Vol 7 No 3 (2020): Summer

Published: 2020-07-01


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    The validity of the findings of the Systematic Review (SR) depends on the methodological quality of the individual studies in which they are included.  Therefore, evaluating the validity of the included studies is an integral component of a systematic review (1).  Bias or systematic error either exaggerates or underestimates the 'true' effect of an intervention or exposure. Typically, four sources for systematic error, including Selection bias, Performance bias, Attrition bias, and Detection bias, are considered in this assessment.

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    COVID-19 pandemic has led to serious challenges in nursing homes around the world. In addition to age-related conditions, living in nursing homes are more likely to be infected with COVID-19 due to the use of shared living space, gathering in common dining and recreational areas, and limited technical and human resources. Nurses play an important role in meeting the complex needs of the elderly in the crisis and it is essential to use specialist nurses for addressing the physical and psychological needs of this high-risk population. In this crisis, the lack of geriatric nurses in nursing homes in Iran causes problems such as the rapid spread of infection, lack of access to quarantine and proper prevention, and further infection of patients and caregivers. These specialist nurses could take many responsibilities in a special condition such as the provision of specialized courses for other care providers who are working in these facilities to prevent the complications of being affecting by the disease. Therefore, it is recommended to prioritize the employment of specialist geriatric nurses, support staff more, and use appropriate technologies to minimize contact with patients, effectively train volunteers in the programs of these centers. It also Necessary to formulate and implement strict regulations and guidelines by these nurses to prevent, rapid diagnosis, and infection control, personal protection, meeting, and isolation of residents of nursing homes.

Case Report(s)

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    “…Sit down. Look at the TV. Move slowly. Wait for death.”
    Background & Aim: Systemic sclerosis or scleroderma is a rare chronic connective tissue disease included among autoimmune rheumatic diseases. The disease affects many organs and the organ system. It also has multiple effects on the patient’s individual life.  In care management, in addition to the physical effects of the disease, its emotional, psychological and social influences must also be considered and managed. The present study aimed to touch the psychosocial aspect of scleroderma and the unseen effects of the disease are presented over a case study.
    Case Report: 52-year-old, female patient, married with two children. Her self-evaluation after the diagnosis of the disease, she explained that her physical state, social reltionships, economic condition, domestic relations and mood were affected by the disease negatively.
    Conclusion: In managing psychosocial problems in nursing care, it is necessary to consider that each patient has different needs, perspectives on life, future expectations and coping mechanisms. The present study reveals the unknown face scleroderma, its psychosocial effects, from a patient’s point of view. 

Review Article(s)

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    Background & Aim: Despite expand using psychological interventions, there is no obvious evidence about the effects of them on sexual function. The study aimed to determine the effect of psychological interventions based on different approaches to the sexual function of women.
    Methods & Materials: Pubmed, ISI, SCOPUS, EMBASE, Cochrane reviews, Science direct, SID, and Magiran were searched up to May 2019. Eligible studies were randomized controlled trials in which the effect of psychological interventions on the sexual function of women was assessed using the Female Sexual Function Index without any limitations based on age, ethnicity, language, and nationality. Two of the authors screened the titles/abstracts and obtained all full text of the candidate studies, independently. The quality of studies was assessed using the Cochrane checklist risk of bias. Meta-analysis performed via standardized mean differences with a random-effects model using Review Manager Software (RevMan) version 5.3.
    Results: Twenty-one studies with 1460 participants were included. The most effective psychological intervention was individual and group type (SMD=3.82; 95% CI, 2.56, 5.08; P<0.001) with cognitive approach (SMD=2.50; 95% CI, 1.06, 3.95; P<0.001), especially in women with no specific condition (SMD=2.17; 95% CI, 1.20-3.15; P<0.001). The effect of psychological interventions on sexual function increased from 1.48 in one month to 2.30 and 3.78 in two and three months after the intervention; however, it decreased to 1.43 in six months or more follows ups (all Ps<0.001). There was a significant change in all FSFI domains (all Ps<0.01).
    Conclusion: Based on the results, individual and group psychological interventions using the cognitive approach and multidimensional therapies with long term follow-ups are suggested for the treatment of sexual dysfunction.

Original Article(s)

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    Background & Aim: A wide range of clinical education of operating room students is done in the operating room. One of the problems in students' clinical education is the lack of appropriate learning tools in the operating room. The use of educational tools that improve students' performance affects students' self-efficacy in the operating room. So, the purpose of this study was to investigate the influence of the surgical preference card as an educational aid tool on the self-efficacy of the operating room students.
    Methods & Materials: This quasi-experimental study was carried out on 64 operating room students of Isfahan University of Medical Sciences at AL-Zahra Hospital in the year 2018. Participates were selected through convenience sampling and were divided into experimental (n=32) and control (n=32) groups. The students in the intervention group performed surgical care with using the surgical preference card. The data collection tool was a clinical self-efficacy questionnaire. Data were analyzed with SPSS-21 software using the independent-t, paired t-test, and chi-square test.
    Results: The findings of this study showed that there was no significant difference between the average self-efficacy score of the control group before and after the intervention (p>0.05). while the average self-efficacy score of the experimental group increased significantly after the intervention as compared with before the intervention (p <0.001).
    Conclusion: The surgical preference card as an educational aid tool improved the students' self-efficacy. Therefore, it is recommended to use this tool for the clinical education of other operating room students.

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    Background & Aim: Expressing emotions is very important both in interpersonal relationships and in the protection and maintenance of the individual's mental health. However, the individual must have certain skills to express his feelings healthily. The most important of these is communication skills. This research aimed to examine the correlation between communication skills and emotional expressions of nursing students.
    Methods & Materials: This correlational study was conducted among nursing students at a public university faculty of nursing in Turkey between 2016 and 2017. Of the total of 1423 students, 632 nursing students were selected using the convenience sampling method. The Introductory Information Form, the Berkeley Expressivity Questionnaire and the Communication Skills Scale were used to collect data. The Mann-Whitney U, Kruskal-Wallis H, and Pearson correlation tests were used for the analysis of the data.
    Results: The mean total Berkeley Expressivity Questionnaire score of the students was found to be 79.45±10.11, and the mean total score of the Communication Skills Scale was 97.67±11.20. Emotional expressions are affected by gender, marital status, class, income level, family structure, the residence where they have lived the longest, place of residence and working status (p≤0.05, p<0.01). It was found that there was a positive-directed correlation between students' emotional expressions and communication skills (p<0.01).
    Conclusion: It was concluded that communication skills and some sociodemographic characteristics of nursing students are correlated with their emotional expressions.

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    Background & Aim: Mandatory Continuing Professional Development (CPD) remains to be an issue among nurses. The relatively new implementation of the CPD Act in the Philippines has led to varying perceptions and oppositions that warrant exploration. This study aimed to determine the awareness, attitude, facilitators, and barriers to CPD among hospital nurses in the Philippines.
    Methods & Materials: This study employed a descriptive, cross-sectional survey design with 237 randomly selected nurses in tertiary hospitals in Iloilo City, Philippines. Self-administered instruments were used to gather self-report data. Data were analyzed using descriptive statistics, t-test, ANOVA, and Pearson’s r. 
    Results: Results indicated that nurses were moderately aware of the CPD law (M=2.31; SD=.31), were positive about the importance of CPD (M=3.91; SD=.72) but were ambivalent toward CPD implementation (M=5.98; SD=2.01). Attitude toward CPD importance significantly differed (p=.000) across age group.  Awareness of CPD law (p=.000) and attitude toward the importance of CPD (p=.000) were significantly related to their attitude toward the implementation of CPD. Awareness that CPD is a requirement for license renewal (90.7%), knowledge that it can help improve skills at work (78.9%), and sponsorship from the organization (62%) were considered the major facilitators while cost (98.75%), not available to all staff (61.6%), and time-related factors (60.3%) were the major barriers to CPD participation.
    Conclusion: Along with current efforts to strengthen CPD in the country, it is hoped that identification of knowledge gaps and addressing the barriers may lead to better understanding, acceptance, and participation of nurses to mandatory CPD.

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    Background & Aim: Nowadays, despite the improvements in the knowledge and attitude of healthcare professionals, there are still obstacles against pain management in Neonatal Intensive Care Units (NICUs). Hence, it is necessary to know about the problems of pain management in NICUs. This research aimed to explore the pain management experiences of NICU nurses and neonatologists.
    Methods & Materials: This content analysis study was conducted on six experienced NICU nurses and two neonatologists in one hospital affiliated to Shiraz University of Medical Sciences who were selected through purposive sampling which continued until saturation. The data were collected through semi-structured interviews and field notes. The data were simultaneously analyzed using inductive content analysis.
    Results: Analysis of the data generated one theme and three categories and seven subcategories. The theme was “pain relief in the shade”. The categories were “responsibility versus ignorance”, “family caregiver as a barrier or facilitator”, and “newborn, sacrificed due to imbalanced context”. This study showed that professional caregivers managed pain on the margin of other cares. The effects of family care were identified as a paradox, helping, or disturbing. The participants also emphasized the impact of environmental disruptions on pain management.

    Conclusion: The experiences of pain management in NICUs were identified at three levels of professional caregivers, family caregivers, and organizational atmosphere. Exploring this experience could help improve pain management and reduce its side effects in susceptible neonates. Hence, healthcare workers are recommended to ensure effective pain management in NICUs by ongoing monitoring and audit.

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    Background & Aim: Patient-centered care is considered a pivotal element of the mission of the healthcare system around the world. However implementing Patient-centered care is not always easy and nurses have admitted this fact reluctantly. The evidence suggests that the first step in implementing Patient-centered care is to change the professionals’ viewpoint, behavior, and understanding. This study examined nurses' perceptions of the components of Patient-centered care and its delivery.
    Methods & Materials: This was qualitative descriptive research with a conventional content analysis approach. Face-to-face interviews were conducted with 21 nurses, working in teaching hospitals in Tabriz, Iran, and 5 field notes were collected. Data were analyzed using the Zhang and Wildemuth method of content analysis.
    Results: Three main themes and eleven sub-themes were extracted. Nurses identified “Effective Communication”, “Careful Care of Distinctive Needs”, and “Valuing the Patients and Their Rights” as the main elements of Patient-centered care.
    Conclusion: Nurses implement some components of Patient-centered care. Yet Patient-centered care remains an ad hoc practice requiring more improvement. This study provided a deeper understanding of nurses' perceptions about the implementation of Patient-centered care and their weaknesses. The finding is consistent with current knowledge, shedding light on Patient-centered care-related practices performed by Iranian nurses and pointing to areas for improvement in implementing Patient-centered care.

  • XML | PDF | downloads: 95 | views: 180 | pages: 226-233

    Background & Aim: Formal dysphagia screening protocols are not yet implemented in some hospitals although there is growing evidence that early dysphagia screening reduces pneumonia rates in stroke patients. Trained professionals are not often available outside weekdays working hours in stroke units, meaning that early screening is usually performed by nurses that use informal detection to screen dysphagia in acute stroke patients. The purpose of this study was to identify which items stroke nurses prioritize in their clinical practice to screen dysphagia in acute stroke patients.
    Methods & Materials: A qualitative study was developed using a focus group technique in five stroke units with a total of 20 stroke nurses selected by purposive sampling in march 2019. Qualitative Data Analysis Software Miner Lite 4.0 was used to assist in content analysis.
    Results: Two categories emerged: clinical data and swallowing and non-swallowing signs, each with a set of dimensions. In the category clinical data, relevance was noted for the dimension Glasgow Coma Scale and sex, identified as the most and least relevant, respectively, for dysphagia screening. In the category swallowing and non-swallowing signs no relevance evolved for preferred items. However, in this category, data suggest that nurses find less relevant in clinical practice speech disorders for dysphagia screening.
    Conclusions: Results reinforce the importance of a standardized approach through the use of valid and reliable dysphagia screening protocols, arguing the need for clear guidance in acute stroke clinical pathways on procedures for dysphagia screening.