A concept analysis of Watson's nursing Caritas process.

AIM: The main objective of this analysis is to give an understanding of Watson's nursing Caritas as a concept. DESIGN: Watson's nursing Caritas is an abstract concept, and difficult to define and operationalize because of its philosophical nature. Watson's nursing Caritas develops a clear relationship between care, caring factors, and the processes of human life. METHODS: We used Walker and Avant's method. PubMed, Scopus, Ovid, EBSCO, Science Direct, Web of Science, Google Scholar, and ProQuest were searched. "Caritas process" and "Watson's caring theory" were searched. In the primary search, 883 articles were found, but eventually, 25 articles were included in the study. RESULTS: We define Watson's nursing Caritas as the process based on caring consciousness, engaging in reliable human caring relationships for healing support, integrity, and development of humanity that alters the concept of caring into a higher ethical commitment inspired by responsibility for others, and different meanings, including kindness, compassion, joyfulness, and peacefulness and leads to the establishment of caring behavior in clinical Watson's nursing Caritas, thus leading to improving performance. CONCLUSION: Clinical nursing Caritas enables nurses to develop an effective human being relationship between nurse-client-family, and ultimately achieve a common experience and perception of caring.

Blood lead level risk factors and reference value derivation in a cross-sectional study of potentially lead-exposed workers in Iran.

OBJECTIVES: This exploratory investigation aimed to measure blood lead levels and associated risk factors in exposed workers in Iran, and to derive appropriate reference values for blood lead in this population as a means of epidemiological comparison. DESIGN: Cross-sectional. SETTING: Manufacturing plants with potential lead exposure in Southern Khorasan Province, Iran. PARTICIPANTS: The study included 630 workers, selected through stratified random sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary measures in this exploratory investigation were venous blood lead concentration (BLC) and associated risk factors of age, gender, work experience, cigarette smoking and history of opium use. The secondary measures were symptoms associated with lead toxicity. Data analyses were conducted using Student's t-test, Mann-Whitney U test, one-way analysis of variance, Kruskal-Wallis test, Spearman correlation coefficient and regression analysis. RESULTS: Mean and median BLCs were 6.5±8.1 µg/dL and 3.9 µg/dL (IQR: 2.9-5.8), respectively. Of the subjects, 85 (13.5%) had BLC ≥10 µg/dL. The derived reference BLC value in this study was 30 µg/dL for men and 14 µg/dL for women. Increasing work experience and age were associated with BLC >10 µg/dL. Radiator manufacturers were up to 12.9 times (95% CI 4.6 to 35, p<0.005) more likely than painters to have BLC >10 µg/dL. Most subjects reported multiple symptoms. CONCLUSIONS: The mean BLC was above the maximum recommended concentration. There was a significant relationship between higher BLC and age or working in a printing factory or radiator manufacturing. These findings can direct efforts towards reducing occupational lead exposure.

Epidemiological and clinical profiles of acute poisoning in patients admitted to the intensive care unit in eastern Iran (2010 to 2017).

BACKGROUND: Acute poisoning is a common chief complaint leading to emergency department visits and hospital admissions in developing countries such as Iran. Data describing the epidemiology of different poisonings, characteristics of the clinical presentations, and the predictors of outcome are lacking. Such data can help develop more efficient preventative and management strategies to decrease morbidity and mortality related to these poisonings. This manuscript describes the epidemiology of acute poisoning among patients admitted to the intensive care unit (ICU) in Birjand, Iran. METHODS: This retrospective, cross-sectional study was conducted to characterize acute poisonings managed in the ICU during a 7-year period from March 2010 to March 2017 in a single center in Birjand, Iran. Patient characteristics, suspected exposure, the route of exposure, and outcome data were collected from hospital medical records. RESULTS: During the study period, 267 (64% male and 36% female) patients met inclusion criteria. Pharmaceutical medication (36.6%), opioids (26.2%) followed by pesticides (13.9%) were the most common exposures 38.2% of these cases were identified as suicide attempts. There were different frequencies in terms of xenobiotic exposure in relation to gender (p = 0.04) and the survival (p = 0.001). There was a significant difference between various xenobiotics identified as the cause of poisoning (p = 0.001). Mortality rate in our study was 19.5%. The incidence of outcomes was significantly higher in patients poisoned with opioids, pesticides, benzodiazepines, and tricyclic antidepressants (p < 0.05). The median length of hospital stay was higher in pesticide-poisoned patients (p = 0.04). CONCLUSION: Opioids and pesticides were the most common exposures. The mortality rate of the poisoned patients in the ICU was proportionately high. The mortality rate due to opioid poisoning is a major concern and the most significant cause death due to poisoning in the region. Further monitoring and characterization of acute poisoning in Birjand, Iran is needed. These data can help develop educational and preventative programs to reduce these exposures and improve management of exposures in the prehospital and hospital settings.

Lead Toxicity due to Ingestion of Lead-Contaminated Opium in a Patient Presenting with Motor Neuropathy and Upper Limb Paresis: A case report.

Opium users may present with central or peripheral nervous system-related symptoms, gastrointestinal complications and anaemia; in such cases, lead poisoning should be suspected and chelation therapy initiated as soon as possible. We report a 64-year-old male patient with a 20-year history of opium addiction who was referred to the Imam Reza Hospital, Birjand, Iran, in 2017 with severe motor neuropathy and paresis in both upper limbs. His primary symptoms were generalised weakness, abdominal and bone pain, constipation and lower limb paraesthesia that had started several months prior. In addition, he reported severe progressive bilateral paresis of the upper limbs of one month's duration. A diagnosis of lead poisoning was confirmed by a blood lead level of 140 µg/dL. The patient underwent chelation therapy after which he improved significantly. At a one-year follow-up visit, he was neurologically intact and symptom-free.

The effects of warmed intravenous fluids, combined warming (warmed intravenous fluids with humid-warm oxygen), and pethidine on the severity of shivering in general anesthesia patients in the recovery room.

BACKGROUND: Shivering is a common complication of general and epidural anesthesia. Warming methods and many drugs are used for control of shivering in the recovery room. The present study is a randomized clinical trial aimed to investigate the effects of two interventions in comparison with pethidine which is the routine treatment on shivering in patients undergoing abdominal surgery with general anesthesia. MATERIALS AND METHODS: Eighty-seven patients undergoing abdominal surgery by general anesthesia were randomly assigned to three groups (two intervention groups in comparison with pethidine as routine). Patients in warmed intravenous fluids group received pre-warmed Ringer serum (38°C), patients in combined warming group received pre-warmed Ringer serum (38°C) accompanied by humid-warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The elapsed time of shivering and some hemodynamic parameters of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data were analyzed by software SPSS (v. 16) with the significance level being P < 0.05. RESULTS: The mean of elapsed time in the warmed intravenous serum group, the combined warming group, and the pethidine group were 7 (1.5) min, 6 (1.5) min, and 2.8 (0.7) min, respectively, which was statistically significant (P < 0.05). The body temperatures in both combined warming and pethidine groups were increased significantly (P < 0.05). CONCLUSIONS: Combined warming can be effective in controlling postoperative shivering and body temperature increase.