Evidence Based Care
Volume:12 Issue: 3, Autumn 2022

Emergency medical technicians (EMTs) at the forefront of the health system face Covid-19 cases. In such situation, they may have doubts about their abilities or priorities and may not make the right decisions. They need moral courage to survive this global crisis's stress and strengthen their decision-making power. The present study aimed to investigate the moral courage and its related factors in EMTs during the Covid-19 pandemic. This cross-sectional study was performed in 2021 on 194 EMTs of Zanjan University of Medical Sciences. Sampling was done by the cluster random method. A demographic information questionnaire and standard moral courage questionnaire were used to collect data. Data were analyzed using independent t-test, ANOVA, Pearson correlation coefficient and Logistic regression. P<0.05 was considered statistically significant. The mean total score of moral courage was high in 88.1% of EMTs (433.31± 49.70 out of 510). The mean score of moral courage in the dimensions of moral self-actualization was 228.98±32.46, risk-taking was 159.04±15.68, and the ability to defend the right was 45.28±7.70. There was statistically significant relationship between the mean score of total moral courage and marital status, age, work experience, and number of working hours (p <0.05).Implications for Practice: The findings of this study showed that EMTs had a high level of moral courage, so it is possible to maintain this important ethical virtue through reinforcements, planning, effective training, and organizational support, and consequently increase the quality of pre-hospital care.

One of the most important ethical requirements of the medical profession is to maintain the human dignity of patients. COVID-19 pandemic imposes a lot of stress on patients, which can be an obstacle to maintain the patients' dignity. The present study aimed to investigate the relationship between resilience and human dignity in patients with COVID -19. This cross-sectional study was performed in 2021 on 180 patients admitted to COVID wards in Birjand, Iran. Data were collected using the Patient Dignity Inventory (PDI) and Conner-Davidson Resilience Scale (CD-RIS). Data were analyzed by SPSS software (version 20) and descriptive and inferential statistics. P<0.05 was considered statistically significant. The mean overall human dignity score of the patients was 51.41 ± 19.56. The women reported a poorer perception of dignity and its distress symptom and social support dimensions than men (p <0.05). The mean overall resilience score of the patients was 65.95 ± 12.96. In control dimension, the mean resilience scores of men was significantly higher than women (p < 0.05). Inverse relationship was found between resilience and human dignity in patients COVID-19 (p <0.001).Implications for Practice: The resilience is a protective factor for the patients' dignity. The preservation of dignity in patients care process during COVID-19 pandemic and the use of effective methods to improve their resilience can be helpful to overcome these stressful situations.

Theory of gerotranscendence is a framework to plan for good aging and death anxiety among the elderly is important issue needs to planning. This study aimed to investigate the effect of a gerotranscendence educational program on death anxiety among the elderly. This quasi-experimental study was conducted on the elderly referring to two primary health services centers in Mashhad, Iran, within June-July 2021. Participants were selected using the purposive sampling method and non-randomly divided into two groups of intervention and control (n=25 each). The elderly in the intervention group received three video files based on the dimensions of the theory of gerotranscendence. They discussed and practiced the strategies of gerotranscendence in a virtual group for 3 weeks. The control group had normal activities in their usual virtual groups. Both groups completed the Templer Death Anxiety Scale at the pretest and 2 weeks after the intervention. Data were analyzed by SPSS21. Mean age of the elderly were 66.36±5.55 years, and 54% of the participants were male. Mean anxiety score in the intervention group was significantly reduced (z=-0.377, P<0.0001). Mean change of anxiety score before and after the intervention in the intervention group (1.8±1.75) was significantly higher than the control group (0.08±1.97); (z=-2.876, P=0.004).Implications for Practice: The gerotranscendence educational program (educational videos and virtual sessions) reduced the death anxiety among the elderly. Therefore, the use of this educational program package in primary health services centers can be an efficient and low-cost method to reduce death anxiety among the community-living elderly.

Intravenous catheter insertion in pediatrics is associated with pain and discomfort. DIVA3 is a pediatric clinical score rule developed to estimate failure in intravenous placement for infants and children. This study aimed to validate the external validation of DIVA 3 as a clinical predictive rule for identifying difficult intravenous access in children. This prospective cross-sectional study was performed on 310 children aged less than 12 years who underwent intravenous catheter placement in the pediatric wards of two specialized pediatrics hospitals in Tehran. The DIVA 3 score was estimated and recorded by a nurse. The measured outcome was failure or success of Peripheral Intravenous (PIV) PIV cannula placement on the first attempt. The number of attempts was recorded for all cases. The failure rates were determined for all children with DIVA score of 4 and graters. The sensitivity, specificity, and positive and negative predictive values were determined considering a confidence interval (CI) of 95%. Sensitivity, specificity, Positive Predictor Value, and Negative Predictive value of DIVA3 (cutoff point ≥4) were 95.9%, 84.3%, 93.8, and 84.3%, respectively (95% CI: 0.932-0.932). For 85 cases, two nurses scored the amount of success in catheterization at the same time using DIVA3 to calculate inter-rater agreement. Kappa values were between 0.52 and 0.89. Implications for Practice: The results support the importance of using DIVA3 despite the variable diagnostic value which had in numerous studies. The results emphasize the relationship between other factors and the need to consider them in the success rate prediction algorithm.

Nurses face a high risk of experiencing excessive fear while caring for patients with COVID-19. However, to our knowledge, no study has yet explored the factors associated with nurses’ fears when caring for patients with COVID-19. The present study aimed to analyze the factors associated with nurses’ fears when caring for COVID-19 patients in Indonesia. This cross-sectional study was conducted on 591 nurses caring for COVID-19 patients. The nurses were recruited from 26 provinces in Indonesia using a purposive sampling method in April 2020. The instruments consisted of a sociodemographic characteristics form and a valid instrument to explore nurses’ fears. Data were analyzed using SPSS software (version 23). In total, 86.8% of the nurses felt fear when caring for COVID-19 patients. Moreover, despite using personal protective equipment, 83.8% of participants answered that they feared getting infected with the virus while caring for patients, and 87.5% of the participants feared that their families might become infected with the virus. Among the nurses who cared for COVID-19 patients, 91.2% feared they might pass the disease on to their families at home. Age, marital status, infection prevention control training, and nurses’ education level were significantly related to nurses’ fears (P<0.05, CI 95%).Implications for Practice: The excessive fear in nurses who care for COVID-19 patients is a major issue for nursing managers. Provision of viral transmission prevention and control programs, self-esteem improvement activities, and having pandemic course subjects in the nursing education curricula can help nurses become more aware and ready to face a pandemic.

Developmental disorders in children are classified into different domains and early recognition and treatment can significantly affect children’s social and individual functioning. This study aimed to compare growth, development, and related factors in 60-month-old children in urban and suburban kindergartens of Khorramabad, Iran in 2020. This descriptive study was conducted on 100 children aged 60-month-old in urban and marginal kindergartens in Khorramabad city of Iran in 2020. The tools were Ages and Stages Questionnaire (ASQ) and a demographic characteristics information form with census sampling. Children were evaluated for growth indices such as height, weight and head circumference. Data were analyzed by SPSS statistical software (version 21) and Epi-Info software and T-test, Man-Whitney and Kruskal Wallis tests. The type of kindergarten had a significant relationship with the total score of development (P=0.012) and the domains of gross motor (P=0.007) and personal-social (P=0.004). The mean prevalence of the developmental disorder was estimated 8.7% for urban and 16.1% for subarban children. Developmental delay is not related to gender, delivery type, maternal education, child’s history of illness, and economic status of the family (P>0.05) and is related to nutrition and supplement use, the familial marriage of parents, father’s addiction and history of developmental disorder (P<0.05).Implications for Practice: Due to the high importance of timely diagnosis and intervention, it is necessary to diagnose and treat developmental disorders at a younger age. Correct planning of managers in the field of nursing can be effective in timely identification of children's developmental disorders and reducing their prevalence.

Chronic pruritus is one of the most common skin manifestations in patients with End-Stage Renal Disease (ESRD).Omega-3 fatty acids could be used as an efficient drug for treatment of pruritus in uremic patients.  Chia seed oil is one of the richest plant sources of omega-3.

This study aimed to compare the effect of topical chia oil and coconut oil on pruritus and laboratory parameters in ESRD patients.

This semi-experimental study with control group was performed on 105 hemodialysis patients in Kerman, Iran in 2021. The participants were randomly assigned into two intervention groups (chia oil and coconut oil) and one control group. The chia and coconut oils were applied topically twice a day for two weeks. Pruritus was measured before, at the end, and two weeks after the intervention. Some laboratory parameters were measured before and at the end of the intervention. Data collection tool was Yosipovitch pruritus questionnaire. P<0.05 was considered statistically significant.

The mean pruritus score was significantly different between the three groups of chia oil (2.61±1.17), coconut oil (3.00±1.15), and control (4.48±0.88) at the end of the intervention and two weeks after the intervention (P <0.001).  The laboratory parameters were not significantly different between the three groups before and after the intervention (P >0.05).Implications for Practice: Chia and coconut oil were effective on reducing pruritus in ESRD patients. Chia oil and coconut oil are cost-effective without any major complications that canbe used to reduce pruritus.

 The culture of patient safety is one of the most important factors in ensuring the quality of nursing care and is essential in enhancing patient safety in the health system.

 This study aimed to determine the patient safety culture from the perspective of nurses working in the Al-Najaf Al-Ashraf Teaching Hospital.

 This descriptive cross-sectional study was conducted in 2021 on 167 nurses working in the electronic surveillance unit (ESU) and critical care unit (CCU) wards of the Al-Najaf Al-Ashraf Hospital. The subjects were chosen in a stratified manner with adequate allocation. Data were collected using personal information forms and a valid and trustworthy patient safety culture questionnaire. Data were analyzed by SPSS software (version 18). P<0.05 was considered statistically significant.

 Independent t-test showed that among the demographic characteristics, gender and marital status had a statistically significant relationship with safety culture (P<0.05). The variable of nonpunitive response to events has the highest proportion of positive responses (73%). In contrast, the most negative response relates to supervisor performance and patient safety promotion expectations (43%). Also, 67% of nurses working in the Al-Najaf Al-Ashraf Hospital reported that patient safety is adequate. Notably, only 6.6% of respondents indicated that the level of protection is very weak.

Implications for Practice: 

According to the findings, the patient safety culture at Al-Najaf AlAshraf Teaching Hospital is appropriate from the perspective of nurses working in this hospital.