Care needs of adults with spinal trauma in the prehospital and hospital setting from the perspective of patient care team: A qualitative research.

BACKGROUND: Appropriate care of patients with definite spinal cord injury or at risk of it in the prehospital and hospital stages requires comprehensive planning in the health system. It is also the requirement of any successful program to explain the needs from the perspective of its stakeholders. Thus, this study aimed to discover the care needs of adults with spinal trauma in prehospital and hospital settings from the perspective of the patient care team. MATERIALS AND METHODS: This qualitative study was conducted with the participation of urban and rural prehospital emergency personnel and emergency departments of educational and therapeutic hospitals affiliated to Isfahan, Tehran, Shiraz, Kermanshah, Ahvaz, and Yasuj Universities of Medical Sciences, through conducting 36 in-depth semi-structured interviews from September to December 2021. Using purposive sampling method, the participants were selected considering the maximum variation. The data saturation was reached after conducting interviews and group discussions with 36 subjects. Data were analyzed using conventional content analysis approach. Lundman and Graneheim approach were used for the study rigour. Data were simultaneously analyzed using MAXQDA software version 10. RESULT: During the data analysis, two themes of prehospital care with two main categories (emergency care and management of secondary complications of spinal trauma) and hospital care with two main categories (emergency care and management of secondary complications of spinal trauma) emerged. CONCLUSION: Emergency care and management of secondary complications of spinal cord injury in the prehospital and hospital stages can affect treatment results, improve quality of life, and reduce mortality rate, secondary injuries, and healthcare costs. Thus, identification of the care needs of the adults with spinal trauma from the perspective of the patient care team can help the authorities to plan appropriate interventions.

Explanation of the sociological patterns of organ donation: An analytical study.

BACKGROUND: In many countries, the consent of family members is required for organ donation from brain-dead patients who are potential candidates for organ donation. In this regard, knowing the factors affecting family members' decision for organ donation can help improve the conditions. This qualitative study aimed to identify the factors affecting family members' decision-making regarding donation of brain-dead patients' organs. MATERIALS AND METHODS: This research applied qualitative research by focusing on the content analysis approach. The study started from April 2021 in Al-Zahra Hospital in Isfahan and Ayatollah Kashani in Shahrekord and continued until data saturation was reached (September 1401). Participants were assigned to one of three groups: brain-dead patients' family members who consented to organ donation, brain-dead patients' family members who declined to consent to organ donation, and people involved in the organ donation process. The sample was selected using the purposive sampling method. The data were collected using unstructured interviews and the field survey method. In this study, a qualitative content analysis with a contractual approach was used to analyze the data. RESULTS: The analysis of the collected data using different methods yielded 11 main categories, including 1) unresponsive healthcare system, 2) inadequate support from government systems, 3) weakness of social work organizations, 4) fear of being stigmatized, 5) cultural values, 6) symbolization, 7) perpetuation and the society's attitude, 8) development of personality system and generalism, 9) human values, 10) spiritual maturity, and 11) belief-religious challenges, leading finally to three themes, including 1) structural and functional weakness of systems, 2) sociocultural factors, and 3) worldview. CONCLUSION: The findings of the present research were able to identify the roots and social factors affecting Iranian families' decisions regarding the consent or nonconsent of brain-dead patient members. Health system administrators and organ donation committees in medical sciences universities in Iran can try to solve the shortage of donated organs by using the specific social aspects introduced in this study. It is also recommended to design effective models for more satisfaction of family members for brain death patient organ donation in healthcare based on the underlying concepts of this study.

A Critical Ethnographic Study of Families of Brain-Dead Patients: Their Experiences and Attitudes to Organ Donation.

Background: Despite the difficulty of making decisions providing facilitating mediators and removing barriers to making decisions about choosing the right path to donate the organs of brain-dead patients by families can assist in improving the services and help the lives of fellow human beings. This study aimed to explain the decision-making mediator for organ donation in families with brain-dead patients in a cultural context. Materials and Methods: This qualitative study with a critical ethnographic approach was conducted based on Carspecken's stages from August 2021 to March 2022. In this regard, 22 participants were selected through the purposive sampling method and considering the inclusion and exclusion criteria. Sampling was continued until data saturation. After obtaining the required ethical approval, data collection was performed through observation, semi-structured interviews, and document review. All data were recorded and managed using MAXQDA 18 software. Results: Based on the results, the main themes and subthemes of this study included "inefficient decision-making mediator" (the shadow of the socioeconomic situation on the medical status of organ recipients, as well as pessimistic influential individuals, social accountability, dialect difference, and ethnic beliefs) and "efficient decision-making mediator" (social learning, material, and spiritual motivation, mother role, and divine reward). Conclusions: The results of this study, derived from a cultural context, can be applied to carrying out future applied and empirical research. Moreover, they can be used in the field of various nursing roles, especially management, care, and education.

Incidence of cervical collar-related pressure injury in patients with head and neck trauma: A scoping review study.

The use of the cervical collar to support the head and neck is inevitable in many patients with head and spinal cord injuries. One of the consequences of using this instrument is the development of pressure injuries. Therefore, in this review study, the incidence of as well as the risk factors for cervical collar-related pressure injury in this group of patients was evaluated. The current study is a scoping review conducted in 2022. Five scientific databases (PubMed, Scopus, Web of Science, ProQuest, and CINAHL), as well as Google Scholar, were searched for relevant studies published from 1990 to 2022 using the following keywords: trauma, spinal cord injury, head injury, head trauma, collar, cervical collar, cervical immobilization, risk factors, incidence, pressure injury, pressure ulcer, and bed sore. The search was performed independently by two researchers. Articles from the initial search were first recorded in special tables, and then, were reviewed and analyzed separately by two researchers. After extraction, information from each article was entered into a special table categorized by year, country, study design, study population, the incidence of cervical collar-related pressure injury, risk factors for cervical collar-related pressure injury, and grades of pressure injury. Of the 10 articles, 6 were retrospective cohort studies, 3 were cross-sectional descriptive studies, and 1 was a case report study. In terms of the study population, one study was conducted on pediatric patients, one was conducted on elderly patients, and eight were conducted on adults with head and neck trauma. In eight articles, the incidence of cervical collar-related pressure injury was reported. The reported incidence varied between 1.1% and 78.4%. In eight articles, risk factors for cervical collar-related pressure injury were reported. The most common risk factors were duration of cervical collar use, hospitalization in intensive care units, low level of consciousness, and longer hospital stay. The current review study showed that a significant percentage of head and neck trauma patients for whom cervical collar is used suffer from different grades of pressure injuries. Hence, healthcare providers should consider this issue when caring for this group of patients and take the necessary preventive measures in this regard. It should be noted that previous studies in this field had significant limitations, and thereby, it is strongly recommended to conduct further studies with a stronger methodology.

Bereaved Families Views on the Death of Loved Ones Due to COVID 19: An Integrative Review.

Families encounter some issues after the death of their loved one due to COVID-19. Therefore, this study aimed to explore the family's views on the death of their loved one due to COVID-19. This integrative review was conducted from May to Jan 2021. We searched PubMed, Google Scholar, Scopus, Web of Science, CINHAL, Magiran, and SID databases. Fifteen studies met the inclusion criteria. The results were classified into two categories, including before and after death. The issues raised before the death of the loved ones include no visit and absence at death time, fear of being infected with the COVID-19, death anxiety, failure to perform religious rites at death, and psychological problems. The after-death issues were related to funeral, burial, rituals, prolonged grieving, maladaptation, loneliness, and repeated mourning. Therefore, health policymakers should provide support before and after the death of loved ones for families.

Investigating the effect of self-management program on stroke's patients' self-efficacy.

BACKGROUND AND AIM: Stroke patients face various challenges that affect their self-efficacy. The purpose of this study is to evaluate the effect of a self-management program on the self-efficacy of patients with Stroke. METHODS AND MATERIALS: This study is a clinical trial, in which 72 patients with stroke participated in this study. They were selected based on the convenience sampling method and assigned to either intervention or control group (36 patients in each group) randomly. The intervention group received 5A based self-management program for 6 weeks (in-person and off-site) and the control group received only routine care includes stroke training booklets and post-discharge care training by the ward nurse. Data were collected through demographic and jones self-efficacy questionnaires, before, immediately after, and 3 months after interventions in both groups and were analyzed with descriptive and analytical statistics using SPSS software (with independent t-test, Chi-square, Fisher and analysis of variance with repeated measures with a significance level of 0.05). RESULTS: Before interventions, the two study groups had no statistically significant difference regarding demographic variables and the mean score of self-efficacy. Immediately and 3 months after interventions, the mean score and mean changes of self-efficacy score in the intervention group were significantly greater than in the control group(p < 0.001). CONCLUSION: The results of the present study show the appropriate effect of self-management program on self-efficacy of stroke patients. These results can be used by different members of healthcare teams to improve patients' self-efficacy. TRIAL REGISTRATION: This study is registered by Iranian Registry of Clinical Trials with decree code: IRCT20190712044181N2 (registration date: 05-11-2019).

Nurses as Gifted Artists in Caring: An Analysis of Nursing Care Concept.

Background: Nursing care happens with the artistic presence of the nurse in the care setting. Despite its importance in nursing, yet many ambiguities surround its definition and characteristics. The aim of this study was to analyze the concept of nursing care. Materials and Methods: This concept analysis was conducted using Walker and Avant's approach. An extensive literature search was done in the Medline, CINAHL, Embase and SID databases to find articles published in English between 1988 and 2019. The search keywords were "care", "nursing care", "concept", "concept analysis", and similar words. According to Walker and Avant's approach, after selecting the concept and determining the aim of analysis, 3742 references were reviewed and 68 articles and 2 books were selected to determine and extract the defining attributes, antecedents, consequences, and empirical referents of the nursing care concept. Results: The three main defining attributes of the concept were relationship, compassion, and professional action. The antecedents were nurse-related, client-related and environment-related, and the consequences were for nurses, clients and community. Conclusions: The defining attributes, antecedents, and consequences determined in the present study help better understand the concept of nursing care. This study highlights the importance of the communicative, caring, and advocacy roles of nurses and their compassionate professional action in the promotion of individual and community health.

Comparison of two new educational techniques on knowledge of nurses about cerebrovascular accident nursing care in emergency department.

BACKGROUND: One of the important challenges faced by health-care system is to raise the level of knowledge of nurses about cerebrovascular accident (CVA) nursing care in the emergency department. Therefore, the aim of this study was comparison of two new educational techniques (noninteractive multimedia learning and workshop) on knowledge of nurses about CVA nursing care in the emergency department. MATERIALS AND METHODS: This experimental study was conducted with a two-group design. Sixty-four eligible nurses working in the emergency department in selected hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, were selected as the study participants. Nurses were randomly assigned into two groups of noninteractive multimedia (n = 32) and workshop (n = 32) using random number table. The data-gathering tools including a demographic questionnaire (6 items) and knowledge questionnaire (24 items) were completed before and 2 weeks after the intervention in both the groups. Data were analyzed using SPSS 18 and descriptive (mean and standard deviation) and analytical statistics (ANOVA, independent t-test, and paired t-test). The level of statistical significance was P ≤ 0.05. RESULTS: The result shows that independent t-test showed that there was not a significant difference between the mean total scores of nurses' knowledge before intervention in the two groups (P > 0/05). Furthermore, the results of paired t-test showed a significant difference in the knowledge score 2 weeks after compared to before the education in both the groups (P < 0.005). In addition, the results of independent t-test showed a significant difference in the knowledge score 2 weeks after the intervention in the two groups (P < 0.005). The average knowledge score in the workshop group was significantly higher than in noninteractive multimedia learning group. CONCLUSION: According to the result, new educational techniques such as noninteractive multimedia learning and workshop could improve knowledge of nurses about CVA nursing care in the emergency department.

Lived Experiences of COVID-19 Patients With Pulmonary Involvement: A Hermeneutic Phenomenology.

The aim of this study was to explore the lived experience of COVID-19 patients with pulmonary involvement. The hermeneutic phenomenology was chosen, as this approach can extract the participant experiences as COVID-19 patients. A total of 10 COVID-19 patients with the pulmonary disease were selected as participants after being discharged from the hospital by purposive sampling method until reaching saturation. Data were collected using semi-structured interviews and by using Greatrex-White and van Manen's methods were analyzed. As a result of data analysis, five main themes were emerged: Symptoms of inducing fear, Annoying loneliness, death anxiety, Spirituality healing factor, and Valuable life again. Based on the results of the interviews, the participants' experiences showed that patients infected with COVID-19, after being discharged from the hospital, due to mental and physical problems experienced during hospitalization, need comprehensive attention and care to regain their health during convalescence.

Lived Experiences of Critically Ill COVID-19 Patients About Death and Dying: A Descriptive Phenomenology.

Thinking about death is one of the most common problems of critically ill patients with COVID-19 in ICUs. Therefore, this study aims to explore the experiences of critically ill patients with COVID-19 about death and dying. This is a descriptive phenomenology approach. Participants in this study had 12 participants who were purposefully selected. The data collection method was semi-structured through interviews. Data were analyzed based on Colaizzi's approach. Data analysis generated two main themes, including personal, and non-personal; challenge thinking about death, and eight sub-themes. Thinking about the death of critically ill COVID-19 patients is a significant challenge that affects the patient's health and prolongs the treatment process. Therefore, it should be careful in the patient's treatment and care program.

Transcultural adaptation and validation of the Persian version of the Brief Emotional Intelligence Scale.

BACKGROUND: Increasing the level of emotional intelligence (EI) is seen as a strategy for improving both relational quality and efficiency at work. As of today, there was no validated Persian brief instrument for evaluating EI. To fill this gap, this article was aimed to investigate the validity and reliability of the Persian version of the Brief Emotional Intelligence Scale (BEIS-10). MATERIALS AND METHODS: A methodological cross-sectional study was conducted among 201 Persian-speaking individuals. These individuals were selected from different parts of Iran using the convenience sampling method. Translation of the BEIS-10 was conducted by employed forward-backward method. Internal consistency was evaluated by Cronbach's α, and for test-retest reliability, the intraclass correlation coefficient (ICC) was employed. The construct validity was investigated by confirmatory factor analysis (CFA). RESULTS: The Persian version of BEIS-10 indicates a good test-retest reliability (ICC = 0.612, 95% confidence interval: 0.384 and 0.769) as well as internal consistency (Cronbach's alpha = 0.748, ranging from 0.359 to 0.868 for different domains). The construct validity was evaluated by CFA and five factors from ten items were confirmed and all goodness-of-fit-indices were in acceptable levels. CONCLUSION: The article concludes that the Persian version of BEIS-10 in five factors from ten items was a reliable and valid instrument for measuring EI in the general population. As well, the article was suggesting that the Persian version of BEIS-10 may stand as a suitable alternative to time-consuming tools for EI measurement since this scale appears to be time-saving and applicable to Iranian society.

The Lived Experience of Nurses Caring for Patients with COVID-19 in Iran: A Phenomenological Study.

OBJECTIVE: This study aimed to explore the lived experiences of nurses caring for patients with COVID-19 in Iran. METHODS: This study was a descriptive phenomenology. Sampling was purposefully performed, and participants were selected in terms of the inclusion criteria. Data were collected through semi-structured interviews using the WhatsApp mobile messaging application. Colaizzi's method was used to analyse the data. The criteria introduced by Lincoln and Guba were used for the study rigour. RESULTS: The data were obtained from 12 nurses caring for patients with COVID-19. The mean age of the participants was 29.41 years (SD = 2.72) with a mean work experience of 6.75 years (SD = 2.52). Three main themes and six subthemes were identified: mental condition (subthemes included "anxiety and stress" and "fear"), emotional condition (subthemes included "suffering and affliction" and "waiting for death"), and care context (subthemes included "turmoil" and "lack of support and equipment"). CONCLUSION: The results of this study show that nurses working in the wards and care centres designated for patients with COVID-19 are experiencing mental and emotional distress and are working in inadequate professional conditions.

Clinical Guideline for Nursing Care of Children with Head Trauma (HT): Study Protocol for a Sequential Exploratory Mixed-Method Study.

BACKGROUND: Head trauma is a major health problem. Its primary complications happen at the time of trauma and are inevitable; thus, head trauma management is focused on the prevention and management of secondary complications. A clear clinical guideline for head trauma care can help nurses effectively prevent and manage secondary complications. This study aims to develop the clinical guideline for nursing care of children under 18 years with head trauma hospitalized in emergency departments, critical care units, and neurosurgery wards. METHODS: This sequential exploratory mixed-method study will be conducted in three main phases as follows: qualitative, systematic review, and integration phases. In the qualitative phase, semi-structured interviews will be conducted to determine the care-related needs of children with head trauma. In the systematic review phase, a systematic review will be performed to find and then to review the most relevant articles, books, and the appropriate clinical guidelines. The quality of the retrieved guidelines will be assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. In the integration phase, the findings of the qualitative and systematic review phases were integrated, the draft of the guideline will be prepared, which will then be revised and validated through a nationwide Delphi survey. DISCUSSION: The guideline for nursing care of children with head trauma can help to more effectively prevent, reduce, and manage the secondary complications of head trauma. Moreover, it reduces disability and mortality rates, improves nursing care quality, decreases healthcare costs, shortens hospital stay, and makes more rational clinical decisions.

Empowerment of Nurses: A Key to Stroke Patients' Satisfactions.

BACKGROUND: Stroke is a major cause of disability around the world. Different studies have shown the inadequate knowledge and skills of nurses to educate and manage stroke patients. Therefore, stroke patients are facing many challenges in their lifetime. In this study, we investigated the effects of nursing empowerment on stroke patients' satisfaction. MATERIALS AND METHODS: This cross-sectional study is the fifth stage (evaluation phase) of action research study that was conducted on 29 stroke patients from Alzahra hospital, Isfahan, Iran, during 2013-2014. Workshops, pamphlets, and booklets were used for nursing empowerment. The stroke patients have been trained by empowered nurses. The data gathering tool that was the researcher-made survey questionnaire included the characteristics of patients, participants' satisfaction with self-care training and nurses' performances. T-test was used for the analysis of the obtained data. RESULTS: Twenty-seven (93.10%) cases mentioned that "they would try to follow all the received trainings". Twenty-three (73.10%) cases were satisfied with self-care training. Majority of patients, 25 (85%) participants were satisfied with the training performances by the empowered nurses and 24 (82.80%) cases were highly satisfied with the nurses' training method. CONCLUSIONS: Most patients were satisfied with the self-care training held by the nurses. Based on the obtained data by questionnaires, the nurses' performance and their training methods were directly associated with a high satisfaction level in stroke patients. Therefore, improving the skills and knowledge of nurses could be a potential approach for increasing the satisfaction levels among stroke patients.

Laying the Foundations of Lifelong Health at the Beginning of Life: Islamic Perspective.

In this systematic literature review, all the Shiite-Islamic documents (Quran and Hadith) without any time limitation were surveyed, analyzed and synthesized for the purpose of determining the foundations of lifelong health. The data were analyzed and combined using inductive qualitative content analysis method. Two main categories were emerged from the analysis: "prevention of health problems" and "health maintenance and promotion." In conclusion based on Islamic perspective, the foundations of comprehensive health of a person, i.e., health in all physical, mental, social, and spiritual dimensions, are begun to form at four stages: the time of marriage of his parents, the moment of their conception, when he is unborn in his mother womb, and during infancy period. Observing religion instructions in this regard is not the sufficient condition for being completely healthy; however, such instructions can provide a base for being a healthy person.

Effects of religious and spiritual care on burn patients' pain intensity and satisfaction with pain control during dressing changes.

OBJECTIVE: Spiritual care, beside other nursing interventions, creates a balance in body, psyche and soul in order to holistically recover one's health. This research aims to study the effects of a religious and spiritual care program on the intensity of pain and the satisfaction with pain control during the dressing changes for the burn patients in a hospital in Iran in 2017. METHODS: This research is a clinical trial study conducting 68 burn patients. The samples were randomly divided into 'experimental' and 'control' groups. The experiment consists of three sessions of spiritual care carried out by the help of the nurse, a clergy and the patient's companion. These sessions have been done before, during and after the dressing change. The pain intensity and the satisfaction with pain control are measured by VAS1 and NRS2 devices. The data is analyzed via SPSS version 20 and through the statistical exams of independent t-test, paired t-test, chi-squared test and Mann-Whitney exam. RESULTS: Before the intervention, there was no significant difference in the average rate of pain (P = 0.25) and the satisfaction with pain control (P = 0.59) between the experimental and the control groups. While, after the spiritual care program was conducted, there appeared a significant difference (P < 0.001): there was a substantial reduction of pain intensity in the experimental group and the satisfaction with pain control in this group increased as well. CONCLUSIONS: A religious and spiritual care can help decrease the pain intensity caused by the dressing change and can increase the satisfaction of these patients with pain control. Therefore, it is recommended that the nurses apply the spiritual cares to alleviate the pain and to increase the satisfaction with pain control in burn patients.

Exploring the reasons for theory-practice gap in emergency nursing education: A qualitative research.

BACKGROUND: Nursing is a scientific profession, based on theory and art of care. However, the theory-practice gap has become the biggest challenge of this profession and decreases the quality of service both in teaching and practice. Thus, it seems necessary to search for these reasons in situations such as emergency department - which has an effective role in patients' health. OBJECTIVES: The objectives of this study were to find the perceived reasons for the theory-practice gap in the process of emergency nursing education from the perspective of professors, nurses, and students, as well as doctors, since they cooperate with nurses and students in the training environment. METHODS: A qualitative study was carried out; this included 18 deep, semi-structured interviews in 7 months with the people involved in the process of emergency department apprenticeship alongside with observing the activities of stakeholders. The data analysis was done in accordance with content analysis method including three steps of preparation, organization, and reporting. RESULTS: The perceived reasons for theory-practice gap were classified into 13 secondary categories. At the end of data analysis, five main categories of student, instructor, environment, culture, and the organizational process, and finally, two themes of "input" and "process" emerged. CONCLUSIONS: Nursing students in emergency department face a number of challenges in implementing theory into practice which stems from the faculty as an academic environment and the hospital as an educational environment. These underpinning reasons for the theory-practice gap influence the quality of nursing education and care delivery in emergency department. Hence, decreasing the theory-practice gap lies in the amendment of any of these factors.

Bridging the theory-practice gap in Iranian emergency nursing education.

BACKGROUND: The theory-practice gap is one of the important challenges of treatment, health, and educational systems. It is affected by different factors like students, teachers, and the clinical environment. This gap has consequences for education, as well as the treatment and health services systems. Thus, it is necessary to find effective strategies to reduce it. Therefore, the present study was conducted with the aim to find strategies to reduce the theory-practice gap in emergency nursing education in the view of stakeholders. METHODS: A qualitative research was conducted, including 18 semi-structured interviews and 3 focus group sessions with the stakeholders in a school of nursing and an educational hospital. Content analysis method was used to analyze the collected data. RESULTS: The strategies to reduce the theory-practice gap in emergency nursing education were divided into 6 primary categories, 2 main categories and 1 theme of action to change. From among the 69 strategies presented to the focus groups, the participants acknowledged 28 strategies as practical and effective. Furthermore, the participants held that it was necessary to have reformative and developmental actions in line with care, supervision, evaluation, and educational processes in order to reduce the gap between theory and practice in emergency nursing education. CONCLUSION: The theory-practice gap is affected by many different factors. Thus, the people involved must pay attention to every influential factor in order to reduce the consequences, and use effective cooperative strategies by taking into consideration the human resources, infrastructures, processes, and the administrative culture in faculty and clinical environments.

Association between Outcome of Severe Traumatic Brain Injury and Demographic, Clinical, Injury-related Variables of Patients.

BACKGROUND: Traumatic brain injury (TBI) is a main health problem among communities. There exists a variety of effective factors on the outcome of patients with TBI. We describe the demographic, clinical, and injury related variables of the patients with severe TBI, and determine the predictors of outcome. MATERIALS AND METHODS: We did this cross-sectional study on all 267 adult patients with severe TBI admitted to three trauma centers of Isfahan University of Medical Sciences (IUMS) from March 20, 2014 to March 19, 2015. Data were extracted from patients' profiles. We considered the patients' outcome as discharged and died. We analyzed the collected data using descriptive (frequency, mean, and standard deviation) and analytical (independent t-test, Mann-Whitney U-test, Kruskal-Wallis test and logistic regression) statistics in Statistical Package for the Social Sciences (SPSS) 16.0. We considered p < 0.05 as the significance level. RESULTS: The mean (SD) age of patients was 43.86 (18.40) years. The majority of the population was men (87.27%). Road traffic accidents (RTAs) were the most common mechanism of trauma (79.40%). The mean (SD) of Glasgow coma scale (GCS) was 6.03 (3.11). In 50.19% of the patients, the pupillary reflex was absent. One hundred and twenty-four patients (46.44%) died before discharge. We found age, gender, GCS, pupillary reflex, hypernatremia, and increased intracranial pressure (IICP) as the predictors of death in severe TBI. CONCLUSIONS: In this study, the mortality rate of patients with severe TBI was high. In addition, some factors were determined as the significant predictors of outcome. The findings can assist in planning to enhance the quality of care and reduce the mortality rate in the patients with severe TBI.

Empowering Nurses in Providing Palliative Care to Cancer Patients: Action Research Study.

BACKGROUND: Chronic diseases such as cancer would lead to various health needs in patients and their families. To meet needs, developing new educational nursing courses is necessary. Therefore this study was conducted to empower nurses through designing and conducting short-term educational courses for training palliative care nurses. MATERIALS AND METHODS: This study was a community-based action research which was conducted at Isfahan hospitals that provide services for cancer patients during 2015 at four stages (planning, acting, reflection, and evaluation). Participants (33 samples) included nurses, head nurses, managers of nursing services, nursing professors and professors of oncology department. Data were gathered through individual and group interviews and analyzed using content analysis. RESULTS: Data analysis resulted in 3 categories of "professional development of nursing in palliative care" which included subcategories of: knowledge-based performance and positive change in attitude, "obstacles to provide palliative care" with subcategories of: insufficient professional responsibility, insufficient ability in managing some of patients' symptoms and inappropriate interaction between nurses and physicians and "strategies for improving provision of palliative care" with subcategories of: improving the interactions between physicians and nurses, continuous trainings for palliative care and the necessity of developing palliative care in the country. CONCLUSIONS: To facilitate the process of providing palliative care to cancer patients, necessary actions and measures must be conducted including improvement of interaction between the members of health team, organizing continuing educational courses on palliative care and development of providing palliative care all over the country by managers of health centers.