The correlation between caregiver burden with depression and quality of life among informal caregivers of hemodialysis and thalassemia patients during the COVID-19 pandemic: a cross-sectional study.

BACKGROUND: Lifelong provision of care to chronically ill patients increase the risk of physical and mental diseases in informal caregivers and adversely affects their quality of life. The present study examined the correlation between caregiver burden, depression, and quality of life among the informal caregivers of thalassemia and hemodialysis patients during the COVID-19 pandemic in southeastern Iran. METHODS: This cross-sectional correlational study used convenience sampling to select 200 informal caregivers involved in providing direct care for patients undergoing hemodialysis (n = 70) and patients with thalassemia (130) for at least 6 months. A demographic questionnaire, Beck's Depression Inventory (BDI), the Quality-Of-Life Questionnaire (SF-36), and the Zarit Burden Interview were used to collect data in 2021. The data were analyzed with SPSS software (version 19) using frequency, percentage, independent samples t-test, ANOVA, and multivariate regression analysis. RESULTS: Most of the informal caregivers of the thalassemia and hemodialysis patients (58% and 43%) reported moderate levels of caregiver burden. There were significant correlations between the caregiver burden and depression (P < 0.0001) and between the caregiver burden and the quality of life (P < 0.009). The level of depression in informal caregivers of patients undergoing hemodialysis was higher than that of the informal caregivers of patients with thalassemia, but the quality of life in the informal caregivers of the patient's undergoing hemodialysis was higher than that of the informal caregivers of the patients with thalassemia. CONCLUSION: Considering the significant correlations between caregiver burden, depression, and quality of life in this study, healthcare providers are recommended to develop educational and supportive interventions to meet informal caregivers' needs, mitigate their emotional distress, fears, and concerns, and prevent caregiver burden in times of greater uncertainty.

Comparison of music and vapocoolant spray in reducing the pain of venous cannulation in children age 6-12: a randomized clinical trial.

BACKGROUND: Venous cannulation is among the most stressful and painful experiences of children hospitalization. Children with thalassemia need regular blood transfusion which needs venous access each time. The quality of care and quality of life of children will be improved if appropriate methods are used to reduce pain. This study aimed to compare vapocoolant spray and music in the reduction of pain of Venous cannulation in children with thalassemia. METHODS: The study was a randomized controlled clinical trial with a cross-over design. Thirty-six children with thalassemia from Thalassemia Patients of Pasteur Hospital in Bam from October to December 2020 and were recruited and randomly allocated to two arms. The pain of venous cannulation (no treatment) was measured in the first blood transfusion session as control. In the second and third sessions, two arms received music and vapocoolant spray before the venous cannulation with a cross-over design. The intensity of pain was measured by a Visual Analogue Scale (VAS). The change in pain scores was tested by ANOVA and Tukey post-hoc test between three measurements. RESULTS: During and after the cannulation, the pain was significantly lower in the vapocoolant measurement than in control and music (p < 0.05). There was a significant effect of vapocoolant spray during the procedure F (2, 90) = 25.604, p = 0.001. Also, there was a significant effect of vapocoolant spray after the procedure F (2, 90) = 10.087, p = 0.004). Music did not reduce the pain during cannulation (p = 0.413) and after that (p = 0.807) significantly when compared with control. CONCLUSIONS: Vapocoolant was an effective method of pain reduction in the reduction of venous cannulation pain. Music was not effective in the reduction of venous cannulation pain when we compared it with controls. The pain of venous cannulation is rated as high and it can have negative effects on the children. There is a need to do more research on the methods of pain reduction of venous cannulation. TRIAL REGISTRATION: The trial is registered: IRCT20111019007844N13, 13/03/2020. Available at: https://en.irct.ir/trial/42904 .

Knowledge and attitude toward professional ethics: A study among Iranian medical and nursing students'.

BACKGROUND: Professional ethics is a set of principles and standards of human behavior that affect individual behavior and leads to improve care that provided by medical staff. The present study examined the knowledge and attitude of medical and nursing students toward professional ethics in Iran. MATERIALS AND METHODS: This descriptive-analytic study was carried out on 176 medical and nursing students in Bam University of Medical Science, Iran in 2019. In this study, students were selected by census sampling. Data collected using two researcher-made questionnaires related to knowledge and attitude toward professional ethics. Data were analyzed in SPSS software. RESULTS: The mean scores of knowledge among nursing and medical students were 86.56 (8.76) and 85.10 (12.19), respectively. The mean score of attitude among nursing and medical students was 127.06 (12.45) and 129.9 (11.88), respectively. Results of the Pearson correlation test showed a positive and significant associated between the score of knowledge and attitude nursing and medical students' (P < 0.001), (r = 0.76) (r = 0.66). Among the demographics characteristics, student age was associated to their attitude and knowledge significantly (P = 0.03). CONCLUSION: Iranian nursing and medical students have a positive attitude and a high level of knowledge about professional ethics. A high level of knowledge was related to the most positive attitude.

How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit?

BACKGROUND: Patients hospitalized in intensive care units are susceptible to chronic malnutrition from changes in protein and energy metabolism in response to trauma. Therefore, nutritional support, especially enteral nutrition, is one of the most important treatment measures for these patients. However, there are several barriers in the hospitals in treating patients with enteral nutrition. This study was performed to compare the perceptions of care providers (physicians and nurses) on the barriers to enteral nutrition in intensive care units. METHODS: This was a cross-sectional descriptive and analytic study. This study included 263 nurses and 104 physicians in the intensive care units of Kerman University of Medical sciences, in south east of Iran. A questionnaire of enteral nutrition barriers in intensive care units was used. IBM SPSS ver. 19 was used to analyze data. RESULTS: There was a significant difference between the two groups in the three subscales of intensive care units (P=0.034), dietician support (P<0.001) and critical care provider attitudes and behavior (P=0.031). There was also a significant difference between having completed educational courses and the score of enteral nutrition barriers in the two groups (P<0.05); the people who received an educational course had a better perception of enteral nutrition barriers. CONCLUSIONS: Physicians and nurses agreed with the perception of enteral nutrition barriers, but there was a difference in their perception on some barriers. Strategies such as in-service training and increasing the knowledge and skills of physicians and nurses can reduce these differences.

The effect of foot massage on the level of consciousness and delirium of intensive care patients: A randomized single-blind controlled trial.

INTRODUCTION: Depressed level of consciousness and delirium are associated with multiple complications in cognitive, perceptual and sensory functions in the patients of the intensive care units. The present study aimed to determine the effect of foot massage by a nurse and patient's family on the level of consciousness and delirium in patients admitted to the intensive care units (ICU). METHODS: This was a randomized parallel single-blind controlled trial. Seventy-five ICU were assigned in three groups (massage by a nurse, massage by patient's family and control group) by stratified block randomization method. Both feet were massaged with Swedish massage (10 min) once a day for six days by a nurse or patient's family. Delirium and level of consciousness was measured before, and post-intervention. RESULTS: The mean level of consciousness in all the three groups increased significantly one-week post-intervention. However, there was no significant difference in the level of consciousness among the three groups during the study. The frequency of delirium in the massage group by the family was 20% before the intervention, which decreased to 12% after intervention. In the massage group by a nurse and control group, 16% of the samples had delirium before the intervention. After the intervention, the prevalence of delirium was 8% in the massage group by a nurse, and it decreased to 12% in the control group, none of which was statistically significant. CONCLUSION: The use of Swedish foot massage did not change the level of consciousness and delirium of patients admitted to the ICU.

Iranian Nurses Perception and Practices for Delirium Assessment in Intensive Care Units.

INTRODUCTION: Delirium is a fluctuating cognitive disorder that occurs in admitted patients, especially in patients who are in intensive care units. Nurses due to persistent contact with patients and direct observation of their mental changes play an essential role in delirium evaluation. Early detection of delirium, identification of risk factors, and its prevention methods are critical to reducing complications, mortality, and treatment costs. This study aimed to determine the perception and the practices of nurses in intensive care units to assess delirium and its barriers. STUDY DESIGN: A cross-sectional study. MATERIALS AND METHODS: All nurses working in the intensive care unit (neurology, trauma, surgery, general, and heart) of educational hospitals in Kerman, Iran, were the study population. The data gathering tool was a questionnaire consisting of four sections: demographic information, nurses' perception, practices, and perceived barriers in delirium assessment. RESULTS: The total score of nurses' perception in delirium assessment was 19.47 ± 3.36, which was higher than the medium score of the questionnaire (estimated score = 16). In all, 45.5% of nurses reported having delirium treatment protocol in their units, and 12.1% of the nurses considered delirium as a priority of evaluating the patient's condition. The most important barrier to delirium assessment was the difficulty of assessing delirium in intubated patients. There was no association between nurses' perception and practices (p value > 0.05). CONCLUSION: Designing and implementing educational programs for improving nurses' practices in this field is necessary. CLINICAL SIGNIFICANCE: Healthcare providers, especially nurses, should be aware of the delirium assessment of the ICU patients to provide better care. HOW TO CITE THIS ARTICLE: Biyabanaki F, Arab M, Dehghan M. Iranian Nurses Perception and Practices for Delirium Assessment in Intensive Care Units. Indian J Crit Care Med 2020;24(10):955-959.

Assessment of Leg Massage on Hemodynamic Parameters of Intensive Care Patients: A Parallel Single-Blinded Randomized Controlled Trial.

OBJECTIVE: We aimed to determine the effectiveness of leg massage by a nurse and patients' families on hemodynamic parameters in patients admitted to intensive care units. METHODS: This parallel single-blinded randomized clinical trial involved 75 patients admitted to the intensive care units at Shahid Bahonar Hospital in Kerman, Iran. Patients were assigned to 3 groups by the minimization method (massage by a nurse, massage by the patient's family, and the control group). Swedish massage was used on both legs (each leg for 5 minutes) once a day for 6 days, and the hemodynamic parameters of patients were measured before intervention, at the end of intervention, and 1 week later. RESULTS: The results showed that mean arterial pressure decreased in all 3 groups 1 week after intervention, which was not statistically significant. Mean heart rate also decreased in all 3 groups 1 week after intervention, which was statistically significant except for massage by family. Mean arterial oxygen saturation significantly decreased in all 3 groups 1 week after intervention but remained normal. The 3 hemodynamic parameters did not differ significantly among the 3 groups. CONCLUSION: According to the results of this study, the use of massage has no effect on hemodynamic parameters.

Factors associated with caregiver burden for mothers of children undergoing Acute Lymphocytic Leukemia (ALL) treatment.

OBJECTIVE: The present study examined the extent to which social support (SS) availability and satisfaction could predict the extent of caregiver burden (CB) among mothers of children with Acute Lymphocytic Leukemia (ALL). METHOD: The study was a cross-sectional, descriptive-correlative study. It was conducted on a sample of 117 mothers whose children were undergoing treatment in a public hospital in Bam, Iran. The Norbeck Social Support Scale and the Caregiver Burden Scale were used to measuring study variables. The data were analyzed using Pearson's correlations, t-tests, ANOVAs, and linear regressions. RESULTS: Significant correlations were observed between CB and SS availability (r = -0.499, p < 0.001), SS satisfaction (r = -0.543, p < 0.001), the age of the child with cancer (r = -0.22, p = 0.01), and duration of treatment (r = 0.336, p < 0.001). Married mothers experienced less CB than those that were widowed or divorced. Within the regression equation, SS satisfaction, SS availability, marital status, and duration of treatment were the predictors of CB. SIGNIFICANCE OF RESULTS: Based on the results of the current study, mothers who have less SS, especially those who are single mothers, with younger children, and who have taken care of their child for an extended duration should be given special attention. Furthermore, it appears that there are distinct cultural variations amongst Iranian mothers which suggest that culture may impact upon SS availability. Results also suggest a need for interventions that enhance nurses' ability to provide support to caregivers and the broader family unit as a whole. Nurses in cancer care need to have psychological competencies to help family members of cancer patients especially mothers and more so those that are single mothers. As integral members of the patient care experience, nurses may be uniquely positioned to provide this needed psychosocial support.

Increased Circulating T Follicular Helper Cells in Iranian Children with Type I Diabetes.

 Type 1 diabetes (T1D) is an autoimmune disease resulting from the damage of pancreatic B-cells mediated by autoreactive CD4+ and CD8+ T cells. In recent years, follicular T helper (Tfh) cells have been recognized as a subpopulation of CD4+ T cells providing help for B cells differentiation and antibody production. In this study, we examined the frequency of circulating CD4+CXCR5+ and CD4+CXCR5+ICOS+ (representing Tfh) cells as well as serum levels of anti-glutamic acid decarboxylase 65 (GAD65) and islet cell autoantibodies (ICA) in children with type I diabetes. We analyzed the percentage of Tfh cells within peripheral blood mononuclear cells in 20 children with T1D (≤300 days from disease onset; Mean age 6.8±4.6 years) and 18 healthy individuals (Mean age 8.8±2.2 years) using flow cytometry. Anti-glutamic acid decarboxylase (GAD) and islet-cell cytoplasmic autoantibodies (ICA) levels were determined by ELISA and indirect immunofluorescence respectively. We found that the frequency of CD4+CXCR5+ and CD4+CXCR5+ICOS+ (Tfh) cells were significantly increased in the peripheral blood of patients compared with healthy controls (p<0.001). Furthermore, elevated levels of anti-GAD and ICA antibodies were detected in children with T1D (p=0.001 and p=0.02 respectively). There was no correlation between Tfh cells frequency and the autoantibody levels. The results of our study indicate an increased frequency of Tfh cells in children With T1D that could suggest a possible role of these cells in the disease pathogenesis.

Nurses' requirements for relief and casualty support in disasters: a qualitative study.

BACKGROUND: Nurses are among the most important groups engaged in casualty support, regardless of the cause, and they are one of the largest care groups involved in disasters. Consequently, these workers should gain proper support and skills to enable effective, timely, responsible and ethical emergency responses. OBJECTIVES: In this study, we investigated the needs of nurses for proper casualty support in disasters, to facilitate better planning for disaster management. MATERIALS AND METHODS: This was a qualitative content analysis study. Interviews were performed with 23 nurses, at educational hospitals and the Faculty of Nursing at Kerman Medical University, who had a minimum of five years working experience and assisted in an earthquake disaster. Intensity and snowball sampling were performed. Data was collected through semi-structured interviews. Interviews were transcribed and coded into main themes and subthemes. RESULTS: Four major themes emerged from the data; 1) psychological support, 2) appropriate clinical skills education, 3) appropriate disaster management, supervision and programming, and 4) the establishment of ready for action groups and emergency sites. The participants' comments highlighted the necessity of training nurses for special skills including emotion management, triage and crush syndrome, and to support nurses' families, provide security, and act according to predefined programs in disasters. CONCLUSIONS: There are a wide range of requirements for disaster aid. Proper aid worker selection, frequent and continuous administration of workshops and drills, and cooperation and alignment of different governmental and private organizations are among the suggested initiatives.

Quality of life, social desirability and their relationship in opium addicted persons in southeast of Iran.

BACKGROUND & AIM: Addiction leads to many problems which may adversely affect addicted people, their families and impose health care agencies with many challenges. This study aimed to examined quality of life (QoL), social desirability and their relationship among opium addicted persons in southeast of Iran. MATERIAL & METHODS: In a cross-sectional study conducted from September 2012 to January 2013, 123 addicted people were studied. Date collection tools were; checklist of demographic data, Iranian version of the 36-item short form QoL (SF-36) and Marlowe-Crowne Social Desirability Scale (MC-SDS). RESULTS: While mean score of QoL was 60.4±29.5, mean score of social desirability were 14.2±3.7. Low, moderate and high levels of social desirability were observed in 4.9%, 90.2% and 4.9% of participants, respectively. Pearson's correlation were not significant between mean score of social desirability and mean score of QoL (p=0.969, r=0.004). CONCLUSION: Addicted participants of present study showed a moderate level of QoL and social desirability, without any significant relationship between QoL and social desirability. Further research is suggested in addicts with social and cultural differences.

Validation of the Persian Version of the Problematic Internet Use Questionnaire (PIUQ).

OBJECTIVE: The most commonly used instrument for the research and treatment of excessive internet use is Young's Internet Addiction Test (IAT). While the IAT has been translated to several languages (including Persian) and has demonstrated good psychometric properties across several independent studies, there is still a room for alternative assessment instruments. This study reports a validation of the Persian version of the Problematic Internet Use Questionnaire (PIUQ). METHOD: A sample (n = 296) from Kerman, Iran was administered the translated Persian version of the PIUQ as well as the Persian version of the University of California, Los Angeles (UCLA) Loneliness scale, Satisfaction With Life scale, and questions related to use of technology and the internet. RESULTS: Analyses using confirmatory and exploratory factor analyses demonstrated that the Persian version of the PIUQ had good internal reliability and concurrent validity (with loneliness and satisfaction with life), but they also had an alternative factor structure that did not support the original factor structure. CONCLUSION: The Persian version of the PIUQ produced adequate psychometric properties (internal reliability and concurrent validity), but care should be taken in the interpretation of the factor structure.

The effect of empowerment program on empowerment level and self-care self-efficacy of patients on hemodialysis treatment.

BACKGROUND: Patients with end-stage renal disease (ESRD) who receive dialysis confront the burdens of long-term illness and numerous physical problems. MATERIALS AND METHODS: This was a quasi-experimental study. The selected patients from Gorgan Dialysis Centre were randomly assigned into an empowerment group (n = 40) and a control group (n = 40). Instruments comprised scales of Empowerment and the Strategies Used by People to Promote Health (SUPPH). Data were collected at baseline and at 6 weeks following the intervention. The data were analyzed by descriptive and inferential statistics through SPSS (version 17). RESULTS: The results indicate that scores of the empowerment (P ≤ 0.001) and self-care self-efficacy (P = 0.003) in the empowerment group showed a significantly greater improvement than the control group. CONCLUSIONS: The study supports the effectiveness of the empowerment program to promote empowerment level and self-care self-efficacy of hemodialysis patients.