Iranian Journal Of Medical - Surgical Nursing
Volume:9 Issue: 3, Aug 2020

 Providing high-quality nursing care is the vision of healthcare systems. Several factors contribute to providing high-quality care, which many of them need further investigation. In this line, qualitative research that helps researchers to access the thoughts and feelings of participants can play an important role in identifying care challenges.

 Therefore, this study aimed to identify nurses’ concerns about the nursing care quality process in Intensive Care Units (ICUs).

 In this study, a conventional content analysis was used for data analyses. Data were collected by unstructured interviews with 10 ICU nurses. Participants were selected using the purposive sampling technique. The sampling continued upon reaching data saturation.

 In total 290 codes were extracted, that using analysis and compare were categorized into three 3 main categories: "care barriers ", "motivational barriers ", and "management barriers ". Twelve sub categories were also extracted, including: "high workload", "not considering the educational needs", "not considering the work standards", "out of duty cares", "ward's bad structure", "personal motivation shortage", "poor work motivation", "personal and organizational motivation interference", "rules without work support", "work inconsistency in the ward", "keeping the position", and "inefficient communications between nurses and physicians".

 In this study, barriers to nursing high-quality care and its related motivational and managerial dimensions were investigated. In other words, the present study identified barriers in different dimensions, and by identifying the effective factors in providing quality care has facilitated the implementation of measures to address the problems.

 Breast cancer is the most common on the list and the leading cause of cancer death in women worldwide. Although radiation therapy is a key component of cancer treatment, it causes several complications, including radiodermatitis.

 The current study aimed to investigate the effect of preventive-care education on radiotherapy-induced dermatitis in patients with breast cancer.

 In this quasi-experimental study, 80 patients with breast cancer who were candidates for radiation therapy were selected by convenience sampling and randomly assigned to the groups of intervention and control. Data were collected using a demographic form and a scale for assessing skin complications developed by the Radiation Therapy Oncology Group (RTOG). Patients in the intervention group were trained individually in three 30-minute sessions on treatment methods, chemotherapy, and prevention as well as radiodermatitis care. While the control group received routine care. Data were analyzed in SPSS 22 using the Mann-Whitney test, chi-squared test, Fisher's exact test, independent t-test, and generalized estimation equation (GEE) at a significance level of < 0.05.

 No statistically significant difference was found between the two groups concerning the marital status, smoking, education level, age, BMI, plasma albumin level, and disease stage. After providing the intervention, the prevalence of radiodermatitis grade 1 was 27.5 and 7.5% in the control and intervention groups, respectively. After six weeks, 30% and 10% of patients in the control group developed radiodermatitis grades 3 and 4, respectively, but only 7.5% of patients in the intervention group had radiodermatitis grade 3. The results of GEE indicated that over time, the probability of developing higher grades of radiodermatitis increases by 1.074. This probability was 1.355 higher in the control group than the intervention group (P value = 0.03).

 This study demonstrated the positive effect of the educational intervention on the severity of radiodermatitis in patients with breast cancer undergoing radiotherapy. Along with medication, implementing an educational program that teaches patients how to prevent radiodermatitis helps to reduce the incidence of radiodermatitis.

 Considering that women are the main components of family health and the main models for education and promotion of healthy lifestyles to the next generation, the study of lifestyle and effective factors in promoting women’s health, especially at reproductive age, is of great importance.

 The present study aimed to determine the predictors of a health-promoting lifestyle in women of reproductive age in Zahedan based on Pender’s health promotion model (HPM).

 This descriptive cross-sectional study was conducted on a sample of 200 women aged 15 - 49 in Zahedan, Southeastern Iran, using multi-stage cluster sampling in 2019. The instruments used to collect the data were the demographic information form, the Perceived Self-Efficacy scale, the Perceived Social Support scale, the Perceived Emotions scale, the Perceived Barriers scale, and the health-promoting lifestyle profile II. The collected data were analyzed by descriptive statistics, Pearson correlation coefficient, independent samples t-test, one-way analysis of variance (ANOVA), and multiple linear regression analysis using the enter method in SPSS software (version 25).

 The mean score of health-promoting lifestyle was 69.82 ± 13.59 out of the score range of 32 to 128. The highest and lowest mean scores were related to the nutrition subscale (20.08 ± 4.3) and the exercise subscale (14.19 ± 4.51), respectively. It was shown that the health-promoting lifestyle had a significant positive correlation with perceived self-efficacy, perceived social support, and perceived emotions (P = 0.001) and a significant negative correlation with perceived barriers (P = 0.005). The results of multiple linear regression analysis showed perceived self-efficacy (P = 0.001), perceived social support, and perceived emotions were predictors of a health-promoting lifestyle in women of reproductive age (P = 0.05, P = 0.001), and these three variables together predicted 37% of the variations in the health-promoting lifestyle score.

 This study showed that women with 54.68% of the total lifestyle score did not have an acceptable lifestyle. Besides, perceived self-efficacy was the most important factor and the strongest predictor of women’s health-promoting lifestyle. Accordingly, some interventions must be planned and implemented to improve the health-promoting lifestyle in women of reproductive age and increase their self-efficacy.

 Teach-back training is one of the interactive teaching methods that assess the learner's understanding by asking questions and provide a proper educational context for behavior change. Involving patients with heart failure in treatment is a top priority.

 Accordingly, the present study aimed to explore the effect of teach-back training on self-care and readmission of patients with heart failure.

 The present quasi-experimental study was conducted on 80 patients with heart failure in the Coronary Care Unit (CCU) and Post Coronary Care Unit (PCCU) of teaching hospitals affiliated to Zahedan University of Medical Sciences in southeastern Iran in 2019. The patients were selected via the convenience sampling method and randomly placed into two intervention and control groups. In the intervention group, self-care training was performed individually using the teach-back method in four sessions, each lasting 30 to 60 minutes. In contrast, the participants in the control group conventionally received self-care training. The instruments used to collect the data were the demographic information form and the European Heart Failure Self Care Behavior (EHFSCB). The EHFSCB was completed by the participants in the two groups in two stages before and three months after the intervention. The number of readmissions and the number of visits to the doctor at the end of the third month after discharge were recorded for all patients by directly asking the patients. The collected data were analyzed using SPSS-22 software, the independent samples t-test, paired-samples t-test, and chi-square test at a significant level of P < 0.05.

 After three months, the mean scores of total self-care behaviors during the intervention were significantly different between the two groups (P < 0.001). Besides, the average number of readmissions due to heart disease three months after the intervention showed the positive effect of the intervention in reducing readmissions in patients in the intervention group (P = 0.002).

 This study showed that teach-back training could affect self-care behaviors positively and reduce the number of readmissions of patients with heart failure. Therefore, it is recommended that nurses use this training method to teach self-care behaviors to heart patients.

 Fatigue is one of the most common complications of cancer. Anemia can be one of the most prevalent causes of fatigue in cancer patients.

 The present study aimed to explore the effectiveness of a nursing care program supplemented with iron intake on the anemia and fatigue in cancer patients undergoing chemotherapy.

 The present study was conducted in a quasi-experimental design on two groups of 90 cancer patients in selected hospitals. The participants were selected via convenience sampling and were randomly assigned to the control and intervention groups. Before the intervention, the Functional Assessment of Cancer Therapy - Anemia (FACT-An) was completed by the patients in both groups. The patients in the control group did not receive any special care other than receiving 150 mg of iron daily. However, the patients in the intervention group received 150 mg of iron daily and attended a nursing care program with four individual training sessions (one session per week). Follow-up was performed for three weeks, and the questionnaire was completed again by the participants in both groups. The collected data were analyzed using the independent samples t-test, paired-samples t-test, and chi-square test in SPSS software (version 22). The data analysis process was performed at a significance level of less than 0.05.

 The mean scores for the patient hemoglobin in the intervention and control groups after the intervention were 11.84 ± 0.58 and 11.10 ± 67.29, showing a significant increase in favor of the intervention group (P < 0.001). Furthermore, the results of the independent samples t-test showed that the mean score of fatigue for the patients in the intervention group (29.37 ± 9.56) was significantly lower than that of the participants in the control group (47.55 ± 11.22) (P < 0.001).

 The present study showed that the implementation of a nursing care program for cancer patients receiving iron supplementation positively affects iron-related blood parameters and fatigue among these patients. Therefore, to control cancer patients' fatigue, medical staff must pay special attention to these training and care programs supplemented with iron intake.
 

 Despite the use of various pharmacological and non-pharmacological methods for reducing stress among patients, one of the most important nursing challenges is how to control anxiety and stress in patients undergoing coronary angiography.

 The present study aimed to compare the effectiveness of nursing consultation and guided imagery-based training on the level of stress and anxiety in patients undergoing coronary angiography.

 The participants in this clinical trial included 60 angiography candidates, admitted to the coronary care unit (CCU) of Ali-Ibn Abi-Taleb Hospital in Zahedan, southeast of Iran, in 2019. The participants were selected using convenience sampling and randomly assigned to three groups: nursing consultation, guided imagery, and control groups. The instruments used to collect the data included a demographic information form and the Depression, Anxiety, and Stress scale (DASS-21). The questionnaires were completed by the participants in all three groups on the day of hospitalization and one hour before angiography. A guided imagery audio file was played one day before angiography for each participant in the nursing consultation group for a maximum of two hours. On the other hand, the guided imagery group, besides receiving routine care, listened to the same audio file for 30 - 45 minutes. However, the participants in the control group only received routine hospital training. The collected data were analyzed in SPSS version 25, using statistical tests, such as analysis of variance (ANOVA), Tukey’s post hoc test, analysis of covariance (ANCOVA), paired samples t-test, Fisher’s exact test, and chi-square test at a significance level of less than 0.05 (P < 0.05).

 After controlling for the significant effect of pretest scores, the results of ANCOVA test showed significant differences between the two intervention groups in terms of the mean scores of anxiety and stress after the intervention (P < 0.001). Also, the mean scores of anxiety and stress decreased in the guided imagery and nursing consultation groups as compared to the control group. However, the two interventions were not significantly different in reducing anxiety and stress among patients undergoing coronary angiography (P = 1).

 In this study, nursing consultation and guided imagery interventions led to a reduction in the stress and anxiety of patients undergoing angiography. Although the two interventions showed no significant difference in terms of effectiveness, they had positive effects on the mental health of angiography candidates. Therefore, these techniques can be employed by nurses, depending on their ease of use and conditions, to reduce stress and anxiety among angiography candidates.

Traumatic birth experiences may lead to serious psychological impairment. Recent studies show that a considerable number of women can develop post-traumatic stress disorder (PTSD).

The aim of this study was to investigate the effect of cognitive-behavioral therapy (CBT) on PTSD in pregnant women with a history of traumatic childbirth.

This quasi-experimental study was conducted on 80 pregnant women with a history of traumatic childbirth, referring to health centers in Zahedan in 2020. The mothers were selected by a convenience sampling method and divided into two groups (40 mothers in each group) according to the random allocation method. The data were collected using the PTSD questionnaire administered before the intervention and five weeks after the final training session. The intervention group received four sessions of CBT during four weeks, and the control group received only routine pregnancy care. Data analysis was performed by SPSS 22 software using the independent t-test, chi-square test, and paired sample t-test at a significant level of < 0.05.

The results of the study showed that the mean post-traumatic stress score of pregnant women before CBT in the intervention and control groups was 27.90 ± 10.91 and 24.97 ± 14.85, respectively, and it changed to 15.25 ± 4.08 and 26.25 ± 11.56, respectively, after the intervention. Independent t-test showed that the mean scores of post-traumatic stress of pregnant women in the two groups were not significant before education (P = 0.31), but it was significant after it (P = 0.0001).

CBT can have significant effects on reducing the severity of PTSD in pregnant women with a history of traumatic childbirth. Thus, it is recommended to include this type of educational intervention in the care program of pregnant women with a history of traumatic childbirth.

Premature birth and infant hospitalization in the neonatal intensive care unit (NICU) is stressful for parents; therefore, training and supporting couples with the aim of reducing stress are very important.

The present study aimed at investigating the effect of family-centered educational, supportive intervention on parental stress of premature infants hospitalized in the NICU.

This quasi-experimental study was performed on the eligible parents of 80 premature infants admitted to the NICU ward of Ali-ibn Abitaleb Hospital in Zahedan, in two groups of 40 intervention and control. Samples were selected by convenience sampling and randomly divided into two groups. The intervention group received five sessions of a family-centered educational support program in five days, with an average of 60 minutes per session, and the control group received only routine training and care. Data were collected using the Parental Stress scale (PSS) questionnaire with approved validity and reliability before and after the end of educational interventions at discharge from the hospital. Data were analyzed by SPSS, version 22 using paired t-test, independent t-test, and chi-square.

Mean of parental stress scores of mothers and fathers of premature infants was not significantly different in the intervention and control groups before family-centered educational-supportive intervention (P > 0.05), but after the intervention, the mean of parental stress scores of parents in the intervention group was significantly lower than the control group (P = 0.001).

Family-centered educational supportive intervention has a positive and significant effect on reducing stress in parents of preterm infants admitted to NICU. Therefore, training and support of parents during the hospitalization of their infants is recommended.