Entering aesthetic concept into the field of patient education: A protocol for an interdisciplinary study to develop a conceptual model.

BACKGROUND: According to the significance of patient education, new conceptual models are constantly required to promote pedagogical competences of health educators. In the field of educational sciences, aesthetic-based education is known as one of the effective types of curriculum planning which has shown many positive pedagogical outcomes. Thus, the researcher's assumption is that, the concept of "aesthetic education" could be transposed from educational sciences to health sciences in order to develop a new formula in the patient education process. The purpose of this study is to explain methods in detail, to develop an aesthetic-based patient education conceptual model through the concept derivation strategy. MATERIALS AND METHODS: 1. Scoping review and inductive data analysis using Walker and Avant's approach to achieve conceptual categories of the concept "aesthetic education." 2. Semi-structured qualitative interviews and directed content analysis to extract the main categories of the concept "aesthetics in the patient education process." 3. Drawing an aesthetic-based patient education conceptual model by allocating new conceptual components to each general step of the patient education process, including needs assessment, goal setting, implementation, and evaluation. 4. Modified Delphi technique to validate the final conceptual model. RESULTS: The first phase will represent the main categories and subcategories of attributes, antecedents, and consequences of "aesthetic education." The second phase will show the main categories and subcategories of attributes, antecedents, and consequences of the new concept named "aesthetic-based patient education." In the third phase, it is expected to achieve a new conceptual model representing the components of aesthetics in the general steps of the patient education process. The fourth phase will propose the final validated conceptual model. CONCLUSIONS: The provided study protocol can be a road map to developing derivative models through concept derivation strategy in health sciences.

Psychometric properties of Persian version of individual innovativeness scale among nursing students: a cross-sectional study.

BACKGROUND: One of the basic necessities for fostering innovation in nursing students is to study the level of individual innovation using an appropriate tool. This study was conducted with the aim of translation and psychometric analysis of 20-item individual innovativeness scale (IIS) developed by Hurt et al., among Iranian nursing students. METHODS: This cross-sectional study was performed on 140 nursing students between September 2020 and June 2021 in one of the southern cities of Iran. IIS was translated through forward-backward method, and its face validity and content validity were examined quantitatively and qualitatively. Then, its construct validity was measured by exploratory factor analysis, and its stability and internal consistency were examined. RESULTS: The evidence of qualitative face validity and content validity of IIS were observed. The impact score was higher than 1.5, content validity ratio was between 0.6 and 1, content validity index was between 0.8 and 1, and SCVI-Average was 0.91. Based on exploratory factor analysis, three sub-scales were extracted that explained 55.49% of the changes in the questions. Cronbach's alpha and intraclass correlation coefficient were 0.880 and 0.949, respectively. CONCLUSION: The Persian version of IIS had acceptable validity and reliability. Therefore, it can be used to assess the level of individual innovation among nursing students and planning interventions in this field. In addition, nursing education researchers can also use this tool for descriptive and interventional studies in the field of individual innovation in nursing students.

An educational program of reducing moral distress (PRMD) in nurses; designing and evaluating.

BACKGROUND: Moral distress is common phenomenon that has negative consequences on nurses, patients, and healthcare systems. This study aims to design and evaluate an educational program to reduce moral distress in nurses. METHODS: This multiphase mixed-method study was done in three stage on February 2021 in Shiraz/Iran. In pre-implementation stage, a content analysis study was conducted on 12 participants were interviewed using purposive sampling and then the program was designed according to qualitative data, panel of expertise and literature review according the seven steps of Ewles and Sminett's model and implemented in one group on 40 nurses using a quasi-experimental design. In Post-Implementation stage, effectiveness of program was evaluated through quantitative and qualitative methods. Quantitative data were gathered by Hamric's 21-question moral distress questionnaire analyzed via SPSS v.25 and analysis of variance repeated measures test. Also, a content analysis study was conducted on 6 PRMD participants using purposive sampling. In Program evaluation stage, convergence of quantitative and qualitative data and the effects of the program were examined. Trustworthiness of qualitative data was accomplished by Lincoln and Guba criteria. RESULTS: First quantitative study revealed the causes of moral distress consisted of deficiency in professional competency, unsuitable organizational culture, personal factors, environmental and organizational factors, management factors, insufficiencies in proficient and efficient communication and nurses' observation of moral dilemma. Results of quantitative stage showed that there was a significant difference (p < 0.05) between the mean score of moral distress before, after, 1 and 2 months after the intervention. The participants in secondary qualitative stage, reported increasing their moral knowledge and skills, improving ethical climate, and moral empowerment. CONCLUSION: The use of different educational tools and teaching methods and the participation of managers in designing strategies had a very effective role in the effectiveness of this educational program.

Exploring senior managers' experiences preparedness to respond to COVID-19: a qualitative study in Iran.

BACKGROUND: Epidemics caused by emerging respiratory viruses are challenging for the health system of most societies, and preparedness of the health system in responding to such epidemics is important. Therefore, the aim of this study was identifying different fields and key issues of the senior managers' experiences preparedness to respond to the COVID-19 epidemic from the Iranian senior managers' point of view. METHODS: This is a qualitative descriptive study. Eighteen in-depth and semi-structured individual interviews were conducted for data collection. For this purpose, 18 senior managers with work experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. The collected data were analyzed according to Graneheim and Lundman's approach. RESULTS: Analysis of the data resulted in the emergence of five themes and twelve sub-themes. The main themes and sub-themes included: (1) capacity improvement consisting of performance improvement and logistic improvement; (2) resource and infrastructure management including supply and support of human resources, infrastructure improvement, and supply of equipment; (3) an increase in epidemiology capacity including epidemiology improvement and emerging disease surveillance; (4) application of the principles of disaster and emergency management including intra- and extra-organizational interaction management, disaster risk management, and data management; and (5) society resilience increase including improving adaptation skill and maintaining health and social participation. CONCLUSION: The results of this study present the key issues for the management of future emergency situations. Health system managers and policymakers in Iran and other countries should be aware of these key issues and apply them in practice to prepare the health systems to respond to next outbreaks. Indeed, the study results can help policymakers and health system managers to plan to achieve acceptable preparedness for the management of such outbreaks.

Impact of Watson's human caring-based health promotion program on caregivers of individuals with schizophrenia.

BACKGROUND: Caring for people with schizophrenia is accompanied by challenges that impact caregiver health. We conducted this study to explore the effect of a Caring Science-Based health promotion program on the sense of coherence and well-being among caregivers of persons with schizophrenia. METHODS: This randomized clinical trial with the Solomon four-group design was conducted on 72 caregivers randomly allocated into two intervention and two control groups. A health promotion program based on Watson's theory was performed individually through five face-to-face sessions and a four-week follow-up. Settings were the psychiatric centers of the three educational, specialty, and subspecialty Ibn-e-Sina, Moharary, and Hafez hospitals affiliated with Shiraz University of Medical Sciences (SUMS), south of Iran. The data were collected using a demographic information form, the Sense of Coherence Scale, and the Caregiver Well-Being Scale. One-way ANOVA, chi-square, Kruskal-Wallis, and independent t-test were used to determine the homogeneity at baseline. In the post-test, multiple between-groups and pairwise comparisons were assessed by One-way ANOVA and Tukey's post-hoc. Within-group comparisons were evaluated using paired t-tests. All tests were two-tailed, and the statistical level was considered 0.05. RESULTS: Data analysis showed that the mean scores of caregiver sense of coherence and well-being from pre-intervention to post-intervention were significantly increased in the intervention groups (p < 0.001). At the same time, there were no significant differences in the control groups. CONCLUSION: The health promotion program based on Watson's human caring theory facilitated ongoing intrapersonal, and holistic caring and improved the sense of coherence and well-being in caregivers of persons with schizophrenia. Hence, this intervention is recommended for developing healing care programs. TRIAL REGISTRATION: https://www.irct.ir/trial/55040 : IRCT20111105008011N2 (11/04/2021).

Strategies of Iranian Psychiatric Nurses to Deal with Moral Distress.

Context: Moral distress is a common phenomenon in nurses that causes feelings of anger, fatigue, reduced quality of patient care, and leaving the nursing profession. To reduce the negative effects of this phenomenon, it is necessary to study the strategies and mechanisms to deal with it. Aims: It has been less studied in psychiatric nurses, so this study was conducted to investigate the mechanisms and strategies of psychiatric nurses in dealing with situations of moral distress. Settings and Design: This qualitative study was conducted based on a conventional content analysis of 12 psychiatric nurses selected by a purposive sampling method in the 2020 winter in Shiraz, Iran, considering the maximum diversity. Data were collected through semi-structured interviews with participants for an average of 40-60 minutes per interview until data saturation. Results: We obtained strategies for dealing with moral distress in psychiatric nurses in four categories. The categories included "Coping strategies," "Establish therapeutic and professional communication," "Managerial support for nurses," and "Commitment to religious beliefs." Conclusions: Psychiatric nurses use personal, team, and management strategies to reduce moral distress in themselves and their colleagues and reduce its adverse effects on patients. Management support and organizational cooperation are necessary for the better implementation of these strategies.

From disobedience to struggle for adaptation: ​​nursing students' experiences of attending the clinical learning environment during Covid-19 pandemic.

BACKGROUND: The Covid-19 pandemic has affected the clinical education of nursing students all over the world. Considering the importance of clinical education and clinical learning environment (CLE) in the education of nursing students, identifying the challenges and problems faced by these students during the covid-19 pandemic helps to plan more effectively in this regard. The aim of this study was to investigate the experiences of nursing students in CLEs during the Covid-19 pandemic. METHODS: A descriptive qualitative research was conducted, which used a purposive sampling technique to recruit 15 undergraduate nursing students from Shiraz University of Medical Sciences between July 2021 and September 2022. Data were collected through in-depth semi-structured interviews. For data analysis, conventional qualitative content analysis based on Graneheim and Lundman approach was used. RESULTS: The data analysis led to emergence of two themes of "disobedience " and "struggle for adaptation". The disobedience theme consists of two categories: "objection to attend CLE" and "patient marginalization". The theme of struggle for adaptation includes two categories: "using support sources" and "applying problem-oriented strategies". CONCLUSION: At the beginning of the pandemic, the students were unfamiliar due to the disease, as well as fear of contracting themselves and infecting others, so they tried not to be in the clinical environment. However, they gradually tried to adapt to the existing conditions by applying support resources and using problem-oriented strategies. Policymakers and educational planners can use the results of this study to plan for solving the challenges of students during future pandemics and improve the condition of CLE.

Research article Individual innovation from the perspective of nursing students: A qualitative study.

BACKGROUND: One of the necessities of today's world that prepares nursing students for their future professional roles is the concept of individual innovation. However, there is no clear definition of individual innovation in nursing. This study was designed and implemented with the aim of investigating the concept of individual innovation from the perspective of nursing students using qualitative content analysis. METHODS: This qualitative study was conducted from September 2020 to May 2021 on 11 nursing students of one of the nursing schools in southern Iran. The participants were selected by purposive sampling method. Data were collected through semi-structured individual interviews. Data analysis was done using conventional content analysis and MAXQDA 2018. RESULTS: Following data analysis, 662 initial codes were extracted forming 9 categories and three main themes. The themes included personal and professional dynamism, professional inventiveness, and the integration of innovation drivers. CONCLUSIONS: The concept of individual innovation in the nursing student included personal and professional dynamics and professional inventiveness. Individual innovation occurred through combination of innovation drivers. Managers and policy makers of nursing education can use the results of this to get acquainted with this concept and develop policies and guidelines to develop nursing students' individual innovation. Through getting familiar with the concept of individual innovation, nursing students can try to flourish this characteristic in themselves.

Assessing the psychometric properties of persian version of Zarit Burden interview among family caregivers of patients with multiple sclerosis.

BACKGROUND: Caring for patients with multiple sclerosis (MS) imposes a great burden on caregivers and affects their lives in various aspects. This study aimed to evaluate the psychometric properties of Persian version of 22-item Zarit Burden Interview (ZBI-22) among family caregivers of patients with MS. METHODS: This methodological study was conducted in Fars province, southern of Iran. For this purpose, 120 family caregivers were recruited to participate in the study from January to March 2022. Zarit Burden Interview (ZBI) was translated into Persian through forward-backward method. Face and content validity were assessed. Construct validity was assessed using exploratory factor analyses (EFA), and its reliability was assessed by measuring internal consistency and testretest stability. RESULTS: According to face validity, the impact scores of all items were more than 1.5. Content validity ratio and content validity index values of all 22 items were 0.64-1 and 0.82-1, respectively. The scalelevel CVI/Ave was 0.97. Based on the results of factor analysis, five factors with eigenvalues more than 1 were extracted, which altogether explained 62.62% of the total variance of ZBI score. Among 22 items, one item was deleted during EFA validity assessment. Factor loading values ranged from 0.40 to 0.88. The reliability of the scale was confirmed (total Cronbach's alpha of the ZBI = 0.88). Moreover, testretest stability assessment revealed no significant difference between test and retest scores (P > 0.05). The intraclass correlation (ICC) for the ZBI and ICCs among its factors were 0.88 and 0.6-0.86, respectively. CONCLUSION: The Persian version of five-factor structure ZBI can be a valid and reliable scale, and it can be used to assess caregiver burden among family caregivers of patients with MS in Iran.

Moral distress in psychiatric nurses in Covid-19 crisis.

BACKGROUND: The COVID-19 pandemic has put heavy pressure on nurses. Psychiatric nurses are also exposed to moral distress due to the special conditions of psychiatric patients and patient's lack of cooperation in observing health protocols. This study has been conducted to explore and describe factors that caused moral distress in Iranian psychiatric nurses during the COVID-19 pandemic. METHOD: This qualitative study with a conventional content analysis approach involved 12 nurses at the Shiraz University of Medical Sciences in Iran. This study was conducted in the winter of 2021. Data collection was performed by semi-structured interviews, data analysis was performed based on the five steps of Graneheim and Lundman. RESULTS: By continuous comparison and integration of data, 17 subcategories, 8 subcategories, and 3 categories were extracted from 252 initial codes. The causes of moral distress in psychiatric nurses during the COVID-19 pandemic were identified as emotional responses (Fear and Doubt), relational factors (Nurses' Relationship with Each Other, Nurse-physician Relationship, and Relationship whit Patients), and Institutional factors (Lack of Attention to Health Instructions, Failure to complete the treatment process for patients and Institutional Policies). CONCLUSION: New dimensions of the causes of moral distress associated with the COVID- 19 pandemic are discovered in this study. Managers and planners should equip psychiatric hospitals with isolation facilities and Personal Protection Equipment for patients and nurses. Strengthening the ethical climate by improving communication skills and individual nursing empowerment to prevent moral distress is recommended.

The effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with multiple sclerosis: a quasi-experimental study.

BACKGROUND: Fatigue is one of the most common problems in patients with multiple sclerosis (MS) and has adverse effects on their sleep status and self-efficacy. This study aimed to determine the effect of distance nurse-led fatigue management on fatigue, sleep quality, and self-efficacy in patients with MS. METHODS: This quasi-experimental study was performed on 60 patients with MS in Arak, Iran. Subjects were randomly assigned into intervention and control groups. The intervention group received eight sessions of nurse-led fatigue management training through the Skyroom platform. The control group received only the usual programs. Data were collected before and two months after the intervention using the Fatigue Severity Scale, the Pittsburgh Sleep Quality Index, and the Multiple Sclerosis Self-Efficacy Scale. The significance level in this study was determined 0.05. RESULTS: After the intervention, the mean score of fatigue severity in the intervention group was significantly lower than the control group (2.52 ± 0.40 vs 5.65 ± 0.52) (P < 0.001). Also, after the intervention, the mean score of self-efficacy in the intervention group was significantly higher than the control group (49.37 ± 3.25 vs 24.43 ± 2.52) (P < 0.001). Furthermore, after the intervention the mean score of sleep quality was lower in intervention group (11.92 ± 2.01) than the control group (15.46 ± 1.40) (P < 0.001). CONCLUSION: Distance nurse-led fatigue management improved fatigue, sleep quality, and self-efficacy in patients with MS. We recommend the use of these courses as an important step toward improving fatigue, sleep quality, and self-efficacy among these patients.

The efficacy of nasal tip hold-press on venous cannulation pain in children: a prospective randomized controlled study.

BACKGROUND: Venipuncture is a common and quiet unpleasant experience for pediatric patients. The pain associated with venous cannulation disturbs the children. Different methods have been used to minimize the pain. The present study evaluated the efficacy of holding and pressing the tip of the nose on the venipuncture pain in pediatric patients. METHODS: A prospective randomize controlled study carried out using the Visual Analogue Scale (YAS) for assessment cannulation pain and the Yale Preoperative Anxiety Scale (YPAS) for the assessment of anxiety before cannulation. Sixty patients aged 6 to 12 years, who needed venipuncture for general anesthesia, were divided into two groups of 30 each: a control group and a study group. Nasal tip was held and pressed during venipuncture by the parents in the study group. No intervention was done in the control group. RESULTS: The YPAS scores were not different between the two groups before venous cannulation (P=0.136). Comparing the two groups. There was no difference regarding the change in HR and BP during venous cannulation. There was significantly lower cannulation pain in the study in comparison with the control group (P=0.010). CONCLUSIONS: Holding and pressing the tip of the nose during venipuncture reduce the severity of venipuncture pain in pediatric patients. This could be secondary to distraction along with the physiological effect of the Valsalva maneuver on pain. Therefore, we recommend that holding and pressing the tip of the nose is a safe and effective method for reducing the severity of pain from venipuncture in pediatric patients.

Application of Orem's theory-based caring programs among chronically ill adults: A systematic review and dose-response meta-analysis.

AIM: This study aimed to clarify the value of caring programs developed according to Orem's Self-Care Deficit Nursing Theory regarding quality of life and self-care as the primary outcomes and self-efficacy, anxiety, depression, and stress as the secondary outcomes among individuals aged 18-70 years with chronic diseases. BACKGROUND: Chronically ill patients need to receive appropriate self-care training, counseling, and support. In this regard, the use of caring programs developed based on theories is highly suggested. Orem's Nursing Theory is the most well-known theory that provides a structure to involve patients in their self-care activities. INTRODUCTION: Orem's Nursing Theory has been increasingly applied to guide practice for patients with chronic health conditions. However, recent trials have reported conflicting findings on the value of its application. METHODS: Eight information sources (e.g., Web of Science Core Collection, PubMed, and Scopus) and the International Clinical Trials Registry Platform were searched up to 30 March 2022. RESULTS: A total of 46 studies and 11 study register entries were eligible. Orem's theory-based interventions significantly improved the quality of life, self-care, and self-efficacy as well as significantly reduced anxiety and depression. However, the value of the interventions on stress was uncertain, as performing the meta-analysis was not possible. DISCUSSION: Orem's Nursing Theory can help nurses in different fields to dynamically and carefully evaluate patients' self-care ability and implement appropriate nursing measures tailored to their needs, interests, and problems. Considering the inconsistent evidence to support the empirical adequacy of this theory, high-quality reviews are essential. CONCLUSION: Orem's theory-based programs had a favorable effect on taking care of adults with chronic diseases. IMPLICATIONS: This study augments the previous reviews related to the applicability of Orem's Nursing Theory. Considering the undesirable evidence quality and the high between-study heterogeneity, further well-designed trials are required to draw an evidence-based conclusion.

Causes of futile care from the perspective of intensive care unit nurses (I.C.U): qualitative content analysis.

BACKGROUND: Medical care that has therapeutic effects without significant benefits for the patient is called futile care. Intensive Care Units are the most important units in which nurses provide futile care. This study aimed to explain the causes of futile care from the perspective of nurses working in Intensive Care Units are. METHOD: The study was conducted using a qualitative approach. Qualitative content analysis was used to analyze the data. Study participants were 17 nurses who were working in the Intensive Care Units are of hospitals in the north of Iran. They were recruited through a purposeful sampling method. Data was gathered using in-depth, semi-structured interviews from March to June 2021. Recruitment was continued until data saturation was reached. RESULTS: Two main themes, four categories, and thirteen subcategories emerged from the data analysis. The main themes were principlism and caring swamp. The categories were moral foundation, professionalism, compulsory care, and patient's characteristics. CONCLUSION: In general, futile care has challenged nursing staff with complex conflicts. By identifying some of these conflicts, nurses will be able to control such situations and plan for better management strategies. Also, using the findings of this study, nursing managers can adopt supportive strategies to reduce the amount of futile care and thus solve the specific problems of nurses in intensive care units such as burnout, moral stress, and intention to leave.

Comparison of the effectiveness of the electronic portfolio and online discussion forum methods in teaching professional belonging and ethical behaviors to nursing students: a randomized controlled trial.

BACKGROUND: Nursing is a profession that has had many ethical aspects and understanding professional belonging and ethics as a deep and complex process is one of the basic concepts in this field. This study aimed to compare the effectiveness of training professional belonging and ethical behaviors in two methods: electronic portfolio and online discussion forum in nursing students. METHODS: This study is a single-blinded randomized-controlled trial (RCT) with two parallel intervention groups and a third control group. The sample size was 90 selected by block randomization method. The educational contents of professional belonging and ethical behaviors were presented to the participants in two ways: electronic portfolio and online discussion forum. Demographic information form, professional belonging questionnaire, and ethical behaviors questionnaire were applied to collect data. Data were analyzed using SPSS version 24 software. Respectively mean, standard deviation and repeated measured, analysis of variance tests was used in descriptive and analytic statistic. (P value < 0.05). RESULTS: Comparison of the mean score of professional belonging and ethical behavior in the three stages of pretest, immediately after the test and four weeks after the test in all three groups was significant (P < 0.001). The control group had a higher mean score of professional belonging immediately after the test (108.18 ± 48.9) compared to the other two groups. Also, the online discussion forum group had a higher mean score on ethical behavior in four weeks after the test (104.2 ± 0.8) compared to the other two groups. CONCLUSION: Training based on two methods of the electronic portfolio and online discussion forum increases and enhances the level of ethical behaviors in students. Therefore, the implementation of such methods of training can be useful in improving, promoting, and learning ethical behaviors in nursing students. On the other hand, training based on the two methods had a negative impact on professional belonging. Therefore, it is suggested that future studies be conducted with a greater focus on areas of professional belonging. TRIAL REGISTRATION: This research has been registered in Iranian Clinical Trial Registration Center (IRCT) with registration number "IRCT20180612040063N1" and registration date "16/07/2018".

The effect of time management education on critical care nurses' prioritization: a randomized clinical trial.

BACKGROUND: Nurses are at the forefront of patient care, and time management skills can increase their ability to make decisions faster. This study aimed to assess the effect of a time management workshop on prioritization and time management skills among nurses of emergency and intensive care units. METHODS: This randomized clinical trial was performed with 215 nurses. The educational intervention about time management was held in the form of a workshop for the intervention group. The time management questionnaire was completed by both groups before, immediately after, and 3 months after the intervention. RESULTS: Most participants were female (n=191, 88%), with a mean age of 31.82 years (range, 22-63 years). Additionally, the participants' work experience ranged from 1 to 30 years (mean±standard deviation, 8.00±7.15 years). After the intervention, the mean score of time management increased significantly in the intervention group, but no significant difference was observed in this regard in the control group. The results also revealed a significant difference between the intervention and control groups regarding the mean score of time management 3 months after the intervention (P<0.001). CONCLUSIONS: Time management training helped nurses adjust the time required to perform and prioritize various tasks.

The effect of Teach-back method education on the control of asthma and family care pressure of patients in Iran.

OBJECTIVES: To investigate the effect of teach-back education on patient asthma control and family care pressure of patients with asthma. METHODS: The present study is a clinical trial and the study population was patients referred to Shahid Faghihi and Shahid Motahhari clinics in Shiraz, Iran. 58 patients with asthma and their caregivers were randomly assigned to the intervention and control groups, for a total of 29 subjects in each group. In the intervention group: the teach-back method was delivered individually to the patient and his or her primary caregiver in three sessions of approximately 60 minutes at one-day intervals. each session included presentations, practical techniques and a booklet. In this study, patients and caregivers in the control group were not trained. Before the intervention, 4 and 8 weeks after the intervention, asthma control test and spirometry test were performed to evaluate asthma control; Also, before the intervention and 8 weeks after the intervention, Zarit test was performed to evaluate the care burden. RESULTS: The findings of repeated measures tests showed that, compared to the control group, the intervention group obtained a greater increase in the vital capacity index (p=0.028) and in the disease control score (p=0.001), as well as a reduction in the burden of care on family members (p<0.001). CONCLUSIONS: The present study showed that teaching asthma related topics to the patient and her caregiver along with the follow-up and supervision of the nurse improves the asthma control of the patient and also reduces the caregiver pressure.

The effect of Teach-back method education on the control of asthma and family care pressure of patients in Iran / El efecto de la educación del método Teach-back en el control del asma y la carga del cuidado familiar de los pacientes en Irán / O efeito da educação do método Teach-back no controle da asma e a carga do cuidado familiar dos pacientes no Irã

Objective. To investigate the effect of teach-back education on patient asthma control and family care pressure of patients with asthma. Methods. The present study is a clinical trial and the study population was patients referred to Shahid Faghihi and Shahid Motahhari clinics in Shiraz, Iran. 58 patients with asthma and their caregivers were randomly assigned to the intervention and control groups, for a total of 29 subjects in each group. In the intervention group: the teach-back method was delivered individually to the patient and his or her primary caregiver in three sessions of approximately 60 minutes at one-day intervals. each session included presentations, practical techniques and a booklet. In this study, patients and caregivers in the control group were not trained. Before the intervention, 4 and 8 weeks after the intervention, asthma control test and spirometry test were performed to evaluate asthma control; Also, before the intervention and 8 weeks after the intervention, Zarit test was performed to evaluate the care burden. Results. The findings of repeated measures tests showed that, compared to the control group, the intervention group obtained a greater increase in the vital capacity index (p=0.028) and in the disease control score (p=0.001), as well as a reduction in the burden of care on family members (p<0.001). Conclusion. The present study showed that teaching asthma related topics to the patient and her caregiver along with the follow-up and supervision of the nurse improves the asthma control of the patient and also reduces the caregiver pressure.

Objetivo. Investigar el efecto de la educación con el método teach-back sobre el control del asma y la carga del cuidado familiar de estos pacientes. Métodos. Ensayo clínico cuya población de estudio fueron los pacientes remitidos a las clínicas Shahid Faghihi y Shahid Motahhari en Shiraz, Irán. Se asignaron aleatoriamente 58 pacientes con asma y sus cuidadores a los grupos de intervención y control, con un total de 29 díadas en cada grupo. Las personas del grupo de intervención recibieron formación con el método teach-back que se impartió individualmente al paciente y a su cuidador principal en tres sesiones de aproximadamente 60 minutos en tres días consecutivos. Cada sesión incluía presentaciones, técnicas prácticas y un folleto. Los pacientes y cuidadores del grupo de control no recibieron formación. Antes de la intervención y a las 4 y 8 semanas después de la misma, se aplicaron las escalas de control del asma y la de Zarit para evaluación de la carga del cuidado y, además se practicó una espirometría. Resultados. Las pruebas de medidas repetidas entre los grupos de estudio mostraron que, comparando con el grupo control, el grupo de intervención obtuvo mayor aumento del índice de capacidad vital (p=0.028) y del puntaje de control de la enfermedad (p=0.001), además, se redujo la carga del cuidado en los familiares (p<0.001). Conclusión. El presente estudio mostró que con la enseñanza de temas relacionados con el asma al paciente y a su cuidador, junto con el seguimiento y la supervisión de la enfermera, se mejora el control del asma en el paciente y también se reduce la carga del cuidador.

Objetivo. Investigar o efeito da educação com o método teach-back sobre o controle da asma e a carga do cuidado familiar destes pacientes. Métodos. Ensaio clínico no qual a população de estudo foram os pacientes enviados às clínicas Shahid Faghihi e Shahid Motahhari em Shiraz, Irã. 58 pacientes com asma e seus cuidadores foram designados aleatoriamente aos grupos de intervenção e controle, com um total de 29 díade em cada grupo. As pessoas do grupo da intervenção receberam formação com o método teach-back que se transmitiu individualmente ao paciente e ao seu cuidador principal em três sessões de aproximadamente 60 minutos em três dias consecutivos. Cada sessão incluía apresentações, técnicas práticas e um folheto. Os pacientes e cuidadores do grupo de controle não receberam formação. Antes da intervenção e às 4 e 8 semanas depois dela, se aplicaram as escalas de controle da asma e a de Zarit para avaliação da carga do cuidado e, além disso se praticou uma espirometria. Resultados. As provas de medidas repetidas entre os grupos de estudo mostraram que, comparando com o grupo de controle, o grupo de intervenção obteve maior aumento do índice de capacidade vital (p=0.028) e da pontuação de controle da doença (p=0.001), ademais de que se reduziu a carga do cuidado nos familiares (p<0.001). Conclusão. O presente estudo mostrou que o ensino de temas relacionados com a asma ao paciente e ao seu cuidador, junto com o seguimento e a supervisão da enfermeira, se melhora o controle da asma no paciente e também se reduz a carga do cuidador.