mohammadjavad ghazanfari

Substance use disorders (SUDs) pose substantial challenges to society, creating widespread negative effects. Given their frequent and direct contact with patients, nurses hold a vital position in managing and addressing these disorders. This systematic review aimed to examine nurses’ understanding of substance use and their perceptions of individuals affected by these conditions.

This systematic review involved a comprehensive search of online databases such as PubMed, Web of Science, and Scopus, utilizing relevant keywords up to July 9, 2021. Only studies published in English and aligned with the review’s objectives were considered. The quality of the included studies was evaluated using the AXIS tool.

A total of 3273 nurses participated across 12 studies. The results indicated that nurses’ knowledge about substance use was moderate, and their attitudes toward substance users were generally positive. Knowledge-related factors included variables such as age, gender, and work experience. Similarly, age, gender, ethnicity, education level, job position, work experience, participation in workshops on substance use, interest in patient care, hours spent on substance use courses during education, and continuing education hours related to substance use were identified as potential factors influencing attitudes.

Therefore, holding workshops and improving guidelines for patient care with SUDs can enhance nurses’ knowledge and attitudes and, ultimately, the quality of nursing care.

Appropriate respiratory support is crucial for improving the clinical outcomes of critically ill patients infected with the SARS-CoV-2 virus. This study aimed to investigate the different modalities of respiratory support and clinical outcomes in patients with COVID-19 in intensive care units (ICUs).
In a retrospective study, we enrolled 290 critically ill COVID-19 patients who were admitted to the ICUs of four hospitals in Mazandaran, northern Iran. Data were extracted from the medical records of all included patients, from December 2019 to July 2021. Patients' demographic data, symptoms, laboratory findings, comorbidities, treatment, and clinical outcomes were collected.
46.55% of patients died. Patients with ≥2 comorbidities had significantly increased odds of death (OR=5.88, 95%CI: 1.97-17.52, P=0.001) as compared with patients with no comorbidities. Respiratory support methods such as face mask (survived=37, deceased=18, P=0.022), a non-rebreather mask (survived=39, deceased=12, P<0.001), and synchronized intermittent mandatory ventilation (SIMV) (survived=103, deceased=110, P=0.004) were associated with in-hospital mortality. Duration of respiratory support in nasal cannula (survived=3, deceased=2, P<0.001), face mask (survived=3, deceased=2, P<0.001), a non-rebreather mask (survived=3, deceased=2, P=0.033), mechanical ventilation (survived=5, deceased=6, P<0.019), continuous positive airway pressure (CPAP) (survived=3, deceased=2, P<0.017), and SIMV (survived=4, deceased=5, P=0.001) methods were associated with higher in-hospital mortality.
Special attention should be paid to COVID-19 patients with more than two comorbidities. As a specific point of interest, SIMV may increase the in-hospital mortality rate of critically ill patients with COVID-19 connected to mechanical ventilation and be associated with adverse outcomes.

Medication Error (ME) is a major patient safety concern in Intensive Care Units (ICUs). Critical care nurses play a crucial role in the safe administration of medication. Thisstudy was conducted to comprehensively review the literature concerning the prevalence of ME and associated factors and outcomes in Iranian ICU nurses.

An extensive search of the literature was carried in international databases including PubMed, Web of Science, Scopus, and Google Scholar, as well as Persian databases such as Magiran and Scientific Information Database (SID) using ME‑related keywords and the Persian equivalent of these keywords, from the first article written in this field to artcles published on March 30, 2021. The appraisal tool (AXIS tool) was used to assess the quality of the included studies.

Fifteen studies were included in this systematic review. The prevalence of MEs made by ICU nurses was 53.34%. The most common types of MEs were wrong infusion rate (14.12%), unauthorized medication (11.76%), and wrong time (8.49%) errors, respectively. MEs occurred more frequently in morning work shifts (44.44%). MEs happened more frequently for heparin, vancomycin, ranitidine, and amikacin. The most important influential factor in the occurrence of MEs in ICUs was management and human factors.

The prevalence of MEs made by Iranian ICU nurses is high. Therefore, nurse managers and policymakers should develop appropriate strategies, including training programs, to reduce the occurrence of MEs made by nurses in ICUs.

 The development of postgraduate nursing education and its transformation needs to know the educational process, awareness of modern methods of its implementation, recognition of material resources and facilities, and awareness of the role and duties of human resources. This integrative review has been conducted with the aim to identify the challenges and strategies of Master of Science in nursing education in Iran.

 In this integrative review, an extensive search of databases such as Iranian Nursing Journals Index (nindex.ir), Iranian Journals Database (magiran), Scientific Information Database (SID), Iranian Research Institute for Information Science and Technology (IranDoc), the Islamic World Science Citation Database (ISC) and the Regional Information Center For Science and Technology (RICeST) was conducted from 1988 (the beginning of the first master's degree in nursing in Iran) to December 4, 2021, using Persian and English keywords related to the aim of the study.

 Altogether, 10 articles from 291 studies were selected. There are several challenges in postgraduate nursing education that nursing educators are looking for solutions to address them. Master nursing education in Iran is not based on goals and mission and graduates do not have a good quality of work. In Iranian universities, the role of the master of nursing in society is not clear and so far, no special review has been made in this regard. Finally, it seems that the master's degree program in nursing in Iran is being implemented without direction and considering the needs of society.

 Developing a coherent theoretical and practical training program in accordance with the needs of the community can be considered as the first step in reforming the program of master of science in nursing education in Iran.

High workload, insufficient resources, and many stressors in the workplace have led to the imposition of physical and psychological pressures on nurses, which exposes them to death anxiety (DA). This systematic review aimed to assess the DA and factors associated with its in nurses during the COVID-19 pandemic.

An extensive search was conducted on Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) databases via keywords such asincluding "Death", "Death Anxiety", "Nurses", and "COVID-19", from December 2019 to November 10, 2021.

818 nurses were enrolled in four papers. The mean age and work experience of nurses Nurses’ mean age and work experiences were 31.21 (SD=5.43) and 7.60 (SD=6.73) years, respectively. The mean DA of nurses during the COVID-19 pandemic was 7.30 (SD=2.23). Also, 31.05% of nurses had a high level of DADA level during the COVID-19 pandemic. Age, sex, work experience, working hours per week, childbearing, several patients needing end‑of‑life care, direct participation in resuscitation operations, cases of direct participation in resuscitation operations, cases of patient death, depression, mental health status, and life satisfaction were influential factors in DA nurses during the COVID-19 pandemic.

Thus, nursing policymakers should pay special attention to these factors related to the use of nurses' health maintenance and promotion programs to increase the quality of nursing care for COVID-19 patients. Also, it is recommended that psychological and communication support be provided to nurses during the COVID-19 pandemic.

The implementation of Complementary and Alternative Medicine (CAM) has increased in recent decades. Due to the positive effects of CAM interventions, 5 to 74.8% of people use these treatments worldwide. However, implementing CAM-related clinical trials is associated with challenging issues. Failure to address these challenges can lead to poor quality of studies, publication of non-scientific findings, and ultimately disregard for human rights and ethics. This review aims to comprehensively review the literature focusing on methodological and ethical challenges for implementing CAM-related clinical trials.

This review of reviews was conducted via international databases, including PubMed/MEDLINE, Web of Science, and Scopus using keywords extracted from medical subject headings such as “Methods”, “Methodological Study”, “Methodological Studies”, “Ethics”, “Complementary Therapies”, “Complementary Medicine”, “Alternative Medicine”, “Clinical Trial”, and “review” from the earliest to May 1, 2022.

In general, challenging issues for the implementation of CAM-related clinical trials can be divided into two categories: 1) methodological and 2) ethical. Methodological challenges included: Risk of bias, Lack of knowledge of researchers, and Blinding. On the other hand, ethical challenges in clinical trial studies are divided into two categories: patients' rights and placebo use.

Overall, the present study emphasizes the need for special attention to the quality of CAM-related clinical trials. Also, this study can pioneer the introduction of critical challenging issues in CAM-related clinical trials and provide appropriate suggestions for researchers to solve these issues in future studies.

In recent years, the number of emergencies in hospitals has increased. Hospitals are one of the main assets for successful disaster management. One of the significant challenges in a disaster is the evacuation of training wards. There are anatomical and physiological differences between adults and children that make children more vulnerable to accidents and disasters. Rapid transfer of sick children on a large scale has always been challenging in this respect. 

This study pursued the goal to determine the challenges of emergency evacuation in specialized hospitals for children and neonates.

Searching online databases, such as Google Scholar, PubMed, Scopus, and Web of Science was done from December 1 to December 20, 2021. The keywords used for the search were based on Medical Subject Headings (MESH) and were combined with other keywords, including evacuation, disaster, pediatric, and patient transfer. All English language studies consistent with the study goal (emergency evacuation challenges in specialized hospitals for children and neonatal) were included in this study.

Out of 2,145 studies, the full text of 11 studies was finally reviewed. The measures taken during natural disasters are divided into three levels: local, state, and national. Emergency evacuation challenges are also divided into five categories: communication, training, transportation, equipment and energy, and management.

This study provided essential perspectives for developing appropriate intervention strategies for the managers and policymakers of health care systems to better prepare in case of natural disasters breaking out in children and neonatal wards.

Burn injuries are under-appreciated trauma, associated with substantial morbidity and mortality.It is necessary to refer patients in need of specialized care to more specialized centers for treatment and rehabili-tation of burn injuries. This systematic review aimed to assess the adherence to referral criteria for burn patients.

An extensive search was conducted on Scopus, PubMed, and Web of Science online databases usingthe relevant keywords from the earliest to October 7, 2021. The quality of the included studies was assessedusing the appraisal tool for cross-sectional studies (AXIS tool).

Among a total of 7,455 burn patientsincluded in the nine studies, 60.95% were male. The most frequently burned areas were the hands (n=3) andthe face (n=2). The most and least common burn mechanisms were scalds (62.76%) and electrical or chemical(2.88%), respectively. 51.88% of burn patients had met≥1 referral criteria. The overall adherence to the referralcriteria for burn patients was 58.28% (17.37 to 93.39%). The highest and lowest adherence rates were related toWestern Cape Provincial (WCP) (26.70%) and National Burn Care Review (NBCR) (4.97%) criteria, respectively.

The overall adherence to the referral criteria for burn patients was relatively desirable. Therefore,well-designed future studies are suggested in order to uncover approaches to improve adherence to referral cri-teria for burn patients.

One of the most important steps in increasing the nurses’ professional competence and consequently improving the quality of nursing care is to evaluate nurses’ clinical competency and then take effective actions to enhance it. This study aimed at exploring the clinical competence of Iranian nurses and factors related to it.

In this systematic review and meta‑analysis, PubMed, Scopus, Web of Science, Scientific Information Database, and Iranmedex databases and Google Scholar search engine were searched to February 14, 2020.

After screening, a total of 25 articles were included. In general, the level of clinical competence of Iranian nurses was at a desirable level. After meta‑analysis of the mean score of nurses’ clinical competence, the combined mean was 161.13 (95% confidence interval [CI]: 137.78–184.48; P < 0.001; I 2 = 99.8%; P value for heterogeneity = P < 0.001) by the Competency Inventory for Registered Nurses (CIRN) questionnaire. The summarized mean of clinical competency measured by the Nurse Competence Scale (NCS) questionnaire was 70.75 (95% CI: 60.80–80.70; P < 0.001; I 2 = 99.9%; P value for heterogeneity = P < 0.001). Factors affecting nurses’ clinical competence were age ≥33 years, nursing work experience ≥9 years, and a master’s degree in nursing. However, the clinical competence of nurses had a significant negative relationship with job stress.

The level of clinical competence of Iranian nurses was desirable. Studies that used the CIRN, reported the highest and lowest clinical competence in clinical care and professional development dimensions, respectively. Studies that used the NCS, reported the highest and lowest clinical competence in dimensions of work role and ensuring quality, respectively.

 Since December 2019, the widespread outbreak of COVID-19 has led to a major public health issue worldwide. With the spread of the COVID-19 pandemic, a series of ethically challenging issues arose that put pressure on healthcare systems around the world. This narrative review aims to comprehensively review the literature focusing on ethical challenges and coping strategies about issues related to the healthcare system and social issues during the COVID-19 pandemic.

 This narrative review was conducted via international databases including PubMed/MEDLINE, Web of Science, and Scopus using keywords extracted from medical subject headings such as "COVID-19", "2019-nCoV disease", "2019 novel coronavirus infection", "Ethics", "Bioethical Issues", "Morals", "Coping Skills", "Coping Skill", "Coping Strategies", and "Coping Strategy" from December 2019 to January 2022.

 In general, ethical issues during the COVID-19 pandemic can be divided into two categories: 1) issues related to the healthcare system and 2) social issues. Issues related to the healthcare system can be divided into two categories: 1) lack of resources, equipment and facilities, and manpower, and 2) problems in patient care such as triage and informed consent. Social issues can be divided into four categories: 1) community engagement, 2) crisis management capacity in remote rural communities, 3) discrimination and health equity, and 4) vaccination. Coping with ethical challenges in crises such as COVID-19 requires changing health empowerment policies and strategies based on evidence-based research. On the other hand, overcome on these challenges requires interdisciplinary collaboration and fast efficient decisions.

 Overall, the present study introduced ethical challenges and coping strategies during the COVID 19 pandemic. The experience gained from this pandemic can be considered by managers and policymakers of health care systems for coping with ethical challenges.

Ocular trauma is one of the most common causes of acquired blindness in children. The epidemiological parameters associated with ocular trauma vary in different populations, especially in children. The objective of this study was to assess the ocular trauma epidemiology in children less than 18 years of age. In this crosssectional study, 145 children (under 18 years) with ocular trauma who referred to the emergency department of Bu-Ali-Sina Hospital in Sari, Iran were enrolled from November 2017 to January 2019. Of the participants, 57.9% were men, 70.4% had blunt trauma, 97.2% had a unilateral eye injury, and 54.5% had a right eye injury. The most risk factor for trauma was stationery (51.0%). Almost half of the patients (52.9%) had corneal injuries. The most trauma locations were at home (67.4%). Most patients (95.0%) had normal relative afferent pupillary defects. Blunt (52.6% vs. 47.4%) and penetrating (72.5% vs. 27.5%) traumas was higher in boys than girls (p=0.03). Most frequent part of eye injuries in blunt and penetrating traumas was related to the cornea (P=0.04). It seems that parents should have more supervision on children at home and give adequate education in using of stationery to school-age children by considering the results of present study.

Decreased life expectancy is considered as a key indicator of human development. Obviously, the increase in mortality, especially in vulnerable groups such as older people, leads to a major disruption in the human development of countries. On the other hand, the destructive social and economic effects of COVID-19 on human life further reduce their life expectancy. Therefore, it is suggested that policymakers and health managers make appropriate decisions such as timely vaccination of older people, future treatment measures, and appropriate behavioral changes to control the disease and improve life expectancy among older people during the COVID-19 pandemic.

Ventilator-associated pneumonia is a serious nosocomial infection that can increase the length of stay, prolong the use of mechanical ventilation, and increase the risk of death in patients in the critical care unit. The aim of this study was to evaluate the knowledge of Iranian critical care nurses toward the prevention of ventilator-associated pneumonia in a systematic review.

In this systematic review, an extensive search of databases, such as PubMed, Web of Science, Scopus, Iranmedex, Magiran, SID and Google Scholar search engine using Persian and English keywords related to the aim of the study, was conducted from the earliest to October 17, 2020.

In total, 8 articles from 1822 studies, with 887 nurses and a mean age of 31.80±5.87 years, and work experiences of 62.04±39.48 months in critical care units, were included in this study. In six studies, the level of knowledge of nurses was insufficient. The lowest and highest levels of knowledge were related to the dimensions of "suction through tracheal tube/tracheostomy and drainage of subglottic secretions" and "selection of the appropriate patient position", respectively. In two studies, a direct relationship was reported between nurses' level of knowledge and work experience. In one study, older age was directly related to the mean score of nurses' knowledges.

The knowledge of Iranian critical care nurses toward the prevention of ventilator-associated pneumonia was insufficient. Therefore, it is suggested that researchers implement appropriate interventions in nurses to improve their knowledge toward prevention of ventilator-associated pneumonia, in future studies.