Prevalence and predictors of burnout among nurses during the COVID-19 pandemic: A survey in teaching hospitals.

BACKGROUND: Occupational burnout is one of the most important consequences of the coronavirus disease pandemic, associated with psychological well-being, quality of care, and intention to leave the nursing profession. This is a major health problem with serious adverse consequences not only for nurses but also for patients and healthcare systems. OBJECTIVE: To assess burnout and its associated factors in nurses who worked in teaching hospitals during the COVID-19 pandemic in Iran. METHODS: A cross-sectional study was conducted on nurses of two COVID-19 referral hospitals in Tehran, Iran. Data were collected using the sociodemographic form and Maslach burnout inventory-human service survey (MBI-HSS) questionnaire. Data were evaluated using SPSS software version 26. RESULTS: A total of 264 participants, 52.7% (n = 139) were males and the mean of them age was 34.41±9.71 years. Almost 50% of nurses experienced burnout, in each dimension. Emotional exhaustion was associated significantly with job retention intention (P = 0.01) and depersonalization was significantly associated with gender (P = 0.02), age (P = 0.01), educational level (P = 0.004), work shifts (P = 0.006), and job retention intention (P = 0.02). In addition, personal accomplishment score was significantly associated with age (P = 0.002), marital status (P = 0.03), educational level (P = 0.03), work shift (P = 0.04) and job retention intention (P = 0.01). CONCLUSION: The burnout rate in the COVID-19 era is high among nurses associated with improper care. Psychosocial support is needed to improve mental well-being among health care workers during unpredictable conditions like pandemics.

Spiritual-Cultural Needs as the Main Causative Factor of Death Anxiety in Iranian COVID-19 Patients: A Qualitative Study.

COVID-19 patients have been reported to more than likely experience a variety of difficult physical and psychological problems. This qualitative study aims to perceive psychological experiences in COVID-19 patients in Iran. The study method is qualitative, with a conventional content analysis approach adopted. Purposive sampling was applied to 20 COVID-19 patients admitted to medical wards at hospitals in Tehran, Iran. Additionally, data were collected using semi-structured interviews. All data were analyzed based on the method proposed by Lindgren et al. (Int J Nurs Stud 108:103632, 2020). Data analysis identified the main theme to be "death fear and anxiety" with five main categories. These categories included the feelings of death panic and apprehension, uncertainty and ambiguity, fear of abandonment, fear of an unknown future for the family, and fear of unmet spiritual-cultural needs. Accordingly, the patients' experiences of COVID-19 contraction were unique. Against this backdrop, understanding COVID-19 patients' complexities, experiences, beliefs, and attitudes about anxiety and death, can lead to an  improved awareness and understanding of the psychological consequences of COVID-19 by executive decision-makers, healthcare personnel and mental health professionals.

A systematic review of the measurement properties of self-care scales in nurses.

BACKGROUND: Self-care is a necessary measure against occupational injuries of nurses and improves nursing performance at the bedside. Nurses have different scales to measure self-care, and researchers are confused about choosing valid and reliable scales. This systematic review aimed to evaluate the measurement properties of self-care scales in nurses to identify the best available scales. METHODS: Four databases (PubMed, Web of Science, SCOPUS, and ProQuest) were systematically searched, with no date limiters, until 9 Jun 2023. A manual search was performed with Google Scholar and the reference list of articles to complete the search. Studies aiming to develop or determine the measurement properties of self-care in nurses were included. Based on Consensus-Based Standards for the Selection of Health Measurement Instruments, the methodological quality of the studies was determined, and the result of each study on a measurement property was rated (sufficient, insufficient, or indeterminate). The quality of the evidence was graded using a modified Grading of Recommendations Assessment, Development, and Evaluation approach (high, moderate, low, or very low). These processes were used to make recommendations and identify the best scale to assess self-care in nurses. RESULTS: Out of 8601 articles, six articles with five different scales were included. Only internal consistency was reported across all scales. Criterion validity, measurement error, responsiveness, feasibility, and interpretability, were not reported in any of them. Content validity was reported only in two studies with inconsistent results and low-quality evidence. None of the scales had methodological quality with a rating of very good and sufficient high-quality evidence for all measurement properties. CONCLUSIONS: None of the scales is strongly recommended to measure self-care in nurses. Only the Professional self-care scale is temporarily recommended until their quality is assessed in future studies. Considering that the content of the examined scales does not meet all the professional self-care needs of nurses, designing a valid, reliable, and specialized scale for nurses is needed.

The Effect of Culturally Appropriate Self-Care Intervention on Health Literacy, Health-Related Quality of Life and Glycemic Control in Iranian Patients with Type 2 Diabetes: A Controlled Randomized Clinical Trial.

Background: Cultural and language differences are necessary factors for diabetes management and self-care education programs in patients suffering from diabetes. This study aims to investigate the effectiveness of culture-based self-care intervention on health literacy, quality of life, and glycemic parameters in patients with type 2 diabetes. Materials and Methods: This randomized clinical trial has been carried out in selected centers in Darreh Shahr, Iran; 80 participants were randomly assigned into intervention and control groups. The intervention group received an educational program for 6 sessions twice a week, but the control group only received routine services. Data were collected using health literacy and life quality scales for diabetic patients, which were completed by both groups before, immediately after, and 3 months after the intervention; hemoglobin A1C (HbA1c) was checked before and 3 months after the intervention. SPSS software was also analyzed data using χ2, Fisher's exact, independent t, and repeated measures analysis of variance tests. Results: There were no significant differences between the 2 groups before the study (p >0.05) goes forward. But, mean scores of health literacy (F2,40 = 5.61, p =0.007), quality of life (F2, 40 = 4.09, p =0.01), and HbA1c levels (t, 39 = 6. 91, p <0.001) have shown significant differences between the 2 groups immediately and 3 months after the intervention have been applied. Conclusions: Culturally appropriate intervention should be offered as a part of the nurse' care program for diabetic to control HbA1c, and improve their life quality and health literacy.

Factors determining the quality of health services provided to COVID-19 patients from the perspective of healthcare providers: Based on the Donabedian model.

Objectives: The present study aims to explain factors determining the quality of health services provided to COVID-19 patients from the perspective of healthcare providers based on the Donabedian model. Method: This qualitative study was conducted at a referral hospital on COVID-19 patients in Tehran, in 2020. The data were collected through individual and semi-structured interviews from 20 participants using the purposive sampling method. Besides, data analysis was conducted simultaneously using the directed content analysis method. Results: Data analysis results produced 850 primary codes in three predetermined categories of the Donabedian model, including the structure (organizational readiness and continuous training), the process (effective management and leadership, safe care, and comprehensive care measures) and outcomes (professional excellence, quantitative and qualitative improvements in hospital services, and acceptability of healthcare professionals). Conclusion: The results of this study can help managers better understand how a public health crisis affects the structure of organizations providing care and treatment, quality of treatment processes in the organization, and the consequences. In addition, this study can be used as a model for optimizing the structures and processes to improve outcomes.

Development and Psychometric Properties of the Mental Health Literacy Questionnaire (MHLQ) Among Young Iranian Soldiers.

Background: Prevention of the incidences of mental disorders, psychological problems, or their rapid diagnosis is an important issue that has led to the creation of a mental health literacy concept and the development of standard tools for evaluating them. This study is the first step in the designing and psychometrics of the Mental Health Literacy Questionnaire (MHLQ) in Iran. The purpose of this study was to design the psychometric properties of the MHLQ in soldiers. Methods: This study is a methodological study that was designed in three phases: 1) Designing the instrument, 2) Assessing the items, and 3) Psychometric assessment. This study was conducted during 2017-2018, and the soldiers were selected by using a convenience sampling method from different garrisons of Tehran, Iran. To evaluate the content validity of the questionnaire 10 experts, to evaluate the face validity 9 soldiers, and for the pilot study 103 soldiers formed the sample size. Finally, construct validity was assessed among 251 soldiers. Results: In the first phase, 78 items were collected and designed. Then, based on the experts' opinions and preliminary studies, the items were reduced to 52 in the "Assessing the items phase" and then to 42 items in the psychometric phase. In the third phase, 31 items remained in the final version. The CVR and CVI scores of the 52 items were 0.91 and 0.94, respectively. Exploratory factor analysis revealed a 4-factor structure with 31 items of special value that were higher than five that accounted for 55.04 of the total scale variance. The fit indices values indicated that the model is fit for the data. In the total scale, the test-retest reliability and Cronbach's alpha were 0.81 and 0.76, respectively. Conclusion: The MHLQ of soldiers has appropriate psychometric properties and can be considered as a suitable tool for evaluation and screening as well as a basis for educational and research interventions.

Association Between Dimensions of Professional Burnout and Turnover Intention Among Nurses Working in Hospitals During Coronavirus Disease (COVID-19) Pandemic in Iran Based on Structural Model.

Purpose: This study was done to assess the dimensions of professional burnout and turnover intention among nurses working in hospitals during the coronavirus disease 2019 (COVID-19) pandemic in Iran based on a structural model. Methods: This cross-sectional study was performed among 170 nurses working in two referral hospitals of COVID-19 in Tehran Province, Iran, from September to December 2020. Data were collected using the sociodemographic form, Maslach Burnout Inventory (MBI), and Turnover Intention Questionnaire. Data were analyzed with SPSS and Amos software version 22 using independent t-test, ANOVA, and structural equation model. Results: The mean scores for burnout in emotional fatigue, depersonalization, and personal accomplishment dimensions were 25.38 ± 7.55, 9.47 ± 4.40, and 34.94 ± 7.80, respectively, moreover for the turnover intention, the score was 6.51 ± 3.17. The reduced personal accomplishment was identified as a positive predictor of turnover intention (p = 0.01). Work position and interest in attending the organization were significantly correlated with the turnover intention (p < 0.05). Conclusions: There is an immediate need to prepare nurses to cope better with the COVID-19 outbreak. Work-related stressors during the COVID-19 pandemic have led to an increase in nurses' burnout and turnover intention. Identifying and managing the factors related to professional burnout will make it possible to prevent the nurses' turnover intention in such critical situations.

Care needs and preferences from the perspective of COVID-19 patients: A qualitative study.

Background: The COVID-19 epidemic is one of the major health problems worldwide due to its inconceivable spreading power and potential damage. Given the increasing prevalence of the disease, the identification of care needs and preferences of patients could play an important role in providing effective training and caring programs. This study was conducted to explain the preferences and needs of care based on the experiences of patients with COVID-19. Methods: This qualitative study with a content analysis approach was performed in 2 months at a referral general hospital and quarantine centers of COVID-19 in Tehran, the capital of Iran, in 2020. The participants consisted of 15 COVID-19 patients selected through purposive sampling. The data analysis was performed using the conventional content analysis method according to the procedure proposed by Graneheim and Lundman. Results: The results were classified into 5 main categories: (1) access to desirable care and comfort services; (2) access to education and information from credible sources; (3) access to specialized care; (4) support social needs; and (5) need for deep emotional interactions. Conclusion: According to our results, identifying priorities and care needs from the perspective of patients with COVID-19 can help improve knowledge, reduce unrealistic patient concerns, and improve emotional interactions between patients and health care providers.

Health literacy knowledge and experience survey: Cross-cultural adaptation and the psychometric properties of the Iranian nurse version.

BACKGROUND: Nurses' knowledge and Experience with Health Literacy can affect the treatment process, improving the quality of health care and effectively communicating with all clients. Evaluation of nurses' knowledge and experience requires a reliable instrument. This study aimed to translate cross-cultural adaptation and testing of Health Literacy Knowledge and Experience Survey (HL-KES). MATERIALS AND METHODS: This cross-sectional methodological study was done during 2018-2019. The study was carried out in two stages: the first phase was designed to obtain a translation and cross-cultural equivalent of the (HL-KES), based on the World Health Organization (2018) and the Sousa and Rojjanasrirat (2011) Guidelines in six steps: preparation, forward translation, reconciliation, back translation, back translation review and pretesting and cognitive debriefing of the translated questionnaires. The second phase was conducted to evaluate the psychometric properties of the questionnaire. RESULTS: The content validity index and content validity ratio values of all items were >0.62 and 0.79, respectively. Based on the Kuder-Richardson formula, the reliability of the knowledge dimension was reported as 0.7. Furthermore, split-half coefficient for inter-rather reliability and test-retest were 0.76 and 0.96, respectively. The reliability of their experiences with the HL-KES was measured using Cronbach's alpha, in which it was 0.82. CONCLUSIONS: The Persian version of the instrument for assessing nurses' knowledge and experience with health literacy had good validity and reliability. It is recommended that it should be used in educational, clinical environments, and also in future research studies.

Assessing health-care needs of patients with diabetes in Iran's health-care system: A modified Delphi method study.

INTRODUCTION: Due to the increasing prevalence of diabetes in the world, the assessment of the patient needs is essential. Understanding the needs of patients will play a very important role in providing an effective training program for patients. This study aimed to explain the health-care needs of patients with diabetes in Iran's health-care system. MATERIALS AND METHODS: The present study was conducted using a modified Delphi technique in three rounds in 2017-2018. In the first round, patients' needs were extracted based on qualitative interviews and a review of the literature. Then, the second and third rounds were determined through surveys, achieving maximum consensus and grading the importance of the patients' basic needs. Participants selected using purposeful sampling and included 58 diabetes patients, family, and providers of the health system who were referred to urban health centers, rural, and one of the clinics of Darreh Shahr, Ilam Province. For data analysis, qualitative content analysis was used in the first Delphi round and descriptive statistics were used in the second and third rounds. RESULTS: Regarding health-care needs of patients with diabetes, four main themes included: information and knowledge needs, need for reinforcement/reform of religious-cultural beliefs, need for health self-management, and ultimately supportive needs have emerged. CONCLUSIONS: According to the results, before designing and developing effective educational programs, the need assessment to improve knowledge, correcting unrealistic attitudes and beliefs, as well as modifying their self-care behaviors and performance in preventing diabetes is recommended.

Palliative Care in the Health System of Iran: A Review of the Present Status and the Future Challenges.

OBJECTIVES: In the near future, the health system of Iran will face serious public health challenges means increase in the elderly population and the rate of chronic diseases. Therefore, it is anticipated that providing palliative care for chronic diseases will be one of the priorities of the country's health system. The purpose of the present study was to explain the present status and the future challenges of providing palliative care in the health system of Iran and help policy-makers to create a future roadmap by presenting a picture of the present status.  Methods: In this qualitative study, 17 semi-structured interviews were conducted with policy-makers, researchers, and managers of the centers providing palliative care in 2018-2019. Interviews were analyzed using directed content analysis based on the Public Health Strategy and framework analysis. RESULTS: According to the WHO Public Health Strategy, palliative care challenges categorized in 13 subcategory and four main category include policy-making, program implementation, comprehensive education and drug availability. CONCLUSION: Providing palliative care that is currently dispersed in some centers does not meet the needs of chronic diseases. Establishing the palliative care system as one of the major goals of the health system of Iran is possible through reforming the fourfold structure of policy-making, implementation, education and drug availability. Therefore, it is suggested that authorities perform comprehensive and systematic management of challenges using foresight methods.
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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.

Effectiveness of applying problem-solving training on depression in Iranian pregnant women: Randomized clinical trial.

BACKGROUND: Depression during pregnancy is one of the major concerns in mental health, hence using interventional methods for the treatment or reducing the rate of depression is considered a priority for maternal and fetal health. The present study aimed to examine the effectiveness of problem-solving training in reducing depression in pregnant women. MATERIALS AND METHODS: This randomized clinical trial was conducted on seventy pregnant women referring to Prenatal Care Clinics, Najmiyeh hospital in Tehran, Iran. The participants were randomly allocated divided into experimental and control groups. The experimental group was given routine prenatal care training at the clinic along with problem-solving skills training based on the Identify, Define, Explore, Act, Look back model in five sessions, but the control group only received routine prenatal care training. Data were collected using the Beck's Depression Inventory at the beginning of the study and at the immediately and 1 month after two groups. Data were analyzed using descriptive and analytical statistical tests. RESULTS: In the experimental group, the mean depression score significantly reduced from 16.06 ± 4.73 before intervention to 12.83 ± 4.10 and 13 ± 4.24 after intervention and at follow-up (P < 0.05). While in the control group, the mean depression from 15.34 ± 2.94 before intervention to 14.80 ± 2.76 and 14.86 ± 2.924 after intervention and at follow-up. It was not statistically significant in the control group (P > 0.05). CONCLUSIONS: Problem-solving training can be used as an optional method of reducing depression in pregnant women, and it is recommended that should be implemented by the health-care team.

Nurses' human dignity in education and practice: An integrated literature review.

BACKGROUND: Human dignity, as a fundamental human right and a moral obligation, has been emphasized in different fields of nursing. The aim of the present integrative review was to explore the nature of nurses' human dignity in educational and clinical settings. MATERIALS AND METHODS: A literature review was conducted on quantitative and qualitative research papers in English and Persian using the PubMed, ProQuest, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Google Scholar, SID, and Irandoc databases from the year 2000 to 2013. Keywords for the search included dignity, nursing, faculty, nurse clinicians, nursing student, and humanism. In total, 12 research papers met the inclusion criteria for the integrative review. RESULTS: From this review, four key themes emerged. The themes consisted of concept of human dignity (it was as an expression of the professional value in nursing settings), factors affecting human dignity (including respect, communication, autonomy and power, competency and ability, structure of the workplace, and value-based education), dimensions of human dignity (including intrinsic and professional domains), and consequences of human dignity [positive (individual and professional growth and caring professional behavior) and negative (loss of motivation, intention to leave the profession, and non-professional image of nursing in the minds of people)]. CONCLUSIONS: The small number of studies found for the review indicates the need for further research in the field of nurses' dignity. Recognizing nurses' dignity can help to improve the nursing practice and provide them a dignified workplace.

Health-related quality of life of chemical warfare victims: an assessment with the use of a specific tool.

BACKGROUND: Exposure to chemical warfare gases significantly changes the quality of life (QoL) of victims and has significant chronic adverse effects. OBJECTIVE: This study sought to assess the health-related QoL (HRQoL) of chemical victims by means of a tool specifically designed for this purpose. The correlation of their QoL with several demographic factors was evaluated as well. PATIENTS AND METHODS: In this descriptive cross-sectional study, 120 chemical warfare victims were selected from subjects presenting to selected medical centers in Tehran in 2012 using convenience sampling. Two questionnaires of demographic information and HRQoL of chemical warfare victims (specific tool) were used for data collection. The data were analyzed using SPSS version 20 software (IBM, Armonk, NY, USA). RESULTS: The mean and standard deviation (mean ± SD) of scores obtained by chemical warfare victims in physical, psychosocial and spiritual domains was 39.6 ± 16.5, 42.1 ± 15.2 and 82.4 ± 15.4, respectively. Different age groups showed a significant difference in the psychosocial domain score (P < 0.01). Also, the physical and spiritual domain scores had significant differences with respect to the level of education (P < 0.001). The occupational status showed significant differences in the psychosocial and spiritual domains scores of QoL (P < 0.001). The physical and psychosocial domain scores also accounted for a significant difference with respect to the duration and severity of pulmonary symptoms (P < 0.05). CONCLUSIONS: Considering the importance and high value of spirituality in chemical warfare victims, it can be used as strategically for these patients to help them cope with their injury and improve their physical and psychosocial health and QoL.

Factors influencing development of professional values among nursing students and instructors: a systematic review.

INTRODUCTION: Professional values are standards of behavior for performance that provide a framework for appraising beliefs and attitudes that influence behavior. Development of professional values has been a continuous and long process and it is influenced by different factors. The aim of this study is "assessing different factors influencing development of professional values among nursing students and instructors". METHOD: In this systematic review, a broad research was performed to find articles from Persian and English databases: pub Med, Pro quest, Elsevier, SID, Google scholar, Ovid and Iran Doc; nursing student, instructors, ethics, professional value, ethical value and educators were used as the key words. Among 3205 achieved articles, by eliminating repeated ones, 22 articles were assessed during the period 1995-2013. Data achieved from the articles were summarized, categorized and analyzed based on the research question. RESULTS: In this study "education and achieving professional experiences", "Students and instructors' perspectives on professional values", "the role of culture in considering and developing professional special values" and "the effect of learners' individual characteristics" were extracted as the four main themes. CONCLUSION: Considering the effect of educational, cultural and individual factors in developing nurses' professional values; it is recommended to the educational and health centers to consider value-based cares in clinical environments for the patients in addition to considering the content of educational programs based on ethical values in the students' curriculum.