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   Table of Contents - Current issue
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July-August 2021
Volume 26 | Issue 4
Page Nos. 289-372

Online since Tuesday, July 20, 2021

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ORIGINAL ARTICLES  

The relationship between self-compassion and the experience of memorial symptoms in patients with gastrointestinal cancer p. 289
Kolsoom Zarei, Amir Musarezaie, Elaheh Ashouri
DOI:10.4103/ijnmr.IJNMR_284_20  
Background: Patients with Gastrointestinal (GI) cancer experience a range of physical and psychological memorial symptoms after developing cancer and beginning to receive medical care. The present study was conducted to investigate the relationship between self-compassion and the experience of memorial symptoms in patients with GI cancer. Materials and Methods: This descriptive-correlational study was conducted in July to August 2019. The study sample included 190 patients admitted to Seyed Al-Shohada Hospital, with GI cancer who entered the study by convenience sampling. Data were collected using a patient demographic information form, Neff's Self-Compassion Scale (SCS), and the Memorial Symptoms Assessment Scale (MSAS) and then analyzed by Pearson correlation coefficient in SPSS-20. Results: The mean (SD) total score of self-compassion was 86.67 (16.65) out of 130, and the mean (SD) total score of memorial symptoms was 1.40 (0.64) out of 4 in patients with GI cancer. The most frequently reported physical symptom was lack of energy, with an 86.84% prevalence, and the most frequently reported psychological symptoms included worrying and feeling nervous, with 70.52% prevalence rates. The total score of self-compassion was inversely correlated with the total score of memorial symptoms, the score of psychological symptoms, and the score of physical symptoms. Furthermore, the total score of the memorial symptoms was inversely correlated with the scores of all the self-compassion components (p < 0.001). Conclusions: Cancer patients had memorial symptoms in both physical and psychological domains. These symptoms decrease with an increase in self-compassion, so compassion-based educational interventions by nurses can be used to reduce these symptoms.
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The effect of jacobson's progressive relaxation technique on postoperative pain, activity tolerance, and sleeping quality in patients undergoing gynecological surgery p. 295
Heba Abdel-Fatah Ibrahim, Wafaa Taha Elgzar, Reda Mhmoud Hablas
DOI:10.4103/ijnmr.IJNMR_180_20  
Background: Inadequate pain management and sleep disturbances of patients undergoing gynecological surgery are associated with delayed recovery time. This study aimed to assess the effect of Jacobson's Progressive Relaxation Technique (JPRT) on postoperative pain, activity tolerance, and sleeping quality in patients undergoing gynecological surgery. Materials and Methods: A randomized controlled clinical trial conducted at Obstetrics and Gynecology Department/Damanhour educational institute, Elbehira, Egypt. The study sample involved 116 patients undergoing gynecological surgery who were equally distributed between intervention and control groups. Data collected from April to September 2019. Four tools were used for data collection: Demographic data interview schedule, pain analog scale, activity tolerance questionnaire, and the Groningen sleeping quality scale. For the intervention group, the women were asked to perform JPRT for 30 min on the second and third postoperative day, three times a day. SPSS 23.0 is used to analyze data using Chi-square, Fisher's exact, independent t-test, and Analysis of Covariance (ANCOVA). A significance level considered at p < 0.05. Results: The study results showed that JPRT significantly improves pain, sleep quality, and activity tolerance mean scores among the intervention group compared to the control group (F1 = 119.13, p < 0.001), (F1 = 361.49, p < 0.001), and (F1 = 157.49, p < 0.001), respectively. ANCOVA results showed that 33% of the decreased pain score, 12% of decreased sleeping quality score, and 26% of improved activity tolerance score are due to JPRT. Conclusion: JPRT should be offered as a part of standard postoperative nursing care for patients undergoing gynecological surgery to control pain and improve sleeping quality and activity tolerance.
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The effect of peer support on foot care in patients with type 2 diabetes p. 303
Zahra Ghasemi, Hojatollah Yousefi, Mohsen Torabikhah
DOI:10.4103/ijnmr.IJNMR_163_18  
Background: Diabetes mellitus is one of the prevalent diseases in the world with several complications including diabetic foot ulcers. The aim of this study was to investigate the effect of peer support on foot care in patients with type 2 diabetes. Materials and Methods: This clinical trial study was performed at selected centers of Isfahan University of Medical Sciences in 2017. Fifty patients with type 2 diabetes were randomly assigned into intervention and control groups. Five 30-min. supportive training sessions were held for the intervention group by the peers and during 35 days. Foot Care Confidence/Foot-Care Behavior Scale For Diabetes (FCCS-FCB) was completed by both groups before, immediately after and 1 month after the intervention. Collected data were analyzed using Chi-square, Mann–Whitney, repeated measures ANOVA and t-test. Results: Mean (SD) age of subjects was 56.46 (7.36) years old Mean (SD) score of self-efficacy (F2, 26 = 54.71, p < 0.001), preventive behaviors (F2, 26 = 28.46, p < 0.001), and potentially damaging (F2, 26 = 27.89, p < 0.001) had significant differences between the two groups immediately and 1 month after the peer support. Conclusions: Peer support can enhance foot care behaviors in diabetic patients. Therefore, using people who are successful in the education and support of patients has a significant role, and nurses can use them as a support in the field of care and follow-up. However, health agencies are responsible for providing the patients with the best guidelines, and these results can be useful as an evidence for them.
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The effect of reducing the fasting time on postoperative pain in orthopaedic patients: A randomized controlled trial p. 310
Mohsen Torabikhah, Hojatollah Yousefi, Amir-Hossein Monazami Ansari, Amir Musarezaie
DOI:10.4103/ijnmr.IJNMR_291_19  
Background: Patients undergoing orthopedics surgery experience the most severe postoperative pain. The fasting time is a factor that affects this complication. The aim of this study was to investigate the impact of fasting time reduction by using oral carbohydrate on postoperative pain and analgesic consumption in orthopedic patients. Materials and Methods: This randomized control trial was conducted between November 2017 and December 2018. Sixty-four patients were randomly assigned into the intervention (which consumed 200 mL of the 12.50% carbohydrate, 2 h before the surgery) and the control group (which was fasted from midnight). Postoperative pain was measured by visual analog scale; the amount of the consumed analgesics was also recorded. The data were analyzed by using Chi-square and t-test. Results: The mean (SD) of the pain scores in the control group immediately and 2, 4, 6, 12 and 24 h after consciousness were 7.19 (2.64), 6.69 (2.17), 6.31 (2.05), 6.16 (2.08), 6.06 (2.24), and 5.38 (1.86), respectively. These scores for the intervention group were 7.44 (1.48), 6.31 (1.25), 5.72 (1.17), 5.59 (1.43), 5.25 (1.13), and 4.97 (1.57). The mean of the pain scores between two groups was not different (p > 0.05). The amount of the consumed morphine (t61 = -2.10, p = 0.039), pethidine (t62 = -2.25, p = 0.028), and diclofenac (t62 = -2.51, p = 0.015) were significantly different between the two groups. Conclusions: The pain intensity in the patients with shortened fasting time was lower, but it was not statistically significant. Moreover, reducing fasting time by using carbohydrate significantly reduced the use of analgesics.
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The effect of sedation protocol on sedation level and pharmacological and non-pharmacological interventions on mechanically ventilated patients p. 316
Masoumeh Namadian, Zahra Taran
DOI:10.4103/ijnmr.IJNMR_165_20  
Background: The use of analgesics and sedatives to provide sedation for Patients in Intensive Care Unit (ICU) is inevitable. The present study aimed to determine the effect of sedation protocol using the Richmond Agitation- Sedation Scale on sedation level and amount of pharmacological and non-pharmacological interventions on patients under mechanical ventilation. Materials and Methods: This randomized clinical trial was conducted on 79 patients under mechanical ventilation in Zanjan. The patients were recruited using the blocking randomized sampling method. In the experiment group, the sedation was provided hourly, using the Richmond sedation Protocol, during the mechanical ventilation period. The level of sedation and pharmacological and nonpharmacological interventions were compared in the two groups using Fisher exact test. Results: Totally, 40 patients in the experiment and 39 patients in the control groups were evaluated. No significant difference was found between the two groups in terms of confounding variables (age, sex, level of consciousness, Acute Physiologic and Chronic Health Evaluation (APACHE) II criterion, underlying disease, and cause of hospitalization). The level of sedation in the experiment group was significantly closer to the ideal score of the Richmond Scale compared to the control group (p < 0.001). The experimental group received significantly more non-pharmacological interventions and fewer pharmacological interventions compared to the control group (P < 0.001). Conclusions: Using a sedation protocol could provide better sedation levels in patients under mechanical ventilation, and reduce the use of sedative medications, and consequently, the cost of hospitalization. Further research is suggested.
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Psychometrics of the persian version of the team assessment questionnaire in providing care for heart failure patients p. 324
Seyed Hamid Seyed-Bagheri, Hadi Khoshab, Mahlagha Dehghan, Fazlollah Ahmadi
DOI:10.4103/ijnmr.IJNMR_118_20  
Background: Teamwork in the health care domain is the preferred mode of care delivery. Few instruments have been developed to assess teamwork in the field of health care, particularly in Iran. This study aimed to validate the Persian version of the Team Assessment Questionnaire (P-TAQ) in care for Congestive Heart Failure (CHF) patients. Materials and Methods: In this cross-sectional study, the validity (face, content, and construct validity) and the reliability (internal consistency and stability) of the cross-cultural adaptation of the Persian version of the Team Assessment Questionnaire (P-TAQ) were assessed. Results: The P-TAQ had adequate face and content validity. The confirmatory factor analysis confirmed the seven dimensions of the questionnaire. The internal consistency of the P-TAQ was 0.91, and the Intraclass Correlation Coefficient (ICC) was 0.89. Conclusions: The P-TAQ is a valid questionnaire in terms of dimensions and items. Assessing teamwork is an essential component of delivering adequate care. By examining the status of teamwork using this questionnaire, it is possible to promote teamwork and to understand its strengths and weaknesses. Future research is necessary to better understand the P-TAQ so that it can be used for the assessment of teamwork outcomes regarding patient safety, cultural barriers, and medical errors.
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The relationship between nursing students' quality of life with their academic achievement motivation in isfahan university of medical sciences, Iran p. 332
SeyedehMahtab Emamjomeh, Ali Toghyani, Masoud Bahrami
DOI:10.4103/ijnmr.IJNMR_389_20  
Background: Quality of Life (QoL) and academic achievement motivation are important aspects of students' living and studying. There is a lack of studies to address the QoL of nursing students and its relationship with their academic achievement motivation in Iran. Therefore, the present study was conducted to investigate this relationship. Materials and Methods: This was a correlational study conducted with baccalaureate nursing students of Isfahan University of Medical Sciences, Iran, from December 2019 to February 2020. Data collection tools consisted of three parts: a demographic questionnaire, the World Health Organization QoL-Brief Questionnaire (WHOQOL-BREF), and the Hermans Achievement Motivation Questionnaire. Pearson correlation coefficient and standard multiple regression were used to evaluate the correlation between QoL mean domain scores and academic achievement motivation score. Results: The QoL mean (SD) domain scores of physical, psychological, social, environmental, and academic achievement motivation score were 14.95 (2.43), 13.42 (2.74), 13.96 (3.39), 13.62 (2.54), and 84.40 (7.73), respectively. Pearson correlations between physical, psychological, social, and environmental QoL mean domain scores with academic achievement motivation score was 0.30, 0.35, 0.12, and 0.22 (p < 0.05), respectively. Using standard multiple regression, psychological mean domain score (ß = 0.31) was the only statistically significant predictor of academic achievement motivation. Conclusions: Relationships exist between academic achievement motivation and QoL domains of nursing students, particularly in the psychological domain. This information provides policymakers to plan multi-faceted arrangements to improve nursing students' academic achievement motivation and QoL particularly in most neglected areas as the psychological aspect.
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The effectiveness of communication skills training on nurses' skills and participation in the breaking bad news p. 337
Elnaz Yazdanparast, Azadeh Arasteh, SeyedHasan Ghorbani, Malihe Davoudi
DOI:10.4103/ijnmr.IJNMR_150_20  
Background: Nurses have an important role in the process of providing information and helping patients prepare for and receive bad news and understand and cope with the bad news they have been given. This study was conducted to evaluate the effect of communication skills training on the level of skill and participation of nurses in breaking bad news. Materials and Methods: This semiexperimental study was performed on 60 nurses working in educational hospitals of Birjand, Iran in 2019. Convenience sampling was performed and the participants were randomly assigned to the two groups of intervention and control. For the experimental group, an integrated workshop on communication skills was held. Before and after the intervention, the Setting, Patient Perception, Invitation, Knowledge, Empathy, and Strategy (SPIKES) SPIKES questionnaire (breaking bad news skills) and the questionnaire of participation in breaking bad news were completed. The collected data were analyzed using descriptive and inferential statistics (independent t-test) in SPSS software. Results: The mean (SD) of breaking bad news skills after the intervention was 57.42 (10.13) in the control group and 65.12 (5.68) in the experimental group and the between-group difference was statistically significant (t59,41 = 3.93, p < 0.001). After the intervention, the mean (SD) of nurses' participation in delivering bad news was 21.17 (5.21) in the control group and 25.77 (4.96) in the experimental group and the between-group difference was statistically significant (t75,48 = 3.94, p < 0.001). Conclusions: It seems that to increase the ability of nurses in the process of breaking bad news, it is necessary to teach them communication skills.
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The patients' experiences of burden of neurofibromatosis: A qualitative study p. 342
Samira Foji, Eesa Mohammadi, Akram Sanagoo, Leila Jouybari
DOI:10.4103/ijnmr.IJNMR_178_20  
Background: Neurofibromatosis Type 1 (NF1) is a common autosomal disorder; the criteria for the diagnosis of NF1 includes café au lait spots, freckling, and Neurofibromas (NF). Skin symptoms have a major impact on patients' Quality of Life (QOL) but little is known about the burden of the disease on patients. The aim of this study was to explore the experiences of patients with NF. Materials and Methods: Using purposive sampling, 20 participants were enrolled in this qualitative content analysis study. The study was carried out between 2019 and 2020. Unstructured interviews and field notes were used to gather data. Data collection was stopped when data saturation was achieved. Results: Data analysis revealed 14 subcategories and 4 categories including “failing and falling behind in life”, “deprivation and restriction”, “social isolation”, and “ineffective adaptation to the disease”, which indicate the perception of patients with NF. Conclusions: In addition to the physical burden due to physical complications and problems, NF imposes a high degree of psychological and social burden on patients causing mental conflicts, which in turn results in them failing and falling behind in life. These findings illustrate the need to develop strategies and use multidisciplinary approaches to support patients, and thus to reduce the burden of NF.
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Contextual barriers of respectful workplace in nursing: A focused ethnography p. 349
Azadeh Nouri, Akram Sanagoo, Leila Jouybari, Fariba Taleghani
DOI:10.4103/ijnmr.IJNMR_274_20  
Background: Respectful relationship among nurses is an important influencing factor of positive work environment and nursing outcomes. Disrespectful interpersonal behaviors set the scene for an unpleasant and unhealthy workplace in nursing. This can be harmful to persons and their organization and affect health care outcomes. This study was designed in order to search for contextual barriers to respectful behaviors in the context of nursing. Materials and Methods: This study was a focused ethnography that was carried out in medical-surgical wards of Shahid Chamran Hospital in Isfahan in 2018-2019. The data collection method consisted of 140 h of participant observation and semi-structured interviews with 34 informants. The nformants comprised 29 nurses, 2 assistant nurses, a physician, and 2 patients who were selected by purposive sampling. The first author of the study made direct observations as an outsider. The data were analyzed by Spradley's method. Results: Three main categories and eight subcategories were obtained from data analysis that are as follows: 1) Personal self: challenges of perceived respect (negative self-concept, unpleasant feelings, and ineffective communication), 2) Organizational-based perceived disrespect (poor organizational climate, inadequate job condition, restrictive organizational structure), 3) Social self: challenges of showed respect (implicit social norms, cultural gap). Conclusions: Individual and social attitudes, interactive communication, and organizational factors are the contextual determinants of a respectful workplace in nursing. Consequently, improving self-concept and effective communication skills as well as adjust organizational conditions and value conceptualization in society may effect a respectful workplace in nursing.
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Relationship between cognitive-behavioral processes and stages of change in nutrient use in overweight women referring to health centers in Isfahan p. 355
Nayerhe Namazi, Firozeh Mostafavidarani, Amirmansour Alavinaini, Zahra Boroumandfar
DOI:10.4103/ijnmr.IJNMR_297_19  
Background: The positive impact of post-needs assessment training on the correction of eating habits is remarkable. The aim of present study was to determine the relationship between cognitive-behavioral processes and stages of change in nutrient use in overweight women referring to health centers in Isfahan. Materials and Methods: The present study was a cross-sectional study conducted in 2017 during a three-month period. Using systematic random sampling, 260 overweight women referring to Isfahan comprehensive health centers were chosen. Data collection was performed by a four-part researcher-made questionnaire including demographic information form, stages of change of behavior, cognitive and behavioral processes questionnaire, and standard 168-item Food Frequency Questionnaire. After confirming its validity and reliability, it was completed by the researcher. Data were then entered N4 software perfect and analyzed using descriptive and analytical tests (ANOVA and Bonferroni Post-Hoc). Results: 59.30% of the subjects were in an inactive and 40.70% in an active phase. There was a significant difference with respect to different stages of change and the use of all behavior change processes (F4= 11.42, p < 0.001). The rate of using cognitive and behavioral processes increased during the nutrient change behavior (p < 0.001). Conclusions: The results of the study showed that moving away from pre-contemplation stage to maintenance phase increases the rate of using these processes that is due to the stability and improvement of changed behavior. Therefore, health plans should be designed based on the stage of the target group.
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Emotional intelligence and quality of nursing care: A need for continuous professional development p. 361
Elmira Khademi, Mohammad Abdi, Mohammad Saeidi, Shahram Piri, Robab Mohammadian
DOI:10.4103/ijnmr.IJNMR_268_19  
Background: Emotional Intelligence (EI) is necessary for personal and professional success. This study aimed to determine the relationship between EI and quality of nursing care from the viewpoint of nurses and patients. Materials and Methods: This descriptive correlational study was conducted using convenience sampling to select the patients (n = 300) and census sampling to select the nurses (n = 100) at Amir Alam Hospital in Tabriz, Iran, in 2018. The data collection tools were the Quality Patient Care Scale (QUALPAC) and EI test by Bradberry-Greaves. Data analysis was performed in SPSS Version 20, using t-test, ANOVA, Chi-square, Pearson's correlation test, and multivariate analysis. Results: The mean (SD) score of EI was 91.17 (12.33) in nurses, and the mean (SD) score of nursing care quality was 184.01 (37.41) and 202.22 (22.30) from the viewpoint of patients and nurses, respectively. There was no significant difference between the two viewpoints (p = 0.652). However, there was a significant correlation between the nurses' EI and quality of nursing care (r = 1.00, p < 0.001). The educational level was the strongest predictor of increase in nursing care quality from the patients' viewpoint, according to the multivariate analysis (β = −0.27, p < 0.001). Conclusions: EI positively affects the quality of nursing care and its dimensions. Therefore, it is recommended that nursing policymakers consider educational programs to strengthen the nurses' EI and enhance the quality of nursing care. Patients, similar to nurses, can be proper indicators of the quality of nursing care; accordingly, simultaneous use of these indicators is suggested.
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SHORT COMMUNICATION Top

Attitude and participation of men regarding prenatal care, Childbirth, and postpartum care in Kashan City, Iran p. 368
Fatemeh Waseghi, Saeideh Nasiri, SeyyedAlireza Moravveji, Zahra Karimian
DOI:10.4103/ijnmr.IJNMR_140_20  
Background: Men's involvement in perinatal care has benefits including reduced preterm childbirth, and better development of children. This study was conducted with the aim to determine the attitude and participation of men in prenatal, childbirth, and postpartum care. Materials and Methods: This cross-sectional study was performed on 280 men in industrial units in Kashan city, Iran (November 2014–March 2015). The participants were selected using cluster sampling method. They completed a researcher-made three-part questionnaire. The data were analyzed using independent-samples t test and analysis of variance (ANOVA). Results: The mean (SD) score of men's attitude and practice regarding perinatal care were 40.12 (5.00) and 61.65 (6.87), respectively. A significant difference was observed between the practice of men with different education levels (F2,75 = 3.63, p = 0.001). Conclusions: The participation of men in perinatal care was low. It is recommended that healthcare providers make visits in the presence of husbands and simultaneously provide training for the couples during the perinatal period.
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LETTER TO EDITOR Top

The importance of compassionate care during the COVID-19 pandemic p. 372
Mansour Ghafourifard
DOI:10.4103/ijnmr.IJNMR_182_20  
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