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   Table of Contents - Current issue
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November-December 2019
Volume 24 | Issue 6
Page Nos. 403-475

Online since Thursday, November 7, 2019

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REVIEW ARTICLES  

Sleep quality in Iranian hemodialysis patients: A systematic review and meta-analysis p. 403
Masood Taheri Mirghaed, Razieh Sepehrian, Amir Rakhshan, HasanAbolghasem Gorji
DOI:10.4103/ijnmr.IJNMR_184_18  
Background: Hemodialysis is a major therapeutic method for many chronic kidney disease patients that causes complications. One of these complications tends to be sleep disorders. This study was performed through systematic review and meta-analysis to determine the prevalence of low sleep quality in hemodialysis patients in Iran. Materials and Methods: Journal papers written in English and Persian searched from January 2000 to July 2018 were selected. The search keywords included (Prevalence OR Epidemiology) AND (hemorenodialysis OR hemodialysate OR 'intermittent chronic haemodialysis' OR 'intermittent chronic hemodialysis' OR 'intermittent haemodialysis' OR 'intermittent hemodialysis' OR 'kidney dialysis' OR 'renal dialysis') AND ('sleep problem' OR 'sleep disturbance' OR 'sleep disorder' OR 'sleep quality' OR 'chronobiology disorders' OR dyssomnia). To determine the pooled prevalence, the stochastic DerSimonian-Laird model was used, computing the effect size with its 95 per cent confidence interval. The main international electronic databases were Embase, PubMed/MEDLINE, ISI/Web of Science (WOS), Scopus, Psych INFO, and Iranian databases such as MagIran, SID and Irandoc. The data were analysed using the Stata (version 13.0). Results: After searching through the databases and other resources, 21 articles (7 in Persian and 14 in English language) were included. The overall prevalence of low sleep quality in dialysis patients was 75.30 per cent (95 per cent confidence interval, 70.08–82.50). The heterogeneity study showed moderate heterogeneity among studies (I2 = 50.30 per cent, p < 0.05). Conclusions: The results of this study showed that the prevalence of low sleep quality in hemodialysis patients has become a common problem. Thus, patients' sleep quality need to be evaluated periodically.
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Assessing the quality of existing clinical practice guidelines for chemotherapy drug extravasation by appraisal of guidelines for research and evaluation II p. 410
Masoud Bahrami, Tayebeh Karimi, Ghasem Yadegarfar, Ali Norouzi
DOI:10.4103/ijnmr.IJNMR_80_19  
Background: Extravasation is a potentially hazardous event that may occur during chemotherapy. The aim of this study is to assess the quality of existing Clinical Practice Guidelines (CPGs) for chemotherapy drug extravasation by Appraisal of Guidelines for Research and Evaluation II (AGREE II). Materials and Methods: Valid electronic databases and CPGs from 2007 to August 2018 were searched by keywords of CPGs, extravasation, chemotherapy, and cancer. CPGs were evaluated independently by five experts through AGREE II tool, and the consensus among evaluators was calculated by ICC (Intra-class Correlation Coefficient). Results: Five of the 111 CPGs matched the inclusion criteria. The methodological quality of CPGs in domains of “scope and purpose,“ “stakeholder involvement,“ “clarity of presentation,“ and “applicability“ were good, in the domain of “rigor of development,“ was acceptable, and in “editorial independence“ domain, it needed more attention of developers of CPGs. The range of assessors' consensus was within a range of moderate to very good (0.55--0.93). Conclusions: The methodological quality of existing CPGs of chemotherapy drugs extravasation assessed by AGREE II tool is appropriate. Four CPGs had high level while one had moderate level of quality. Therefore, their use is recommended in the clinic to reduce the risk of chemotherapy extravasation to the entire treatment team and the nurses working in the oncology departments.
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The needs of women who have experienced “maternal near miss“: A systematic review of literature p. 417
Sedigheh Abdollahpour, Abbas Heydari, Hosein Ebrahimipour, Farhad Faridhosseini, Talat Khadivzadeh
DOI:10.4103/ijnmr.IJNMR_77_19  
Background: Maternal Near Miss (MNM) event is associated with emotional, psychological, and social effects on women. Determining the needs of women with these experiences is the key to programming for providing high-quality care and reducing its burden. Hence, this study was conducted to determine the needs of women who have experienced MNM. Materials and Methods: In this literature systematic review, to achieve the intended information, articles published in Web of Science and PubMed databases were systematically searched. The search strategy focused on three keywords or phrases: “maternal morbidity“ OR “maternal near miss“ AND “needs.“ Publication date was all relevant articles before 2019, and publication language was restricted to English. Article search was conducted by two independent reviewers. After the primary search, 2140 articles were found. Eventually, 77 articles, including 20 qualitative studies and 57 quantitative studies, were enrolled for final evaluation. Results: According to the results, the needs of these women could be categorized into six groups of “Management and care needs of health system,“ “Educational needs of health system,“ “Follow up and continuity of care at the primary care level,“ “Need to develop a physical, psychological and social of care packages,“ “Social support,“ and “Psychosocial support and counseling.“ Conclusions: The near-miss events change the mothers' living conditions, and therefore, they need to receive special support, given the difficult conditions they are undergoing. It is necessary that a supportive program be designed to follow-up MNM after the discharge to be run by the primary care team.
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ORIGINAL ARTICLES Top

The effect of the appraisal interview on nurses' performance in neonatal intensive care units p. 428
Azam Bigdeli, Marzieh Adel-Mehraban, Mahboobeh Namnabati
DOI:10.4103/ijnmr.IJNMR_14_19  
Background: Performance appraisal system can be an effective role to improve the infants' health in the Neonatal Intensive Care Unit (NICU). The most important challenge of the nurses' performance appraisal system is that the process is not conducted correctly. The aim of this study was therefore to determine the effect of the appraisal interview on the performance scores of the nurses in NICU. Materials and Methods: A randomized clinical trial study was conducted with 71 nurses in two selected hospitals of Isfahan University of Medical Sciences in 2018. The participants worked in the NICU and were selected through convenience sampling method, and then, were randomly assigned to the intervention and control groups. The intervention was an appraisal interview which was done by head nurses, who attended a training workshop to know how to conduct an appraisal process. Control group was appraised without an interview. The performance scores of both groups were collected through approved Nurse Appraisal Tool, developed by the Ministry of Health and Medical Education for nurses, and analyzed by SPSS Software before and after the intervention. Results: Independent t-test showed no significant differences in mean scores of nurses' performance appraisal before the intervention between the two groups (p = 0.91), but independent t-test showed that these scores were significantly higher in the intervention group compared to the control (p = 0.007). Conclusions: According to the findings, nurses' performance scores can be increased through an acceptable performance appraisal system with an interview process.
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Vancomycin infusion methods on phlebitis prevention in children p. 432
Maryam Tork-Torabi, Mahboubeh Namnabati, Zahra Allameh, Sedigheh Talakoub
DOI:10.4103/ijnmr.IJNMR_149_18  
Background: Hospitalized children require antibiotic therapy. The most common side effect of intravenous injections is Phlebitis. Due to high usage of Vancomycin in children and subsequent phlebitis in their intravenous lines, the current study aimed at comparing the effects of two intervention and routine vancomycin infusion methods in preventing phlebitis in hospitalized children. Materials and Methods: The current study is a quasi-experimental study investigating 74 individuals between ages of 1 month and 6 years undergoing treatment using vancomycin. First, 37 children, hospitalized in internal medicine ward of Isfahan Paediatrics' Hospital, Iran with vancomycin infusion orders, were placed in control group, and another 37 children were placed in the intervention group through matching with control group. The intervention group used phlebitis prevention guidelines, created by the authors, while control group used routine infusion method of the hospital. Data were analyzed by SPSS software, and statistical significance was set at 5%. Results: The occurrence of phlebitis was 45.90% in intervention and 89.10% in control group. Results showed that the frequency of phlebitis in intervention group was significantly lower than control group (χ2= 15.79, df = 1, p < 0.001) and the average time of phlebitis onset in control group was also significantly lower than that of the intervention group (t72= 2.99, p = 0.004). Conclusions: According to the results, intervention vancomycin infusion method is more effective in reducing phlebitis as a result of intravenous catheter, compared to the routine vancomycin infusion method.
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The relationship between maternal confidence, infant temperament, and postpartum depression p. 437
BabuHalina JayaSalengia, Singaravelu Rajeswari, SiralaJagadeesh Nalini
DOI:10.4103/ijnmr.IJNMR_208_18  
Background: Although several studies have emphasized the correlation of infant temperament and maternal confidence, this topic has not been explored in different culture and geographical contexts. We study association of maternal confidence, infant temperament, and postpartum depression among postnatal mothers. Materials and Methods: This cross-sectional study was conducted at Sriramachandra Institute of Higher Education and Research, India from July 2017 to May 2018. The sample population comprised of mothers at 6 weeks of postnatal period attending the Immunization Clinic. The instruments used were standardized Karitane's Parenting Confidence Scale (KPCS), Bates Infant Characteristics Questionnaire (BICQ), and Edinburgh Postnatal Depression Scale (EPDS). A structured questionnaire was used to collect data from postnatal mothers. Data were analyzed with Statistical Package for the Social Sciences (SPSS) ver. 19, using analysis of variance, correlation coefficient, multivariable regression. Results: In this study, 64.40% of the population had high level of confidence and 80% postnatal mothers had no depression. A significant association (t2= 18.15, p = 0.001) was seen between maternal confidence, family support, and place of living. Regression analysis showed that confidence of postnatal mothers has a significant influence (t2= 12.48, p < 0.005) on infant temperament. Conclusions: Two-third of the postnatal mothers had high confidence level with no depression. A positive correlation between postpartum depression and infant temperament was found to be associated with income, parity, and maternal confidence. A significant association was also seen of infant temperament with type of family, income, place of living, and sex of the baby.
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The effect of sexual education based on sexual health model on the sexual function of women with infertility p. 444
Nahid Marvi, Nahid Golmakani, Hamid Heidarian Miri, Habibollah Esmaily
DOI:10.4103/ijnmr.IJNMR_199_17  
Background: Infertility has deep psychological impacts on the sexual function of women such as a sense of fear, failure, and incompetence. It can also result in reduced sexual desire, unattained orgasm, and other sexual disorders. However, sexual education is assumed to improve the sexual function in these cases. Therefore, we study the effect of sexual education based on Sexual Health Model (SHM) on sexual function disorders in women with infertility. Materials and Methods: A singleblind, randomized controlled trial was conducted on 108 women with infertility (54 intervention group and 54 control group) aged between 18 and 40 years at the Milad Infertility Center of Mashhad in 2016. The intervention comprised three 90-min sessions administered during 1 week. At first, a pretest (Female Sexual Function Index [FSFI]) was completed, and 1 month after the end of the intervention, the posttest (FSFI) was completed. To analyze the data, independent t-test, Mann–Whitney test, and Wilcoxon test were run. Results: The mean (Standard Deviation [SD]) age of women and their spouses was 30.61 (5.42) and 34.42 (5.73)years, respectively. Results of Mann–Whitney test showed that after 1 month of intervention, there was a significant difference between intervention and control groups (Z = −4.87, p < 0.001). Moreover, results of Wilcoxon test showed a significant difference in the sexual function in the intervention group before and after the intervention (Z = 2.81, p < 0.001). Conclusions: Given the positive effects of SHM-based sexual education, this method could be considered as a subset of sexual education materials used for women with infertility suffering from sexual disorders.
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Comparing the effect of foot and hand reflexology on pain severity after appendectomy: A randomized clinical trial p. 451
Hosein Taheri, Vahid Naseri-Salahshour, Ahmadreza Abedi, Mahbobeh Sajadi
DOI:10.4103/ijnmr.IJNMR_85_18  
Background: Appendicitis is one of the main causes of acute pain. The aim of this study was to determine the effects of foot and hand reflexology on pain severity following appendectomy. Materials and Methods: This clinical trial was conducted on 38 patients undergoing appendectomy in Alimoradian Hospital of Nahavand, Iran, in 2016. The samples were selected using convenience sampling, and then, randomly assigned to hand and foot reflexology groups via simple random sampling. In the foot reflexology group, the dorsal and plantar surfaces of the feet were lubricated using natural olive oil for five minutes. Next, reflexology was done by applying pressure to the appendix reflex area for 20 minutes. The same intervention was applied in the hand reflexology group. The severity of pain was measured using a Visual Analog Scale (VAS) before the intervention and one, three, and 24 hours after the intervention. Data were analyzed using Chi-square, One-way Analysis Of Variance (ANOVA), and repeated measures ANOVA. Results: The results of one-way ANOVA showed no significant difference in the mean pain severity between the two groups (p = 0.771), whereas pain severity in the foot reflexology group was significantly lower than that of the hand reflexology group after the intervention (t = 1.63, p = 0.001). Conclusions: The results of this study showed that foot reflexology was more effective than hand reflexology in pain alleviation.
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Intention to leave the nursing profession and its relation with work climate and demographic characteristics p. 457
Fatemeh Sharififard, Hamid Asayesh, Hossein Rahmani-Anark, Mostafa Qorbani, Valiollah Akbari, Hossein Jafarizadeh
DOI:10.4103/ijnmr.IJNMR_209_18  
Background: Because of the importance of staff shortage in health systems, considering the intention to leave the job and its related factors among nurses is very important. The aim of this study was to identify the association between the intention to leave the nursing profession and work climate and demographic characteristics. Materials and Methods: A cross-sectional survey was conducted among 206 nurses, by random sampling method from six hospitals (response rate = 92%). A set of self-administered questionnaires were applied for the evaluation of intention to leave and work climate. Results: The high level of intention to leave the profession was expressed by 23.70% of the participants; 25.10% of the participants had the moderate intention. Data analysis revealed that work climate, type of employment, marital status, and overtime working were significant predictors of nurses' intention to leave after controlling other independent variables (R2 = 0.10, p < 0.001). Conclusions: It was found that work climate and some demographic characteristics can be seen as indicators for intention to leave among nurses; therefore, considering the so-called variables is required. Further studies are needed to identify other aspects of the issue.
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Nursing educators' experiences regarding students' mistakes in clinical settings p. 462
Alehe Seyedrasooli, Vahid Zamanzadeh, Akram Ghahramanian, Faranak Jabbarzadeh Tabrizi
DOI:10.4103/ijnmr.IJNMR_46_19  
Background: There is always the possibility of mistakes for nursing students, given the nature of the clinical wards. Nursing educators are the primary figures responsible for the nursing students' performance in clinical wards. The present study intended to describe nursing educators' experiences in relation to clinical mistakes made by nursing students. Materials and Methods: The present research was conducted using a descriptive phenomenological approach in 14 nursing educators. Deep semistructured interviews were performed to gather data, and triangulation and member checking were utilized to ensure data integrity. The data were analyzed using Colaizzite seven-stage method. Results: The themes extracted through comparison and analysis included three main themes “encountering an unpleasant event“, “internal confrontation“ and “the change in the effectiveness of teaching“ besides 6 sub-themes including “emotional excitement“, “honest reaction to the issue“, “struggling with the fear of recurrence of the mistake“ “coping with the event“, “passive teaching“ and “trying to be enhance one's capabilities in teaching“Conclusions: Regardless of the possibility of gaining fruitful experiences from a clinical mistake, its occurrence could be followed by negative experiences and consequences for the educators. It is thus essential that appropriate packages in this regard be provided in the empowerment programs for young educators to prepare them for correct confrontation with mistake occurrence. It is suggested that further qualitative studies be conducted to extract the steps educators take in confrontation with nursing students' clinical mistakes.
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SHORT COMMUNICATIONS Top

The effects of self-compassion education on the self-efficacy of the clinical performance of nursing students p. 469
Mahin Moeini, Esmaeil Sarikhani-Khorrami, Amir Ghamarani
DOI:10.4103/ijnmr.IJNMR_77_18  
Background: The objective of the present research was to assess the influence of self-compassion training on the self-efficacy of clinical performance in nursing students, owing to the significance of proposing novel approaches to ameliorating efficiency in nursing students, underscoring the growth of positive psychologic aspects, such as self-compassion. Materials and Methods: The present study is a field research conducted in 2016 where 52 internship nurses were chosen via simple random sampling and were randomly divided into two groups (intervention and control); these two groups were compared in two phases: Prior to and following the intervention. Self-efficacy of clinical performance, as a standard questionnaire, was collected from the samples. Data were analyzed through the use of paired t-test, independent t-test, Chi-square, Mann--Whitney tests. Results: Independent t-test indicated that, compared with the control group, the efficaciousness of students' self-efficacy of clinical performance in the intervention group noticeably increased (t54= 6, p < 0.001). Conclusions: In nursing students, self-compassion training enhances their effective clinical performance.
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Evaluation of nurses' attitude toward the provision of oral hygiene care to hospitalized patients at two private hospitals in South India p. 472
Sreenivas Nagarakanti, Joshna Avuluri, Vijay K Chava
DOI:10.4103/ijnmr.IJNMR_39_19  
Background: Several hospitalized patients with complex medical issues depend on nursing staff for their daily health care due to several functional limitations. This study investigates the Oral Hygiene Care (OHC) activities and attitudes of nurses toward hospitalized patients. Materials and Methods: A cross-sectional survey was conducted at two private hospitals using a self-administered, structured questionnaire distributed to 585 nursing staff. Data were analyzed through percentages. Results: About 85.70% of the nurses ranked OHC as important; among them, 74.00% ranked as important to extremely important. Very few (2.40%) rated providing OHC to be an unpleasant task and the majority (41.80%) felt lack or proper training is one of the reasons for providing OHC satisfactorily. Conclusions: Nurses experienced significant behavioral and physical difficulties while providing OHC, but still found it important. Therefore, training programs are needed for nurses to improve OHC to hospitalized patients.
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LETTER TO THE EDITOR Top

Mutual support: A solution to improve patient safety during nurses' work overload p. 475
Zahra Khademian
DOI:10.4103/ijnmr.IJNMR_144_19  
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