An exploration into the challenges of managing the COVID-19 pandemic in mass education centers in Iran: A qualitative content analysis.

Background: During the COVID-19 pandemic, Iran's mass education centers, which house a large number of trainees, encountered numerous difficulties in managing the disease. Understanding these challenges can help manage future pandemics. This study was conducted to explore the challenges of managing the COVID-19 pandemic in mass education centers in Iran. Methods: In this qualitative study, we used a qualitative content analysis of data collected from June to October 2022 in eight mass education centers in Iran. Semi-structured interviews (n=19) were used for data collection. Results: Four main themes and eleven subthemes were identified: The essence of dormitory life (Subthemes included: "The high population density in the dormitory", "Public toilets" and, Interprovincial travel), the inflexibility of the profession (Subthemes included: "Inapplicable health protocols" and, "Inflexible rules and regulations"), Negligence (Subthemes included: "Not adhering to health protocols", "Non acceptance of illness", and "High-risk taking"), and Weakness of health-care platform (Subthemes included: "shortage of healthcare facilities", "Lack of specialized personnel", and "The uni-dimensional aspect of healthcare services"). Conclusion: We identified several challenges that made the handling of COVID-19 difficult in Iran's centers for mass education. These findings can help future research in addressing the challenges and designing adaptable plans for pandemic management in mass education centers.

Experience of frontline nurses who managed the COVID-19 crisis: A qualitative study.

Background: The health system was challenged during the COVID-19 pandemic. Nurses, as part of the health system, were expected to manage themselves in a situation where everyone was in crisis and to be able to do their work quietly and calmly. This study was conducted to show how Iranian nurses faced the COVID-19 crisis. Methods: In a qualitative content analysis study, 16 participants, including eight nurses, five supervisors, and three head nurses of a university hospital in Tehran, Iran, were interviewed between February and December 2020. Using purposive sampling, nurses who were working with patients with COVID-19 were selected to be involved. Data were analyzed using MAXQDA 10 software, and codes were categorized based on similarities and differences. Finding: Data analysis revealed 212 codes. These codes were classified based on similarities and differences in 16 categories, and four main themes emerged: unpreparedness, positive adaptation, negative coping, and reorganization. Conclusion: Since nurses are on the frontline in times of biological disaster, the COVID-19 pandemic provided an opportunity to demonstrate the role of nurses in reducing the burden of disease, identifying problems and opportunities, and planning appropriate interventions.

Auditing the status of prioritization of nursing actions in the trauma emergency department.

INTRODUCTION: Patient assessment is considered as one of the key actions of nurses to provide professional services. Prioritizing the care needs based on the assessment could save patients' lives. Nurses should be able to prioritize patients' care needs and then, based on this prioritization, plan for patient life-threatening situations one after the other. The aim of this study was to audit the status of prioritization of nursing care for trauma patients in the trauma emergency department of Kowsar Hospital in Sanandaj. METHODS: This study was a quasi-experimental study (pre- and post-training) conducted using simple random sampling during the February to June 2021, in the emergency department of Kowsar Hospital in Sanandaj. The data collection tool was a standardized checklist for prioritizing nursing care, which contained a total of 53 items. At the beginning of the study, 64 nurses (32 in the experimental group and 32 in the control group) entered the study and the experimental group was evaluated based on a standardized prioritization checklist. Then, the data were collected and after statistical analysis, based on the obtained results and examining the weaknesses, the intervention group nurses participated in an educational course for one month. The checklist assessment was performed again and the results were compared with the results of the first assessment (before the intervention). RESULTS: The number of items requiring training in the experimental group before the intervention was 258 cases which decreased to 53 cases after training and this decrease was statistically significant (p < 0.05). However, in the control group, the number of measures requiring training in the first stage was 220 cases, which in the second stage of assessment fell to 213, but this decrease was not statistically significant (p > 0.05). CONCLUSION: By auditing the status of nursing care prioritization in the trauma emergency department and providing training related to focusing on the identified weaknesses, nurses' skills to prioritize patients' care needs as well as the quality of nursing care delivery increased.

A mediating role for mental health in associations between COVID-19-related self-stigma, PTSD, quality of life, and insomnia among patients recovered from COVID-19.

INTRODUCTION: Patients with COVID-19 often suffer from psychological problems such as post-traumatic stress disorder (PTSD) and self-stigmatization that may negatively impact their quality of life and sleep. This study examined mental health as a potential mediating factor linking self-stigmatization and PTSD to quality of life and sleep. METHODS: Using a cross-sectional design, 844 people who had recovered from COVID-19 were called and interviewed. Data were collected using structured scales. Structural equation modeling was applied to assess fitness of a mediation model including self-stigma and PTSD as independent factors and quality of life and insomnia as dependent variables. RESULTS: Mental health, COVID-19-related self-stigma, and mental quality of life were associated. Insomnia, PTSD, and COVID-19-related self-stigma displayed significant direct associations (r = .334 to 0.454; p < .01). A mediation model indicated satisfactory goodness of fit (CFI = 0.968, TLI = 0.950, SRMR = 0.071, RMSEA = 0.068). Mental health as a mediator had negative relationships with COVID-19-related self-stigma, PTSD, and insomnia and positive associations with quality of life. CONCLUSION: Mental health may mediate effects of COVID-19-related self-stigma and PTSD on quality of life and insomnia. Designing programs to improve mental health among patients with COVID-19 may include efforts to reduce negative effects of PTSD and COVID-19-related self-stigma on quality of life and insomnia.

Validation of the 30-item nurses' observation scale for inpatient evaluation and mental health-care promotion.

CONTEXT: The 30-item nurses' observation scale for inpatient evaluation (NOSIE-30) developed for the behavioral and observational rating of psychiatric inpatients. AIMS: The purpose of this study was to evaluate the validation of the NOSIE-30 and mental health-care promotion. MATERIALS AND METHODS: The participants with psychiatric disorders were selected from 310 inpatients referred to the military educational hospital in Iran. This study was carried out in two phases: First, translation of the NOSIE-30 into Persian followed the stepwise, iterative procedures developed by the International Quality of Life Assessment project approach. Second, face validity, criterion-related validity and construct validity, and reliability of the Persian version were determined. The concurrent validity was assessed by using the global assessment of functioning (GAF) instrument. Data were analyzed with the SPSS software of version 22. Exploratory factor analysis, the Cronbach's alpha coefficient, and interrater agreement with intraclass correlation coefficient and Pearson's correlation coefficient were used to data analysis. RESULTS: Pearson's correlation coefficient between the NOSIE and GAF was 0.75. The interrater reliability for subscale scores and structure of the NOSIE were ranging from 0.70 to 0.94 and Cohen's kappa = 0.74. Furthermore, the internal consistency of the scale's total scores was estimated by Cronbach's alpha = 0.85. CONCLUSIONS: The finding indicated that NOSIE-30 Persian version scale has the desirable validity and reliability for evaluating the nursing care of inpatients. Thus, nurses can promote mental health care by applying this scale in the psychiatric setting.

Overcrowding Management and Patient Safety: An Application of the Stabilization Model.

BACKGROUND: Emergency department is among the most crowded hospital units. The function of this department considerably affects the functions of other hospital units as well as patient satisfaction. The Stabilization Model is a strategy with potential effectiveness in managing overcrowding in emergency department. This study aimed to determine the effects of overcrowding management based on the stabilization model on patient safety in emergency department. MATERIALS AND METHODS: This pretest-posttest quasi-experimental was conducted in 2015 in the emergency department of a teaching hospital located in Tehran, Iran. Primarily, the perceived safety of 35 patients was assessed using the Patient Safety Assessment Questionnaire. Then, an overcrowding management intervention was implemented based on the stabilization model. Finally, the perceived safety of 35 newly recruited patients was assessed after the intervention. The SPSS software (v. 16.0) was employed for data analysis through the Chi-square, the Kolmogorov-Smirnov, and the independent-sample t tests. RESULTS: The mean (SD) score of patient safety was 27.45 (8.43) in the control group and 34.45 (4.04) in the intervention group and the between-group difference was statistically significant (t34 = 50.37, p < 0.001). The rate of patient safety increased from 65% at baseline to 82% after the intervention. CONCLUSIONS: Overcrowding management based on the stabilization model can significantly enhance patients' perceived safety. Therefore, this strategy can be used to ease emergency department overcrowding and enhance patient safety and care quality.

Predictors of Self-Management among Kidney Transplant Recipients.

PURPOSE: Self-management among kidney transplant recipients is a key factor in long-term survival. The present study aims to determine the predictors of self-management among kidney transplant recipients in Iran. MATERIALS & METHODS: This cross-sectional analytical study was conducted on 360 kidney transplant recipients who were selected from six transplantation clinics affiliated to six major universities of medical sciences in Iran. The data were collected using a demographic and clinical characteristics questionnaire and the Persian version of the 24-item Self-Management Scale for Kidney Transplant Recipients. RESULTS: The mean score of the participants' self-management was 62.39±8.04. Multiple regression analysis revealed that the significant predictors of self-management among kidney transplant recipients were age (B = -0.319), gender (B = -1.70), pre-transplantation dialysis duration (B = 0.256), dialysis type (B = 3.060), duration after transplantation (B = 0.08), and marital status (B = 4.44) (R2 = 0.444). CONCLUSION: This study showed that kidney transplant recipients in Iran have a moderate self-management status. The significant predictors of their self-management were age, gender, marital status, pre-transplantation dialysis type and duration, and the length of time passed after transplantation. The findings of this study provide a basis for developing interventions to improve self-management among kidney transplant recipients.

What is the Role of Preoperative Breathing Exercises in Reducing Postoperative Atelectasis after CABG?

BACKGROUND: Atelectasis and hypoxemia are frequently reported after coronary artery bypass graft surgery (CABG). Some studies confirm the benefits of breathing exercises on pulmonary complications, but the efficacy of preoperative breathing exercises in patients undergoing CABG is controversial. In this study, the effect of preoperative breathing exercises on the incidence of atelectasis and hypoxemia in patients candidate for CABG was examined. METHODS: In a single-blinded randomized clinical trial, 100 patients who were undergoing coronary artery bypass graft surgery were randomly allocated into two groups of experimental and control, each consisted of 50 patients. Before the operation, experimental group patients were enrolled in a protocol including deep breathing, cough and incentive spirometer. In the control group, hospital routine physiotherapy was implemented. All the patients received the hospital routine physiotherapy once a day for 2 to 3 minutes in the first four days postoperatively. Arterial blood gases and atelectasis were compared between groups. RESULTS: There was no significant difference between groups in terms of atelectasis and hypoxemia (p Value>0.05). CONCLUSION: Preoperative breathing exercise does not reduce pulmonary complications in patients undergoing CABG.

Resilience and its Predictors among the Parents of Children with Cancer: A Descriptive-Correlational Study.

CONTEXT: As a common debilitating illness, cancer is among the leading causes of child mortality in developed and developing countries. Cancer diagnosis for children is considerably stressful for their parents. Resilience is a key factor behind effective coping with cancer-related problems. This study evaluated resilience and its predictors among the parents of children with cancer. AIM: This study evaluated resilience and its predictors among the parents of children with cancer. SETTINGS AND DESIGN: This cross-sectional descriptive-analytical study was conducted in 2017 on 400 parents of children with cancer in Tabriz Children's Hospital, Iran. METHODS: A demographic questionnaire and the Connor-Davidson Resilience Scale were used to collect the data. Parents were conveniently recruited from Tabriz Children's Hospital. STATISTICAL ANALYSIS: Data were analyzed using the SPSS for Windows program (v. 16) via descriptive and inferential statistical methods. RESULTS: The mean score of parents' resilience was 66.83 ± 14.28. Fathers obtained significantly higher resilience scores than mothers (P < 0.001). The predictors of parents' resilience were financial status, parents' gender, fathers' employment status, and children's gender. CONCLUSION: The parents of cancer-afflicted children, particularly their mothers, have low resilience and therefore may be at risk for different physical and mental health problems. Health-care providers need to identify at-risk parents and provide them with greater psychological and educational support.

Evaluating the Psychometric Properties of the Persian Self-Management Scale for Kidney Transplant Recipients.

PURPOSE: There was no appropriate instrument for assessing the self-management of Iranian kidney transplant recipients. This study was done to translate the Self-Management Scale for Kidney Transplant Recipients into Persian and evaluate its psychometric properties. MATERIAL AND METHODS: This cross-sectional methodological study was done from October 2016 to March 2017. The psychometric properties of the scale were evaluated in the following four steps: forward-backward translation, face and content validity assessments, construct validity assessment via exploratory factor analysis, and reliability assessment via internal consistency and test-retest techniques. RESULTS: The means of item impact score, content validity ratio, and simplicity, clarity, and relevance content validity indices were 3.94, 0.73, 0.96, 0.93, and 0.98, respectively. Exploratory factor analysis revealed a four-factor structure for the scale which explained 70.75% of the total self-management variance. The four factors of the scale were "self-monitoring", "self-care behaviors", "early detecting and coping with abnormalities", and "drug management". The Cronbach's alpha and the test-retest intraclass correlation coefficient of the scale were 0.73 and 0.90, respectively. CONCLUSION: The Persian Self-Management Scale for Kidney Transplant Recipients has acceptable validity and reliability. It can be used in educational and clinical environments and also in research studies for measuring kidney transplant recipients' self-management.

Early mobilization reduces the atelectasis and pleural effusion in patients undergoing coronary artery bypass graft surgery: A randomized clinical trial.

Atelectasis and pleural effusion are common after coronary artery bypass graft surgery (CABG). Longer stay in the bed is one of the most important contributing factors in pulmonary complications. Some studies confirm the benefits of early mobilization (EM) in critically ill patients, but the efficacy of EM on pulmonary complications after CABG is not clear. This study was designed to examine the effect of EM on the incidence of atelectasis and pleural effusion in patients undergoing CABG. In a single-blinded randomized clinical trial, 100 patients who were undergoing coronary artery bypass graft surgery were randomly assigned into two groups each consisted of 50 patients. Patients in the experimental group were enrolled in a mobilization protocol consisting of the mobilization from the bed in the first 3 days after surgery in the morning and evening. Patients in the control group were mobilized from bed in third postoperation day, according to the hospital routine. Arterial blood gases, pleural effusion, and atelectasis were compared between groups. Atelectasis and pleural effusion was reduced in experimental group. The partial pressure of oxygen in arterial blood in third postoperative day and the percentage of arterial oxygen saturation in the fourth postoperative day were higher in the intervention group (P value < .05). EM from bed could be an effective intervention in reducing atelectasis and pleural effusion in patients undergoing CABG.

Stress and Fear of Exposure to Sharps in Nurses.

BACKGROUND: Injuries caused by sharp objects, which involve biological hazards are considered as one of the most important factors that lead to stress among the nursing staff. Contact with sharp objects is a major concern among healthcare workers, especially nurses. OBJECTIVES: This study was done to determine the amount of stress caused by exposure to sharp medical instruments among nurses. MATERIALS AND METHODS: This was a cross-sectional research on 527 nurses, working at different medical centers across Iran, with a cluster-sampling method. The relevant data was collected with a valid and reliable questionnaire. The Cronbach's alpha coefficient of internal consistency of this instrument was 0.92 and interclass correlation coefficient was 0.94. RESULTS: The results showed that ward satisfaction, having master of science, age, and number of contacts were significantly able to predict variance in stress scores. The adjusted line regression model explained 36% of the overall variance in stress score (R2 = 0.60). CONCLUSIONS: The results of this study showed that exposure to sharp objects may cause high stress in the nursing staff. Considering higher levels of stress in the area of contact care, the provisions on how to deal with patients and safe care can help reduce stress.

Factors Associated with Needlestick Injuries in Health Care Occupations: A Systematic Review.

INTRODUCTION: Needlestick and sharps injuries (NSIs), are among the main job-related injuries that health care workers experience. In fact, contraction of hepatitis B or hepatitis C from work-related NSIs is one of the most common occupational hazards among health care workers. AIM: The aim of this study was to determine the factors associated with NSIs in health care occupation. MATERIALS AND METHODS: In this study, a systematic and purposive review with emphasis on the research question was run to retrieve, evaluate and consolidate the required information. The following four key words were used to search for the relevant articles published from January 1998 to May 2015: NSI health care workers, risk factor and factors associated, in Science direct, EBSCO Host, PubMed, ProQuest, SID and Cochrane Library. Several steps of evaluation were taken to select and analyse the full texts of relevant articles. According to the inclusion criteria, we finally selected 11 articles from the 18642 retrieved articles. RESULTS: The data of the analysed articles indicated that the highest incidence of NSIs was seen in nurses and that the associated factors were age, level of education, number of shifts per month and history of related training. The highest rate of NSIs was related to instrument preparation followed by injection and recapping of used needles. Findings show that health care workers suffer a high rate of needlestick injuries. CONCLUSION: It was seen that device, location, or action cannot be separately considered as responsible for all types of the NSIs. Rather, each of them has a contribution to the NSIs. Nevertheless, factors with higher frequency should be given a higher priority.

Effect of Job Specialization on the Hospital Stay and Job Satisfaction of ED Nurses.

BACKGROUND: In recent decades, the increasing crowdedness of the emergency departments has posed various problems for patients and healthcare systems worldwide. These problems include prolonged hospital stay, patient dissatisfaction and nurse burnout or job dissatisfaction. OBJECTIVES: The aim of this study was to investigate the effect of emergency department (ED) nurses' job specialization on their job satisfaction and the length of patient stay in the ED. PATIENTS AND METHODS: This before-after quasi-experimental study was conducted from April to May 2014 at the Baqiyatallah Hospital, Tehran, Iran. Initially, 35 patients were recruited as controls and the length of their stay in the ED was measured in minutes via a chronometer; Moreover, nurses' job satisfaction was evaluated using the Mohrman-Cooke-Mohrman job satisfaction scale. Then, a job specialization intervention was developed based on the stabilization model. After that, 35 new patients were recruited to the treatment group and received specialized care services. Accordingly, the length of their stay in the ED was measured. Moreover, the same nurses' job satisfaction was re-evaluated after the study. The study intervention lasted one month. Data were analyzed using the SPSS software version 20 and statistical tests such as the Kolmogrov-Smirnov, the paired and the independent t, and chi-square tests. RESULTS: There was a significant difference between the two groups of patients concerning the length of their stay in the ED (P < 0.001). Moreover, compared with the pretest readings, nurses had greater job satisfaction after the study (P < 0.001). CONCLUSIONS: The job specialization intervention can improve nurses' satisfaction and relieve the crowdedness of the EDs.

Effect of Education on Stress of Exposure to Sharps Among Nurses in Emergency and Trauma Care Wards.

BACKGROUND: Health care services can cause injuries to medical staff. One of these injuries is exposure to needle-sticks. This can result in the transmission of blood-borne diseases, such as HIV and hepatitis B; the staff undergo continuous stress. Thus, it is necessary to use some method to reduce this stress. OBJECTIVES: The purpose of this study was to examine the effect of education based on the stabilization model on stress induced exposure to needle sticks among nurses working in emergency and trauma wards. PATIENTS AND METHODS: This Quast- Experiental Study was performed on 35 nurses working in emergency and trauma wards of our hospital in October-December 2013. Data were collected using a two-part questionnaire; Reliability and validity of the questionnaire were confirmed (α = 0. 92 and ICC = 0.94).Data were analyzed using SPSS version 20. The one-sample Kolmogorov-Smirnov test, independent t-test and paired sample t-test were also used. RESULTS: The mean and standard deviation of stress experienced by nurses before and after the intervention were 64.94 ± 15.67 and 43.91 ± 10.73, respectively. Findings indicated that education decrease needle stick stress in nurses significantly (P < 0.001). CONCLUSIONS: According to the results of this study, the stress level induced due to needle-stick exposure and its complications is high and interventions for reduction are essential.

Barriers to nursing care in emergency wards.

BACKGROUND: Caring is the essence of nursing. Since care is influenced by cultural, economic, and social factors, various diverse barriers exist in the realization of care. The aim of the study was to clarify barriers to caring in emergency patients based on experiences of nurses and patients and their relatives. MATERIALS AND METHODS: A qualitative design of content analysis was used to identify the barriers to caring in emergency patients. In-depth interviews were conducted with 18 Iranian nurses working in a university hospital emergency ward and with seven patients. Participants were selected purposefully. Data were analyzed according to qualitative content analysis. RESULTS: After the classification analyses and integration of codes, seven categories were acquired. Finally, following three themes were extracted: Identified barriers to nursing care in emergency wards - the nature of critical ward, performance weakness of nurses, and deficiency in clinical management. CONCLUSIONS: According to the results of this study fundamental and management education for nurses, empowerment of nurses, principle and scientific triage, effective supervision, nurses' support, wage increase, and motivation in nurses are important to achieve the research purpose.