فصلنامه حیات
سال بیست و پنجم شماره 3 (پیاپی 83، پاییز 1398)

Postoperative pain is one of the clinical challenges for nurses who care for patients. The objective of this review was to evaluate the effect of preoperative education on postoperative pain after elective surgery.
Methods & Materials: A literature search was done on PubMed, CINAHL, Cochrane Library, Web of Science, Scopus and EMBASE to find the articles published in English on clinical trials from January 2012 to June 2018.

Out of 153 studies retrieved, 13 studies (2482 people) were reviewed. Generally, most studies indicated the effectiveness of preoperative education on postoperative pain relief (7 studies, n=1678). In other studies, there was no significant difference between education and the degree of pain reduction in the patient. Also, the results of some studies (n=204) showed that education with empathy could reduce anxiety in half of the cases.

Preoperative education as a complex intervention can reduce postoperative pain. Interactive education with empathy reduces patient’s anxiety and the need for postoperative analgesics. Therefore, training skilled nurses and the providers of such education is suggested for managing pain in patients.

Substance use as a crisis and a long-term chronic disorder can lead to psychological burden and reduce the quality of life of family caregivers. The aim of this study was to determine the effect of the quality of life therapy intervention on the burden of the family caregivers of addicts.

This is a clinical trial. The research population included all the family caregivers of the recovering addicts, admitted to Baharan psychiatric hospital in Zahedan in 2018. The samples were 80 people who were randomly divided into either intervention or control group. Caregivers in the intervention group received eight sessions of group counseling based on the quality of life therapy and on the basis of the determined content, every other day. Before the intervention and eight weeks after the intervention, the data were collected using the Zarit burden questionnaire and were analyzed by statistical tests through the SPSS software version 21.

Before the intervention, there was no significant difference in the mean score of burden between the two groups (P=0.25). After the intervention, the mean score of family caregiver burden in the intervention group (40.10±12.92) was significantly lower than in the control group (46.80±13.58) (P<0.01).

The quality of life therapy intervention in this study had a positive and significant effect on reducing the burden of family caregivers of addicts. Therefore, it is recommended that healthcare providers use this counseling approach along with addiction treatment programs to improve the psychological well-being of family caregivers.
Clinical trial registry: IRCT20160924029954N11

The success of the surgical safety checklist in reducing surgical mortality and morbidity largely depends on the degree of compliance with the checklist and correct implementation of its components by the staff. The aim of this review is to determine the challenges of effective implementation of the surgical safety checklist and to provide solutions for its more effective implementation.

 In the present systematic review, all the relevant qualitative papers published from 2010 to October 2018, were examined. A  literature search was done in databases SID, Iran Medex, Iran doc, Magiran, Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar, Cochran Library with keywords patient safety, surgical procedures, operative, checklist, World Health Organization, implementation science, qualitative research and their equivalent terms in Persian. Inclusion criteria were articles written in English or Persian, qualitative studies and relevant to the objectives of the study. Exclusion criteria were review articles, posters, presentations, letters to editor and quantitative studies.

The findings of the review of 14 qualitative studies showed that the most important challenges in effective implementation of the surgical safety checklist were unpredictable priorities, lack of collaboration and coordination of the surgical team members, mismatch between the checklist and hospital setting, lack of patient’s cooperation and lack of a planned approach towards implementing the checklist. The strategies to improve the implementation of the surgical safety checklist included checklist localization, improving the collaboration and coordination of all the team members, training and practicing, patient participation, and active organizational leadership.

The introduction of the surgical safety checklist to the health care setting is a permanent challenge and requires ongoing evaluations and its integration into the workflow in the hospital, active and effective leadership, explanation of why and how to use it by managers and receiving support from the organization. Continuous education, performance evaluation and the participation of all the surgical team members in the implementation of the checklist are key factors for effective implementation of the surgical safety checklist.

Providing self-care education to patients and their family leads to improvement in the quality of life and increase in participation in self-care programs. The aim of this study was to compare the effect of education by peer and nurse on self-care in hemodialysis patients.

 In this quasi-experimental study, 105 hemodialysis patients from three selected hospitals in three cities of Isfahan province (Zarinshahr, Falavarjan and Mobarakeh) were selected by the simple random sampling method from February 2016 to September 2016. Three centers were randomly assigned to three groups including education by peer, education by nurse and control. The individual face-to-face education was provided by the peer or the nurse to hemodialysis patients, and the control group only received routine education. Data gathering tool was the hemodialysis patients’ self-care questionnaire which was completed for three groups before and one month after education. The data were analyzed using the SPSS software version 18 through Chi-square test, paired t test, the analysis of variance and Tukey’s post-hoc test at the significance level of P<0.05.

There were no significant differences between the three groups in age, duration of dialysis, gender, and level of education (P>0.05). The Tukey’s multiple comparisons tests showed that the effect of nurse intervention on self-care improvement was significantly more than peer intervention and the control group (P<0.001) and also the effect of peer intervention on self-care improvement was significantly more than the control group (P<0.001).

Education by a nurse is effective in the self-care behaviors of hemodialysis patients and will improve these behaviors. Also, using peer experiences has advantages for hemodialysis patients such as easy, low-cost and effective education, based on life experiences and lack of need for special equipment.

Creating and maintaining a safe environment is an important part of care in psychiatric wards. The results of previous studies indicated that some features of the physical environment facilitate the ward’s safety. The experiences of people who are most likely to be present in these environments can be the best source for identifying these features. Therefore, this study was conducted to explain patients’ and employees’ perceptions toward the features of a safe physical environment in psychiatric wards.

 In this exploratory qualitative descriptive study, seven patients at discharge time and nineteen employees working in psychiatric wards were interviewed about their experiences in psychiatric wards and 84 hours of field observation was done. The data were analyzed using a qualitative content analysis approach according to the method proposed by Graneheim and Lundman.

The results showed a safe physical environment in psychiatric wards meant “having an accident-free environment”. This theme was abstracted from two main categories included “Accidents prevention through design” and “having a natural life environment”, which, according to the experience of the staff, is required to balance the two. The subcategories of “having the design of accidents prevention” were “eliminating or modifying accident-causing objects”, “wards based on the characteristics of the patients” and “conditions for facilitating staff performance” and the subcategories of “having a natural life environment were “meaningful activities", “healthy and pleasant conditions” and “preserved privacy”.

According to the results of the study, it is necessary to create a physical environment free of accidents and at the same time to meet the daily needs of patients in order to prevent physical and psychological damage to patients and staff in psychiatric wards.

White lie is one of the inevitable challenges that creates an ethical dilemma during the patient care process. White lie remains an abstract concept in caring process. The aim of this study was to analyze the concept of white lie in the caring process using a hybrid model.

A hybrid model of concept analysis including three phases was used in this study. In the theoretical phase, different databases including PubMed, CINAHL, Scopus, Science Direct, Google scholar, SID and Magiran were searched for finding relevant articles published in 1980-2018. The keywords were truth, white lie, care and deception (in Persian and English). In the fieldwork phase, semi-structured in depth interviews were conducted with nurses. In next step, by combining the two previous stages, the final analysis was performed.

In the theoretical phase, the attributes of the concept were determined, including “harmlessness”, “without personal motivation” and “use in compulsion situations”. In the fieldwork phase, three main categories such as “the sweetness of the bitter truth”, “harmless sentences to prevent harm” and “temporary relief to balance the situation” were identified from the data analysis. By merging the concepts extracted from the theoretical and fieldwork phases, “white lie in the patient care process” was defined as “an ethical decision without personal motivation, which is chosen in unstable situations to prevent predictable harms to the patient in facing the bitter truth”.

Although a definition of white lie was developed based on the above three phases, the further development of this concept requires a deeper look at the Iranian-Islamic culture. Therefore, further research is recommended in other medical centers in the country.

Iranian elderly population is increasing, and a high percentage of this population suffers from diabetes. Considering that the concept of active aging has not been developed in the context of chronic diseases that are common in aging (such as diabetes), the purpose of this study was to analyze the concept of active aging in diabetic elderly patients based on a hybrid model.

Three stages of hybrid model (theoretical, field work and final analysis) were used in this study. In the theoretical phase, 35 articles (published in 1990-2016) from scientific databases were analyzed. In the field work phase, 10 participants were interviewed and then a qualitative content analysis was performed. In the final phase, the findings of the two previous stages were merged and analyzed.

The definition of active aging for the diabetic elderly is a comprehensive, dynamic, multidimensional and culturally dependent process that requires a sense of satisfaction, happiness, well-being, security, and physical and mental health, that is achieved through social participation, providence of appropriate health and employment services, awareness of diabetes, and financial, emotional, family, and governmental support that brings subjective and objective benefits to the international, national and individual levels (such as adaptation to illness, a sense of worth and self-esteem). In order to achieve this, paying attention to the whole life span from childhood to old age is needed.

The results of this study suggest that health, security, satisfaction, participation, access to health services, support and knowledge of diabetes play an important role in activating elderly people with diabetes in Iran.

Patient monitoring in cardiac intensive care unit (CICU) is considered to be non-invasive and safe, but it can cause unintentional catastrophic consequences due to the alarm fatigue. The aim of the study was to determine the status of monitoring system alarms and nurses’ alarm fatigue.

 This descriptive, cross-sectional study was carried out in cardiac intensive care units of a hospital in Fars province from January to March 2019. The alarm status of 24 monitoring devices was observed for 100 hours in 100 patients under the physiological monitoring. Patients under monitoring were included in the study using a continuous and convenience sampling. Also, 62 nurses working in five CICUs of this hospital completed the alarm fatigue questionnaire (through census). The data obtained from the observation and the questionnaires were analyzed by the SPSS software version 16 using descriptive statistics.

The auditory alarms of monitoring devices were turned off and only visual alarms could be recorded. In the visual alarms recorded during 100 hours, 131 alarms (53.47%) were technical, followed by the false, nuisance, and ultimately real or actual alarms with rates of 40 (16.33%), 38 (15.51%) and 36 (14.69%), respectively. The mean (and standard deviation) score of alarm fatigue among nurses was 21.04 (7.52), and the alarm fatigue score for %50 of nurses was higher than the average score.

Turning off the auditory alarms can lead to serious risks to patients. Also, a high proportion of technical, nuisance, and false alarms can cause alarm fatigue in nurses. Adopting solutions in accordance with standard guidelines and checking physiological monitoring devices in hospitals are necessary in order to reduce false, nuisance, and technical alarms. Failure to pay attention to these issues leads to the alarm fatigue among nurses, which itself results in numerous consequences such as compromising the patients’ safety.