Vol 7 No 1 (2020): Winter
Adapting with World Health Organization goals from the 1980s, the Iranian Health system made efforts to establish the “Health for All” plan, which resulted in reducing infectious disease. In the meantime, NCD has become the leading cause of death in Iran due to the expansion of urbanization and lifestyle changes. Next, the Iranian Ministry of Health took some actions and reform plans for encountering this issue. Nevertheless, each of them failed to achieve all of their pre-defined goals. Notably, the outcomes of the Health Reform Plan were highlighting secondary prevention and overcrowded hospitals. Considering that shifting efforts to PHC based and community-centered health care could be more effective in reducing Non-Communicable diseases. IraPEN is last introduced plan launched in 2014 by the Ministry of Health and Medical Education, to provide universal health coverage, including access to NCD prevention and care. Some policymakers believe that the successful implementation of the program will require a new generation of health care providers. However, based on developed countries' experiences and recommendations of the World Health Organization, using the capacity of existing healthcare providers such as nurses would be more reasonable than introducing new health care providers. Now, Iran has lots of graduated nurses from bachelor to Ph.D. degree that is well-educated in preventive and community-based care. Nevertheless, based on the present policy, their role has been restricted in hospitals. Hence, using the existing capacity of nurses would be superior to introducing a new health care workforce.
In order to perform the data analysis process, mean value and variance or standard deviation are required in a meta-analysis study for integrating data. However, sometimes reports published from studies only report Median, Range and Sample size. When no indication of the distribution of primary data (normal distribution or lack of normal distribution) is available, items such as mean and variance and standard deviation can be estimated based on simple formulas . The purpose of this article is merely to introduce proven formulas with applied examples.
Background: Pressure ulcer (PU) is a costly, painful, and often a preventable problem with varying prevalence in different health centers. PU is associated with prolonged length of stay and mortality. This systematic review and meta-analysis aimed to estimate the prevalence of PU in Iran’s intensive care units (ICUs).
Method: In this research, 9 articles published in Persian and English were studied. National (Science Information Database (SID) and MagIran) and international databases (PubMed, Scopus, and Web of Science) were searched using the keywords of pressure ulcers, bedsore, pressure sore, decubitus ulcer, pressure injury, Iran, and all of possible combinations without time limitations. Data were analyzed using meta-analysis and the random effects model. The heterogeneity between studies was investigated by I2 statistic, and the Stata software (version 11).
Results: The total prevalence of PU in Iran’s ICUs was 19.59% (95% confidence interval [CI]: 13.15- 25.97). The prevalence of PU in region 1 of the country was 28.55% (95% CI: 12.27-44.84), and it was 10.31 (95% CI: 3.88-16.75) in other areas of the country. Meta-regression results showed a significant correlation between the prevalence of PU and the mean age of the patients (P = 0.122) as well as study sample size (P = 0.043).
Conclusion: We found that the overall prevalence of PU in Iran’s ICUs was relatively high. Considering the high prevalence of PU in Iranian ICUs, it seems necessary to investigate and implement effective interventions to control and reduce this problem.
Background & Aim: Considering that the main responsibility of the nurses is to give care to the patients, concept analysis of good care by providing a clear definition will promote nursing practice and quality of healthcare. This study aims to clarify the concept of good care through the use of Rodgers's evolutionary approach.
Methods & Materials: This study used Rodgers's evolutionary approach. The keywords of good care, quality care, and similar words were used for searching from CINHAL, PubMed, Emerald, Elsevier and Scopus databases. Literature published in English between 2000- 2018 was included. Forty one articles were selected and content analysis was used to distinguish attributes, antecedents, and consequences of the good care.
Results: According to the finding, care was considered as good that was accompanied by the up-to-date knowledge and by doing procedural cares skillfully and safely leaded to recovery, reducing health care costs, and patient satisfaction through an effective and efficient relationship with the patient.
Conclusion: Skillful practice, well-informed knowledge and effective communication are the most important inputs for nurses to provide good care for the patients and the lack of these, especially in the case of using unprofessional workforce in nursing, is a serious threat to patient care.
Background & Aim: Identifying older people with the risk of falls in hospitals is particularly essential for the prevention of falls. Review of literature revealed that the association of falls and fear of falls had not been investigated extensively in previous studies in Iran. This study aimed to determine the relationship between falling and fear of falling among elderly hospitalized patients.
Methods & Materials: In this descriptive-correlational study, 1123 subjects were recruited. Of all subjects, 385aged hospitalized patients, 60 years old and above, were conveniently selected based on inclusion criteria in Shahroud Imam Hossein hospital from March to December 2016. Johns Hopkins fall risk assessment tool (JHFRAT) was used to evaluate the risk of falls among older people and the Falling Efficiency Scale (FES) was applied to assess fear of falling. SPSS software version 19with the significance level of p<0.05. Chi-Square test and exact test of Fisher and logistic regression has been used for data analysis.
Results: All aged patients (n=1123) admitted in the emergency room were assessed for eligibility to inclusion in the study. Of all subjects, 385 patients were included in this study. The subjects' mean of age was 71.68±4.32 years, age range: 60-84. Of all samples (n=385) of study, 90 (23.4%), 151(39.2%), and 144 (37.4%) had low, middle, and high risk of falls, respectively. Of all participants of the study, 193(51%) subjects were male, and 192(49%) were female. One-third (36.4%) of the subjects had fear of falls and (33.8%) experienced fall in the last six months before admission. A statistically significant relationship was found between the incidence of falls and fear of falling (P<0.001).
Conclusion: This study found JHFRAT and FES as two applicable instruments for assessment of aged people. The result of this study concluded that evaluation of fear of falling and the risk of falls among hospitalized elderly patients are recommended as a routine procedure to predict the risk of falls. Nurses are in the best position to evaluate the fear of falls and risk of falls, so it is recommended considering the fear of falls as a potential risk factor for falls in the hospital.
Background & Aim: The world's older adults population is increasing and is expected to increase in the future. Ageism is one of the difficulties elderly people experienced. Nursing students as a candidate for the nursing profession will frequent contact with older adults. Ageism attitudes among nursing students are important for this reason. The aim of this study is to determine the attitudes of nursing students toward ageism and the factors affecting it.
Method & Materials: The study was cross-sectional and the data were collected from January to February 2019. The study included 509 students. A demographic data form and the Ageism Attitude Scale were used to collect data.
Results: The mean age of the participants was 20.94±1.30 years and 439 (86.2%) participants were female. Female nurse students show lower ageist attitudes than male (p<0.001) and between the year of study and attitudes to ageism (p = 0.001). A statistically significant difference was found between nurse students caring for older people and those not caring for older people and attitudes to ageism (p<0.001).
Conclusion: In nursing students, giving care to older people during their education, and having lived with an older relative should be considered to reduce ageism. We offer that nurse curriculums revised to reduce ageism according to factors affecting attitudes to ageism.
Background & Aim: Human Immunodeficiency Virus (HIV) prevalence is increasing, and this disease has become a crisis for the modern world. Today, the survival of patients has been increased, such that HIV is considered a chronic disease. So, Paying attention to health-promoting intervention is necessary. Thus, the current study aims to determine the effect of educating lifestyle based on the Pender model on health-promoting behaviors in HIV patients.
Methods & Materials: In this randomized clinical trial study, 70 HIV patients who had inclusion criteria were selected and then divided into intervention and control groups randomly. The intervention group received 6 one-hour education sessions weekly based on Pender lifestyle (nutrition, physical activity, stress management, spiritual growth, interpersonal relationships, and health responsibility). A demographic questionnaire and HPLP2 were used, which were completed by both groups before the intervention and 8 weeks after the intervention. Chi-Square, Fisher, Independent t, and ANCOVA statistical tests and SPSS 16 software were used to analyze data.
Results: results showed that there was no significant difference in various dimensions of health-promoting lifestyle between two groups before intervention. However, intervention group scores for nutrition (28.08±6.23 vs. 23.58±6.04), physical activity (22.26±6.46 vs. 16.39±6.09), stress management (25.03±5.14 vs. 19.96±6.41), spiritual growth (29.49±6.11 vs. 25.45±8.54), interpersonal relationships (29.17±6.14 vs. 23.11±7.45) and health responsibility (28.36±6.06 vs. 23.89±5.74) were significantly higher than control group 8 weeks after intervention. Moreover, the total score of health-promoting behaviors had a significant difference in the intervention group compared to the control group (166.7±28.43 vs. 134.5±35.68, p<0.001).
Conclusion: Based on the findings, it can be said that educating lifestyle based on the Pender model causes HIV patients to use health-promoting behaviors, which are recommended as a useful theory-based program for managers and providers of health services.
Background & Aim: Intrauterine device and depo-medroxyprogesterone acetate are among the most effective reversible contraception in the world, still few consensuses exist about sexual and mood changes of these two conventional methods. The present study has compared the sexual satisfaction and depression level in these two methods.
Methods & Materials: A cross-sectional study was conducted between August 2017 and January 2018, in 300 married women aged 19-50 year, in Tehran, Iran. One hundred and fifty IUD users and 150 DMPA consumers, 12-18 months after starting the current method, recruited to the study from 34 health centers of Tehran University of Medical Sciences by convenience sampling. Two standard questionnaires of Index of sexual satisfaction (ISS) and Patient Health Questionnaire (PHQ) were used for assessing sexual satisfaction and depression, respectively. Chi-square and independent t-test were used for the homogeneity of the two groups. The linear logistic regression analysis was conducted to estimate the strength of associations.
Results: There was not any significant difference between two groups in demographic characteristics such as age, marriage duration, education level, number of children and breastfeeding condition (P>0.05). Significantly higher sexual satisfaction (P<0.001) and lower depression level (P<0.001) reported in IUD users than DMPA consumers in the t-test. A multivariate regression confirmed that sexual satisfaction increased 6.4 scores in the IUD group in comparison to DMPA users (P= 0.003, B= -6.4), and with increase 1 year to duration of the marriage, sexual satisfaction increase 0.33 score. For depression, the only significant variable was the contraceptive methods, and depression level increase 1.24 scores in DMPA users than IUD consumers. (P=0.006, B= - 1.24). Although in univariate analysis, some variables showed effects on sexual satisfaction and depression, multivariate regression results did not confirm any significant relationships.
Conclusion: Both sexual satisfaction and mood level was higher among IUD users. This paper reconfirmed that IUD is a preferable method in women who are eligible to use both methods.
Background & Aim: The nursing profession should include information technology into nursing education curriculums to provide the necessary knowledge and skills. This study was done to evaluate the effect of mobile-assisted education regarding intramuscular injection on the ventrogluteal site by using the Instagram application and to nursing students.
Methods & Materials: The study was designed experimental randomized controlled. Students participating in the study were divided into the Instagram app (n=69) and classroom teaching (n=69) groups by using simple random sampling. Mobile-assisted teaching methods trained the students in the Instagram app group by using Instagram. The students in the classroom teaching group were trained in the classroom. The data of the study was collected by Student Demographic Form, Knowledge Evaluation Form and Skill Checklist. The Wilcoxon Signed-Rank Test evaluated the mean scores of the dependent groups, and the Mann-Whitney U test evaluated the mean scores of the independent groups
Results: While it was not found any statistically significant difference between two groups regarding the knowledge mean scores of the students in the Instagram app and classroom teaching groups immediately after and 15 days (p=0.445; p=0.111). The comparison of mean scores of skills of the students between the two groups was not revealed a statistically significant difference in the phase of preparation for IM injection (p=0.460), the phase of application (p=0.711), the ending phase of IM injection (p=0.581) and total mean scores of skill checklist (p=0.379).
Conclusion: The results of the present study indicate that mobile assisted teaching by using the Instagram application was found to be as effective as classroom teaching for evaluating the knowledge and skills of nursing students.
Background & Aim: Clinical outcomes and mortality rate of patients with ST-segment elevation myocardial infarction (STEMI) strongly depend on the time of percutaneous coronary intervention (PCI). One way to reduce the delay in this treatment is to use telecardiology in the prehospital setting. The purpose of this study was for comparison of telecardiology on the first medical contact to balloon time and outcome (size of infarct area, left ventricular ejection fraction, and major adverse cardiac events) of patients with myocardial infarction (MI) transported by Tehran Emergency Medical Services to selected hospitals in Tehran, Iran.
Methods & Materials: The present retrospective, comparative study was conducted in 2018 in Tehran city on the medical records of 300 patients with STEMI transported with and without telecardiology (150 records per group). Data for this study included demographic characteristics; how to transport the patients to medical centers, first medical contact to balloon time (FMCTB), and clinical outcomes. Data were analyzed using independent t-test, Fisher's exact test, Chi-square, Mann-Whitney and Kruskal-Wallis test by SPSS software, Version 20.
Results: First medical contact to balloon (FMCTB) time, infarction size based on creatine kinase, the patient mortality rate in one month, and repeated PCI in the group transported with telecardiology was significantly lower than that of the group transported without telecardiology (P<0.05). Left ventricular ejection fraction (LVEF) in the first 24 hours, infarction size based on troponin I level, the rate of readmission due to acute coronary syndrome (ACS) and the rate of coronary artery bypass grafting (CABG) were not statistically significant between the two groups (P<0.05).
Conclusion: The results of this study showed that the use of telecardiology could reduce the delay in performing PCI and improve some of the clinical outcomes of patients with STEMI. These results can be used to improve the quality of care for patients with STEMI by pre-hospital emergency personnel, physicians and nurses involved in the care of these patients.
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