difference in understanding and empathy, and Difference in training and experience). Conclusion. The obtained results of this study suggest that the careful planning of resources, the promotion of managerial practices as well as empowerment program of the staff, healthcare managers and policymakers can take a pace forward in order to enter into a hearty coordination between these two services for the attention of victims of road traffic accidents.

Objetivo. Examinar los desafíos para la cooperación entre los servicios de emergencias prehospitalarias y hospitalarias en la entrega de víctimas de accidentes de tránsito. Métodos. Estudio cualitativo con análisis de contenido. Se utilizaron entrevistas semiestructuradas para la recopilación de los datos. Se seleccionaron y entrevistaron quince personas de los equipos de atención prehospitalaria y del servicio de emergencias de un hospital a partir del muestreo intencional. Los participantes expresaron sus experiencias de cooperación entre estos dos grupos en la entrega de víctimas de accidentes de tráfico. Las entrevistas se transcribieron textualmente y se utilizó el análisis de contenido para explicar e interpretar el contenido de las entrevistas. Resultados. Emergieron tres categorías principales: Escasez de recursos de infraestructura (equipos, espacio físico y de personal); Gestión ineficiente y no científica (responsabilidad inestable, actividades basadas en información desactualizada, motivación deficiente, y baja productividad de personal); y Lenguaje no común (diferencia en comprensión y empatía, y diferencia en capacitación y experiencia). Conclusión. Los resultados obtenidos en este estudio muestran dificultades con la planificación de los recursos y la promoción de las prácticas de gestión, así como la necesidad de un programa de empoderamiento del personal. Se deben formular políticas para poder avanzar en el mejoramiento de la coordinación de los servicios en la atención a víctimas de accidentes de tráfico.

Objetivo. Examinar os desafios para a cooperação entre os serviços de emergências pré-hospitalar e hospitalar na entrega de vítimas de acidentes de trânsito. Métodos. Estudo qualitativo com análise de conteúdo. Se utilizaram entrevistas semiestruturadas para a recopilação dos dados. Através da amostra intencional se selecionaram e entrevistaram quinze pessoas das equipes de atenção pré-hospitalar e do serviço de emergências de um hospital. Os participantes expressaram suas experiências de cooperação entre estes dois grupos na entrega de vítimas de acidentes de trânsito. As entrevistas se transcreveram textualmente e se utilizou a análise de conteúdo para explicar e interpretar o conteúdo das entrevistas. Resultados. Emergiram três categorias principais: Escassez de recursos de infraestrutura (equipamentos, espaço físico e de pessoal); Gestão ineficiente e não científica (responsabilidade instável, atividades baseadas em informação desatualizada, motivação deficiente, e baixa produtividade de pessoal); e Linguagem não comum (diferença em compreensão e empatia, e diferença em capacitação e experiência). Conclusão. Os resultados obtidos neste estudo mostram dificuldades com a planificação dos recursos e a promoção das práticas de gestão, assim como a necessidade de um programa de empoderamento do pessoal. Se devem formular políticas para poder avançar no melhoramento da coordenação dos serviços na atenção as vítimas de acidentes de trânsito.