A respiratory critical care nurse training program for settings without a registered respiratory therapists: A protocol for a multimethod study.

BACKGROUND: The increasing elderly population and prevalence of chronic diseases have raised the need for ICU beds. However, limited bed availability often causes delays in admission, leading to wasted treatment time. OBJECTIVES: This study aims to create and implement a training program for respiratory critical care nurses (RCCNs) in settings without registered respiratory therapists (RRTs). METHODOLOGY/DESIGN: The study will use a multimethod sequential research design, including a scoping review, content analysis, Delphi methods, and a randomized clinical trial. The scoping review will gather extensive information on respiratory care for critically ill patients and the responsibilities of RCCNs. Content analysis and expert interviews will identify opportunities and challenges in RCCNs' provision of respiratory care. The Delphi method will integrate the results to develop a comprehensive training program for RCCNs. Subsequently, five RCCNs will undergo theoretical and practical examinations after completing the three-month training program, and the impact of RCCNs on critically ill patients' outcomes will be evaluated through a clinical trial. ANTICIPATED FINDINGS: The study aims to provide a comprehensive training program for RCCNs and investigate its impact on the outcomes of critically ill patients through a clinical trial. CONCLUSION: The training program will equip RCCNs with the necessary skills and knowledge to provide respiratory critical care from the emergency department to hospital discharge. This pioneering study aims to improve patient outcomes in settings without RRTs by offering a unique program for RCCNs. IMPLICATIONS FOR CLINICAL PRACTICE: The development and implementation of this training program for RCCNs in settings without RRTs will address the gap in respiratory care and potentially improve patient outcomes. By empowering RCCNs with specialized training, healthcare facilities can ensure the provision of high-quality respiratory care throughout a patient's critical illness journey, enhancing the efficiency and effectiveness of healthcare teams, especially in resource-limited settings.

Development and psychometric evaluation of the family intensive care units syndrome inventory.

BACKGROUND: Family members of patient in the intensive care unit (ICU) experience a set of problems which are entitled Family Intensive Care Units Syndrome (FICUS). OBJECTIVES: The aim of this study was to develop and psychometrically evaluate the FICUS Inventory (FICUSI) in Iran. METHODS: This sequential exploratory mixed method study was conducted in 2020 in two main phases. In the first phase, FICUSI was developed based on the results of an integrative review and a qualitative study. In the second phase, the psychometric properties of FICUSI, namely, face, content, and construct validity, reliability, responsiveness, interpretability, and scoring, were evaluated. The sample for the construct validity evaluation consisted of 283 ICU family members. RESULTS: The primary item pool of FICUSI had 144 items and was reduced to 65 items or omitting overlapping and similar items. The scale-level content validity index of FICUSI was 0.89. In the construct validity evaluation through exploratory factor analysis, 31 items with factor loading values more than 0.3 were loaded on two factors (namely psychological symptoms and nonpsychological symptoms) which explained 68.45% of the total variance. The Cronbach's alpha and the test-retest intraclass correlation coefficient of FICUSI were 0.95 and 0.97, respectively. CONCLUSION: FICUSI is a valid and reliable instrument which can be used in clinical settings and studies for FICUS assessment. Further studies for the cross-cultural adaptation of FICUSI in other contexts are recommended. RELEVANCE TO CLINICAL PRACTICE: Health care providers in clinical settings can use FICUSI to assess FICUS among the family caregivers of patients in ICU. Health care providers' better understanding of FICUS helps them understand the quality of their own services for the family members of patients in ICU.

Developing the marine medicine syllabus for medical sciences students: a multiphase design study.

BACKGROUND: Marine medicine is one of the medical fields that deals with the health and safety of people related to the sea but the marine medicine syllabus for education to the students is not specified yet. The present study aimed to develop the marine medicine syllabus to medical sciences students education. METHODS: This study was conducted in three phases. First, a literature review was conducted to find the concepts and topics related to marine medicine. Second, a content analysis research method was conducted. Data collection was done first by using semi-structured interviews with the 12 experts in marine medicine. Sampling was purposeful and continued until data saturation was reached. The information obtained from the interviews was analyzed by conventional content analysis with Geranheim's method. The found topics in the literature review and content analysis of interviews were combined and formed the initial draft of the marine medicine syllabus, which was validated with the Delphi method in the third phase. The Delphi was conducted in two rounds and the panel consisted of 18 experts in the field of marine medicine. After the completion of each round, the items that had less than 80% consensus among the participants were removed and the remaining topics after round two formed the final syllabus of the marine medicine. RESULTS: The findings showed that the marine medicine syllabus should include an overview of marine medicine, health at sea, common physical diseases and injuries at sea, subsurface medicine and hyperbaric, safety action in marine incidents, medical care at sea, psychology at sea and medical examinations of people working at sea main topics and their sub topics. CONCLUSIONS: Marine medicine is an extent and specialized medical field which has been neglected and it is necessary to teach this lesson to medical sciences students with the syllabus found in the present study.

Identifying Structure, Process and Outcome Factors of the Clinical Specialist Nurse: A Scoping Review Study.

Background: In order to achieve the major goals of transformation in the health care system, organizing and developing the existing potential properly play a pivotal role. The objective is to conduct a scoping review to describe available extent of literatures about scattered structure, process, and outcome factors of the clinical specialist nurse and redesign those as three cohesive and interconnected factors. Materials and Methods: A scoping review of studies was conducted from 1970 to June 20, 2020, focusing on the structure, process, and outcome factors of the clinical specialist nurse from six databases. Results: Forty-six studies were carried out. Structure (individual characteristics, intra-organizational, and governance factors), process (professional interactions, and roles and duties of a specialist nurse), and outcome (patient and family, nurse, and organizational outcomes) factors were identified. Conclusions: With the correct knowledge of the factors, it is possible to achieve the desired therapeutic, organizational, and professional results of nursing by providing the necessary fields in the structure, process, and outcomes. The identification of structures, processes, and outcomes that influence clinical nurse's role implementation may inform strategies used by providers and decision makers to optimize these roles across healthcare settings and guarantee the delivery of high-quality care.

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.

Lived experience of Iranian pre-hospital medical staff during the COVID-19 pandemic: a descriptive phenomenological study.

Background: Pre-hospital medical staff faced numerous challenges during the COVID-19 pandemic. However, these challenges specific to pre-hospital services have not been thoroughly explored in Iran. This qualitative study aimed to examine the essence of pre-hospital care during the COVID-19 pandemic. Methods: This phenomenological study was conducted from June to August 2021 in Tehran, Iran. Semi-structured interviews were conducted with pre-hospital medical staff. Data analysis was performed using Colaizzi's approach, and rigor was ensured by adhering to the consolidated criteria for qualitative reporting research. Results: A total of 17 pre-hospital medical staff were interviewed, and five themes were extracted from the data: workload and resilience, damage, lack of control, under preparedness, and post-traumatic growth. These themes highlight the resilience demonstrated by pre-hospital medical staff, who faced an unprecedented crisis with limited preparedness and significant damage. Conclusion: The findings of this study indicate that pre-hospital medical staff in Iran encountered challenges during the COVID-19 pandemic due to a lack of preparedness and substantial damage. Despite these adversities, the participants exhibited resilience and experienced post-traumatic growth. The study emphasizes the importance of proper planning and preparedness to enhance the resilience of emergency medical services during pandemics. Furthermore, the results underscore the need to address the challenges faced by pre-hospital medical staff and improve the quality of care provided to patients during crises such as the COVID-19 pandemic.

Perceptions of undergraduate nursing students toward providing care to COVID-19 patients.

Background: Undergraduate nursing students were inevitably recruited to provide care in response to overloaded hospitals with COVID-19 patients. The placement was potentially a stressful event and we aimed to understand the students' perception of direct nursing care during the pandemic. Methods: This qualitative content analysis study carried out in 2020 (May-June) in Tehran, I.R. Iran. Using explanatory questions, we interviewed 15 undergraduate nursing students who provided direct care for at least 2 months to patients hospitalized with COVID-19 in the beginning of the pandemic to obtain their deep experiences. We applied the MAXQDA 10 to extract codes, used the qualitative content analysis method for investigation, and then applied the Lincoln and Guba criteria for rigor and trustworthiness. The study was approved by the National Committee for Ethics in Biomedical Research (IR.BMSU.REC.1399.070. available at: https://ethics.research.ac.ir). Results: Four hundred and 54 codes were identified, which were then sorted into 12 categories underlying four main themes of "hard and unpredictable," "posttraumatic growth," "on the path to self-determination," and "commitment." Conclusion: Even though the undergraduate nursing students experienced some stress in the beginning, with close support, their caregiving skills improved and they were able to meet the national healthcare needs. More studies are needed to confirm our findings regarding the experiences of the nursing students in combating COVID-19.

Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial.

Background: Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery. Methods: In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups (n = 35), intervention and control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilators setting changes, and alarms were compared between the groups. Results: The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, p > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, p < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were significantly lower in the intervention group. However, the differences in the length of stay in ICU between the two groups were not significant (p = 0.219). Conclusion: Our results suggests that capnography can be used as an alternative to ABG. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings. Clinical Trial Registration: Current Controlled Trials, IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192.

Emotional intelligence of nurses caring for COVID-19 patients: A cross-sectional study.

PURPOSE: The aim of this study was to assess the emotional intelligence of nurses caring for COVID-19 patients. METHODS: This was a descriptive cross-sectional study that was conducted from May to July 2020 in Tehran, Iran. Nurses caring for patients with COVID-19 were requested to fill in Bradbury and Graves's questionnaire online using a questionnaire in electronic format. RESULTS: Finally 211 nurses completed the questionnaires. Most of the nurses were working in critical care wards and caring for critical patients (61.6). Nurses' emotional intelligence was reported to be 63.19 (8.22). In general, the nurses' emotional intelligence was moderate. Between the dimensions, self-awareness and self-management had the highest scores. Also, the lowest score was related to self-management. The ward type and complexity of care had no effect on the scores of emotional intelligence. Nurses caring for patients with moderate disease severity had a higher relationship management score than nurses caring for critically ill patients (P < 0.05). CONCLUSION: The total score of emotional intelligence was moderate. Due to the continuation of the COVID-19 pandemic and the possibility of mental and physical fatigue of health care workers, improving emotional intelligence can be effective in resilience and stability of the psychological status of employees.

Incidence of cardiac complications following COVID-19 infection: An umbrella meta-analysis study.

BACKGROUND: COVID-19 causes fatal cardiac damages. Despite many overwhelming meta-analysis related to cardiac complications following COVID-19 disease, no umbrella meta-analysis study has been conducted. OBJECTIVES: We aimed to report the summarized pooled incidences of cardiac complications in the overall, critically ill, and deceased patients, compare the cardiac complications between the severe/non-severe or deceased/non-deceased patients, and also compare poor outcomes between patients with/without acute myocardial injury (AMI). METHODS: PubMed, Scopus, web of science, Cochrane, ProQuest, Springer, Sage journals were searched before April 2021. After assessing the quality and duplicate data, data were run by the random/fixed-effect models, I2 heterogeneity index, Egger's test, and sensitivity analysis. RESULTS: After removing duplicate data, in the overall COVID-19 patients, the pooled incidence of AMI, heart failure, arrhythmia, cardiac arrest, and acute coronary syndrome (ACS) were 21%, 14%, 16%, 3.46%, and 1.3%, respectively. In the patients with severe disease, the pooled incidence of AMI and shock were 33 and 35%, respectively. Similarly, in the deceased COVID-19 patients, the pooled incidence rate of AMI and arrhythmia were 56% and 47.5%, respectively. The patients with severe disease were at higher risk of AMI (RR = 5.27) and shock (OR = 20.18) compared with the non-severe cases. Incidence of AMI was associated with transfer to the intensive care units (ICU) (RR = 2.92) and mortality (RR = 2.57, OR = 8.36), significantly. CONCLUSION: Cardiac complications were found to be increased alarmingly in COVID-19 patients. Baseline and during hospitalization checking with electrocardiography, echocardiography, and measuring of cardiac biomarkers should be applied.

The family intensive care unit syndrome: A qualitative content analysis.

BACKGROUND: Hospitalization of patients in an intensive care unit (ICU) is associated with a series of psychological problems for their family members called family intensive care unit syndrome (FICUS). Nonetheless, family members of patients in ICU often receive little attention from health care providers. Exploring family members' experiences of their patients' hospitalization in ICU helps health care providers focus more clearly on their problems. AIMS AND OBJECTIVES: This study aimed to explore FICUS-related experiences among the family members of patients in ICU. DESIGN: This was a qualitative content analysis study. METHODS: This qualitative study was conducted in 2019. Participants were 14 family members of patients in ICU who were purposively selected from three hospitals in Tehran, Iran. Data were collected using semi-structured interviews and were analyzed using qualitative content analysis. RESULTS: Participants' experiences of FICUS fell into four categories, that is, threat to psychological well-being (with four subcategories), threat to physical health (with three subcategories), threat to social health (with three subcategories), and change in spiritual orientation (with two subcategories). The 12 subcategories of these categories were emotional disturbances, hopelessness, changes in sleep pattern, mood changes, physical symptoms, aggravation of the existing illnesses, negligence towards personal health, alteration in social interactions, alteration in the burden of responsibility, alternation in the life process, resort to spiritual beliefs, and spiritual conflict, respectively. CONCLUSION: FICUS symptoms are not limited to psychological problems, rather they include a wide range of psychological, physical, social, and spiritual problems, which can affect the different aspects of family members' lives. Along with care delivery to patients in ICU, health care providers should provide care and support to patients' family members. RELEVANCE TO CLINICAL PRACTICE: FICUS is a major threat to health among the family members of patients in ICU. Careful assessment of these family members helps identify family members who are at risk for FICUS and identify FICUS effects on their decisions and health status.

Home health care for mechanical ventilation-dependent patients: A grounded theory study.

The number of people requiring home mechanical ventilation is increasing. Both family and patients experience a quite different situation. There is a significant knowledge gap about the caring process, families and health care team responsibilities, challenges they face, and how they manage. This study aimed to discover the process of home health care (HHC) to mechanical ventilation-dependent patients. The Straus and Corbin version of the grounded theory method was used. The preliminary study was conducted in 2015, and then for updating the theory, a complementary study was done in 2019. Sampling began purposefully and then was followed by theoretical sampling. A total of 28 participants, including 14 professional health care workers, 12 family members, and two improved patients were interviewed. Data were analysed using MAXQDA 2010 with constant comparative analysis method. After this step and the formation of concepts, structure, and the relation between them and exploring the process, the related theory was presented. The data analysis revealed 64 primary categories, that have been clustered into eight categories, and finally in three main concepts of "challenging care with stress and ambivalence", "step-by-step care delegation", and "professional and limited". After organising the memos, drawing the diagrams, and writing the storyline, "challenging care with stress and ambivalence" emerged as the main concern. Families tend to provide care without reducing quality. So, using the "step-by-step care delegation" strategy they delegate the care from professional to unprofessional caregivers. This strategy could lead to the "supported independence" of families and "professional development" of nurses. Families experience a challenging situation during care delivery to mechanical ventilation-dependent patients at home. The most important challenge is insufficient insurance coverage and an inappropriate legal framework for service delivery. Hence, the study results could be used by policymakers to improve HHC policies.

The effect of the family presence on anxiety and agitation of patients under mechanical ventilation after open heart surgery: a randomized clinical trial.

BACKGROUND: Family-centered care has been considered as a philosophy of care. Family presence in intensive care units (ICUs), especially in the acute phase of the disease is controversial. This study has been carried out in order to determine the effect of the family presence on anxiety and agitation in patients undergoing coronary artery bypass grafting (CABG). MATERIALS AND METHODS: In a clinical trial, 70 patients were randomly allocated into groups of experimental and control. In the experimental group, during the weaning process from the mechanical ventilation, a family member was present at the bedside. The degree of anxiety and Richmond's Agitation and Sedation Scale (RASS) were compared in seven consecutive time stages, including the time of entry into the ICU, the first respiratory drive, the family entrance, 20 min and 1 h after the presence of the family member, the time of extubation, and 1 h after extubation. RESULTS: There was a significant difference between the two groups in the mean scores of the anxiety scale in the first (P =0.008), second (P=0.002), and third stages (P =0.005). This difference was not significant in the fourth to seventh stages (P>0.05). As the baseline anxiety levels were different, a covariate adjustment was used for comparisons between treatments, adjusting the main analyses for baseline anxiety levels. Analysis showed that groups were not different. Also, there was no significant difference in the mean scores of RASS between the two experimental and control groups at any of the seven stages (P> 0.05). CONCLUSION: According to the findings of the present study, the presence of a family member does not reduce the level of anxiety and agitation of patients undergoing cardiac surgery. However, it can be concluded that this intervention is feasible in acute and complex situations after open heart surgeries. TRIAL REGISTRATION: This study has been registered in the Iranian Registry of Clinical Trials with the code IRCT201609014299N4 .

Psychological consequences for family caregivers of patients receiving hemodialysis: threat or opportunity?

BACKGROUND: Family caregivers of patients receiving hemodialysis experience physical and psychological disorders. They are unfortunately neglected. The aim of this study was to explain the psychological consequences for family caregivers of patients receiving hemodialysis. METHODS: This qualitative inductive conventional content analysis research approach was conducted in Tehran, Iran. Nineteen hemodialysis patient caregivers were enrolled via purposive sampling. Data collection was conducted through in-depth and semi-structured interviews until reaching data saturation. All interviews were recorded, transcribed, imported into the Open Code Software, and analyzed using the Graneheim and Lundman methods. RESULTS: The results included two main categories: (1) threats to the psychological integrity; (2) development of capabilities. The first main category comprised the sub-categories of "care-related negative feelings and emotions," care-related stress and its behavioral impacts on care, "psychological disorders arising from care provision," and "impaired quality and quantity of sleep." The second main category comprised of the sub-categories of "care-related positive feelings and emotions" and "coping strategies." CONCLUSIONS: The present study showed that though caring for hemodialysis patients threatens the caregiver's psychological integrity, it provides the opportunity of development capabilities.

The effect of foot reflexology massage on delirium and sleep quality following cardiac surgery: A randomized clinical trial.

BACKGROUND: Delirium is the most common neurologic disorder after cardiac surgery and affects both short and long-term outcomes. This study was conducted to evaluate the effect of foot reflexology massage on the incidence of delirium and sleep quality in patients undergoing cardiac surgery. METHODS: In this randomized clinical trial, 60 patients who were candidates for CABG surgery were randomly assigned into two equal groups (n = 30); intervention and control groups. In the intervention group, foot reflexology massage was done on each foot for 15 min, for two consecutive days. Delirium observation screening scale, the Richard Campbell sleep questionnaire (RSCQ), and pain intensity using VAS were compared. RESULTS: in the second postoperative day, delirium was observed in 8 (26.7 %) and 7 (23.3 %) of patients in the intervention and control groups, respectively (p > 0.05). The measured odds ratio for the effect of massage on delirium is 0.83 (95 %CI 0.71-2.69, p = 0.76). The difference in RSCQ scores was not significant between groups of intervention and control (68.32 ± 10.41 VS. 62.80 ± 11.86, P = 0.06). The pain intensity was lower in the intervention group (P < 0.001). CONCLUSION: Foot reflexology was not effective in reducing delirium and improving the sleep quality, but the pain intensity was decreased. It seems that the precise pathology and predicting model of delirium should be identified, and appropriate interventions should be planned accordingly.

Role model nursing leaders in COVID-19 crisis.

BACKGROUND: Applying the principles and skills of management, including planning, organising and leadership skills, will greatly help to improve the quality of nursing manager duties. This is even more important during crisis management, such as the COVID-19 crisis. The objective of the present study was to express the experiences of nursing managers in the COVID-19 crisis. METHODS: A qualitative conventional content analysis approach was used to discover the nursing leadership style in the COVID-19 crisis. The present study was conducted in one hospital in Tehran, Iran. 20 Iranian nursing managers in all nursing management positions such as head nurse, matron and supervisor were interviewed. Semi-structured interview was conducted at one hospital in Iran, using reflective and open-ended questions. Interviews were audio recorded and transcribed. The study was carried out in 2020 while data saturation occurred, no new categories or codes have emerged and the study questions were answered. Credibility and conformability were established through member checking. The report of the analysis was returned to the participants in order to get the assurance that the researchers had portrayed their real world in codes and extracted categories. RESULTS: Four main themes emerged from data analysis including 'managers as role model', 'full responsiveness', 'being in constant challenge' and 'post disaster growth'. CONCLUSION: Nursing management is one of the activities that the manager must be constantly aware of the activities of his subset. This requires a constant presence in the workplace and communication with nursing staff. Also, in times of crisis, the manager, in addition to having scientific ability, must also have sufficient experience. These two factors will lead to crisis management. Also, training staff and managers in crisis management is one of the most important issues in nursing management.

Family Intensive Care Unit Syndrome: An Integrative Review.

BACKGROUND: Hospitalization in the Intensive Care Unit (ICU) brings about psychological and physical symptoms in patients' family members. Family Intensive Care Unit Syndrome (FICUS) is a term used to explain the psychological symptoms of the family of a patient in response to the patient's admission to the ICU. The purpose of this study was to define FICUS along with its symptoms and predictors. MATERIALS AND METHODS: The Web of Science, PubMed, Scopus, Google Scholar, and SID databases were searched for literature published in 2005-2018 with the keywords "FICUS," "intensive care unit," "family," "caregivers," "anxiety," "depression," and "post-traumatic stress disorder" in their title and abstract. The strategy for conducting an integrative review provided by Whittemore and Knafl (2005) was used in this study. RESULTS: Twenty articles were included in the final data analysis. Following the patient's admission to the ICU, family members experience multiple psychological symptoms such as FICUS. The most commonly reported symptoms were anxiety, depression, post-traumatic stress disorder (PTSD), complicated grief, sleep disorder, stress, and fatigue. The low education level, having a critically-ill spouse, adequate support, financial stability, preference for decision-making, understanding of the disease process, anxiety, depression, or previous acute stress were predictors of FICUS. CONCLUSIONS: On the basis of the results, families also experience physical symptoms, so the FICUS is not limited to the occurrence of psychological symptoms. This study found that there is no universal definition for the term "FICUS" in the research literature. Thus, further research is needed to explore FICUS in the health field.

Designing and Validation of Health-Related Quality of Life Inventory for Family Caregivers of Hemodialysis Patients.

BACKGROUND: Family caregivers are important sources of care for hemodialysis patients. Although caring for a family member is a pleasant feeling, experiencing lots of physical and psychological caregiving burden influences the quality of life among family caregivers of hemodialysis patients. This study aimed to design and validate the quality of life inventory for family caregivers of patients on hemodialysis. METHODS: A sequential-exploratory mixed method was conducted in Tehran, Iran, in 2017-2018. In the qualitative phase, the researcher conducted in-depth semi-structured interviews with 19 participants. Finally, a pool of 93 items was extracted from this phase. Then, psychometric properties such as face validity (Impact Score>1.5), content validity ratio (CVR>0.63), content validity index (Item Content Validity Index: ICVI>0.78 , Scale Content Validity Index/Average: SCVI/Ave>0.8) and Kappa value (Kappa>0.7, internal consistency (Cronbach's alpha>0.7), relative reliability (ICC: interclass correlation coefficient), absolute reliability (Standard Error of Measurement: SEM and Minimal Detectable Changes: MDC), convergent validity (Correlation Coefficient between 0.4-0.7), interpretability, responsiveness, feasibility, and ceiling and floor effects were assesse. RESULTS: The quality of life inventory for family caregivers of hemodialysis patients was developed with 34 items and five factors (namely patient care burden, conflict, positive perception of situations, self-actualization, fear, and concern). The findings confirm that the scale is acceptable regarding validity, reliability and other measurement features. CONCLUSIONS: This inventory is consistent with the health care status in Iran. Therefore, it can be used to measure the quality of life among family caregivers of hemodialysis patients.

Delayed Symptoms in Patients Recovered from COVID-19.

BACKGROUND: COVID-19 is a new disease, so we don't know what comes next. Since information on delayed symptoms is limited, this study was conducted to assess the frequency of delayed symptoms in patients with COVID-19. METHODS: This follow-up cross-sectional study was conducted in a referral general hospital in Tehran, Iran from Feb to Apr 2020. Two hundred patients hospitalized for COVID-19 and were discharged were assessed for delayed symptoms 6 wk after discharge. RESULTS: The mean age of the participants was 55.58±13.52, and 160 (80%) Of them were male. On admission to hospital, patients reported a mean of 5.63±2.88 symptoms per patient, range from 1 to 14 symptoms. Dyspnea was seen in 119 (59.5%) 0f them as the most frequent symptom. Then weakness, myalgia, and shivering were reported with a frequency of 111 (55.5%), 107 (53.5%), and 103 (51.5%), respectively. Six weeks after discharge reassessment was done. None of the patients was readmitted to the hospital. Ninety-four (42%) of them were symptom-free. Fatigue was the most frequent delayed symptom with a frequency of 39 (19.5%), and then dyspnea, weakness, and activity intolerance with a frequency of 37 (18.5%), 36 (18%), and 29 (14.5%) were reported, respectively. CONCLUSION: Fatigue, dyspnea, weakness, anxiety, and activity intolerance were most frequent delayed symptoms, respectively. Majority of patient was symptoms free and those with symptom, had mild to moderate symptoms. The importance of symptoms is not fully recognized. Follow up clinics and in some cases rehabilitation programs may be helpful.

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.