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   Table of Contents - Current issue
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September-October 2020
Volume 25 | Issue 5
Page Nos. 361-444

Online since Tuesday, September 1, 2020

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REVIEW ARTICLE  

Family intensive care unit syndrome: An integrative review p. 361
Yaser Saeid, Mohammad Mahdi Salaree, Abbas Ebadi, Seyed Tayeb Moradian
DOI:10.4103/ijnmr.IJNMR_243_19  
Background: Hospitalization in the Intensive Care Unit (ICU) brings about psychological and physical symptoms in patients' family members. Family Intensive Care Unit Syndrome (FICUS) is a term used to explain the psychological symptoms of the family of a patient in response to the patient's admission to the ICU. The purpose of this study was to define FICUS along with its symptoms and predictors. Materials and Methods: The Web of Science, PubMed, Scopus, Google Scholar, and SID databases were searched for literature published in 2005–2018 with the keywords “FICUS,” “intensive care unit,” “family,” “caregivers,” “anxiety,” “depression,” and “post-traumatic stress disorder” in their title and abstract. The strategy for conducting an integrative review provided by Whittemore and Knafl (2005) was used in this study. Results: Twenty articles were included in the final data analysis. Following the patient's admission to the ICU, family members experience multiple psychological symptoms such as FICUS. The most commonly reported symptoms were anxiety, depression, post-traumatic stress disorder (PTSD), complicated grief, sleep disorder, stress, and fatigue. The low education level, having a critically-ill spouse, adequate support, financial stability, preference for decision-making, understanding of the disease process, anxiety, depression, or previous acute stress were predictors of FICUS. Conclusions: On the basis of the results, families also experience physical symptoms, so the FICUS is not limited to the occurrence of psychological symptoms. This study found that there is no universal definition for the term “FICUS” in the research literature. Thus, further research is needed to explore FICUS in the health field.
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ORIGINAL ARTICLES Top

Knowledge and practices of intensive care unit nurses related to prevention of ventilator associated pneumonia in selected intensive care units of a tertiary care centre, India Highly accessed article p. 369
Geetanjli Kalyan, Ravina Bibi, Ravinder Kaur, Reena Bhatti, Reeta Kumari, Romina Rana, Rupa Kumari, Manpreet Kaur, Rupinder Kaur
DOI:10.4103/ijnmr.IJNMR_128_18  
Background: Ventilator-Associated Pneumonia (VAP) is a recognized nosocomial infection and a leading cause of high morbidity and mortality. Intensive Care Unit (ICU) nurses are in the best position to put the known evidence-based strategies into practice to prevent VAP. The aim of the present study is to assess the knowledge and practices of ICU nurses related to prevention of VAP in selected ICUs of a tertiary care centre in India (2013–2014) and to find out the association between knowledge and practices. Materials and Methods: A descriptive survey was conducted in the different ICUs of a tertiary care hospital in India. Purposive sampling technique was used and 108 ICU staff nurses were enrolled during the period of data collection. The tool used for data collection was a self-developed valid and reliable knowledge-based questionnaire and an observational checklist. The descriptive (frequency and percentages) and inferential (Chi-square test) statistics was used. Results Out of the 108 nurses enrolled in the study, 82 (75.93%) had average, 24 (22.22%) had good and only 2 (1.85%) of the ICU nurses had poor knowledge. Assessment of the practices revealed that 68 (94.44%) nurses had average and only 4 (5.55%) nurses had good practice. There was no association between the knowledge and practices of ICU nurses related to prevention of VAP. (χ2 = 0.14, p = 0.710). Conclusions: Although the nurses were having good to average knowledge scores, their practices were not associated with knowledge scores. There is a need to find out the ways that would help the nurses to adhere to good practices.
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Professional responsibility and its related factors among bachelor degree nursing students in Iran: A cross-sectional study p. 376
Saeed Ghasemi, Batool Nehrir, Leila Karimi
DOI:10.4103/ijnmr.IJNMR_20_20  
Background: Professional responsibility is important for bachelor degree nursing students, but it has not been measured specifically among these students and findings of the studies on its related factors are inconsistent. This study aimed to determine the level of professional responsibility and its related factors among bachelor degree nursing students in selected public nursing schools in Iran. Materials and Methods: For this cross-sectional study, 388 bachelor degree nursing students from 8 selected public nursing schools in Iran were selected through convenience sampling (2018–2019). The participants completed the demographic questionnaire and Responsibility among Bachelor Degree Nursing Students Scale (RABDNSS). This valid and reliable scale consists of 45 items that determine professional responsibility and its 5 subscales. Data were analyzed using descriptive and inferential methods in SPSS software. Results: The mean (SD) total score of professional responsibility was 175.26 (23.58), indicating a high level of responsibility. The highest and lowest mean (SD) scores were obtained in the subscales of situational self-mandatory 4.20 (0.52) and positive professional attitude 3.71 (0.82), respectively. Students' educational grade average and level of interest in nursing were significantly correlated with professional responsibility and its subscales (p < 0.05). Conclusions: The relationship of students' interest in nursing and students' educational grade average with professional responsibility can be useful for planning admission policies and evaluating and promoting professional responsibility related behaviors among nursing students. However, further research in these areas is recommended.
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Overcrowding management and patient safety: An application of the stabilization model p. 382
Hosein Babatabar-Darzi, Iman Jafari-Iraqi, Hosein Mahmoudi, Abbas Ebadi
DOI:10.4103/ijnmr.IJNMR_254_19  
Background: Emergency department is among the most crowded hospital units. The function of this department considerably affects the functions of other hospital units as well as patient satisfaction. The Stabilization Model is a strategy with potential effectiveness in managing overcrowding in emergency department. This study aimed to determine the effects of overcrowding management based on the stabilization model on patient safety in emergency department. Materials and Methods: This pretest-posttest quasi-experimental was conducted in 2015 in the emergency department of a teaching hospital located in Tehran, Iran. Primarily, the perceived safety of 35 patients was assessed using the Patient Safety Assessment Questionnaire. Then, an overcrowding management intervention was implemented based on the stabilization model. Finally, the perceived safety of 35 newly recruited patients was assessed after the intervention. The SPSS software (v. 16.0) was employed for data analysis through the Chi-square, the Kolmogorov-Smirnov, and the independent-sample t tests. Results: The mean (SD) score of patient safety was 27.45 (8.43) in the control group and 34.45 (4.04) in the intervention group and the between-group difference was statistically significant (t34 = 50.37, p < 0.001). The rate of patient safety increased from 65% at baseline to 82% after the intervention. Conclusions: Overcrowding management based on the stabilization model can significantly enhance patients' perceived safety. Therefore, this strategy can be used to ease emergency department overcrowding and enhance patient safety and care quality.
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The effect of type of delivery on the nitric oxide metabolites and endothelial dysfunction in pregnant women p. 387
Maedeh Mojiri, Maryam Kianpour, Mehdi Nematbakhsh, Parvin Bahadoran
DOI:10.4103/ijnmr.IJNMR_103_19  
Background: Since endothelial dysfunction is related to atherosclerosis, this study was planned to determine the effect of type of delivery on Nitric Oxide (NO) metabolites and endothelial function. Materials and Methods: This Cohort study was conducted in 2015 in selected hospitals of Isfahan. 88 nulliparous women with gestational age of 39 weeks and above were enrolled in this study using convenience sampling method and finally, after giving birth, 51 mothers with vaginal delivery, 21 with urgent C-section and 13 with elective C-section were considered for data analysis. The serum levels of NO metabolites were measured in the laboratory with standard kits and data was analyzed using student and paired t-test, one-way ANOVA, and Chi-square test. The significance level was considered less than 0.05 for all tests. Results: The NO metabolites levels in mothers who had vaginal delivery or urgent C-section showed a significant difference before and after delivery (normal vaginal delivery (NVD): t50 = 5.61, p < 0.001, Urgent C-section: t23 = 5.38, p < 0.001). But those with elective C-section showed no significant difference in the nitrate and total nitrite levels before and after delivery (p > 0.05). Conclusions: Since reduction in serum levels of NO metabolites may possibly indicate endothelial dysfunction and predict cardiovascular disease, especially atherosclerosis in the future, it could be concluded that, childbirth, regardless of the type of delivery, could damage the endothelial cells but C-section (urgent or elective) could cause more disruption than vaginal delivery.
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Information seeking experiences of family caregivers of patients with persistent vegetative state: A qualitative study p. 393
Fateme Goudarzi, Heidarali Abedi, Kourosh Zarea
DOI:10.4103/ijnmr.IJNMR_187_18  
Background: Providing care for patients in Persistent Vegetative State (PVS) by family caregivers without enough training and knowledge may be problematic both for the patients and for the caregivers. Therefore, the present study tries to explain the experiences of family caregivers of patients with PVS of seeking information needed to provide adequate care. Materials and Methods: Twenty two participants, including 17 family caregivers and 5 professional caregivers were enrolled by purposive sampling into this qualitative content analysis study, carried out between 2013 and 2015. Unstructured interviews and field notes were used to gather the data. Data collection was stopped when data saturation was achieved. Data analysis was performed by content analysis based on Graneheim and Lundman's approach. Results: As a result of the analysis of the collected data a main theme emerged labeled as “Seeking constructive education” with three categories including “Neglected requisite education,” “Greedy search for useful education” and “Dynamic independence in care.” Conclusions: In this study, information seeking by family caregivers of patients with PVS was constructive. Family caregivers insistently sought needed information from various sources. Ultimately, they found these insistent efforts beneficial and fruitful, because their efforts made them independent in providing care for their patients.
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The effect of combined inhalation aromatherapy with lemon and peppermint on nausea and vomiting of pregnancy: A double-blind, randomized clinical trial p. 401
Farzaneh Safajou, Narges Soltani, Mohsen Taghizadeh, Zahra Amouzeshi, Maryam Sandrous
DOI:10.4103/ijnmr.IJNMR_11_19  
Background: Nausea and vomiting are almost inevitable features of pregnancy which have a serious impact on the quality of life of pregnant women. This study aimed to determine the effects of combined inhalation aromatherapy with lemon and peppermint on nausea and vomiting of pregnancy. Materials and Methods: The parallel randomized clinical trial was conducted on 90 pregnant women suffering from nausea and vomiting of pregnancy referred to health centers in Birjand-Iran- from February 2015 to August 2016. Participants were randomly divided into two groups. The combined lemon and peppermint essential oils were used as an inhaler for the intervention and the placebo for the control group. Both groups were trained to place three drops of the solution onto a cotton ball and keep it in a 3-cm distance of their nose. The intensity of nausea, vomiting and fatigue was assessed through 24-hour Pregnancy Unique Quantization of Emesis (PUQE-24) questionnaire and Fatigue Severity Scale (FSS), respectively. Results: Mean (SD) scores of nausea and vomiting intensity before the intervention and on the first day of intervention were not significantly different between the two groups, but became significant on the second, third, and fourth days of intervention. The results showed that the effect of time on the mean intensity of nausea and vomiting was significant in the aromatherapy group (F2,84 = 22.92, p < 0.001) but was not significant in the placebo group (F2,78 = 0.26, p = 0.836). Conclusions: The combined lemon and peppermint aromatherapy could reduce mild to moderate intensity of nausea and vomiting during pregnancy.
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The effect of sensory stimulation on quality of life of the elderly and their self-efficacy for coping with the fear of falling p. 407
Alehe Seyyedrasooli, Morteza Ghojazadehm, Sakineh Goljaryan, Mohammad-Salar Hosseini, Mahdieh Esmaeilnezhad
DOI:10.4103/ijnmr.IJNMR_172_19  
Background: Aging causes major changes that affect the performance of all senses, and as a result, a critical change in the quality of life is expected. Falling and the fear of falling is one of the major health risks that affect the quality of life among elderly, threatening their independent living. This study was conducted to determine the role of sensory stimulation on the quality of life and self-efficacy in coping with fear in the elderly population. Materials and Methods: During this randomized controlled trial, 80 elderly volunteers from healthcare centers were divided into four intervention groups (music, photo album, aromatherapy, and hand massage) and one control group. Data collection was performed using the Older People's Quality of Life Questionnaire and Falls Efficacy Scale-International tools. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software program, version 16.0. Results: Comparing the scores of the quality of life and self-efficacy questionnaires, no statistically significant difference was reported among the groups (p < 0.05). Conclusions: Sensory stimulation seems to have no impressive effect on the improvement of self-efficacy in coping with the fear of falling and the quality of life in the older population.
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Near-death experience among Iranian muslim cardiopulmonary resuscitation survivors Highly accessed article p. 414
Hadi Khoshab, Seyedhamid Seyedbagheri, Sedigheh Iranmanesh, Parvin Mangolian Shahrbabaki, Mahlagha Dehghan, Batool Tirgari, Seyed Habibollah Hosseini
DOI:10.4103/ijnmr.IJNMR_190_19  
Background: Near-Death Experience (NDE) refers to a broad range of subjective experiences associated with forthcoming death. The majority of Cardiopulmonary Resuscitation (CPR) survivors experience NDEs. It seems that near-death events are experienced differently by people with different cultural and religious viewpoints. Thus, this study aimed to explain NDEs in Iranian Muslim CPR survivors. Materials and Methods: A qualitative hermeneutic phenomenological approach influenced by Ricoeur was used to understand the meaning of CPR survivors' NDEs. Eight survivors were interviewed in private. The study was conducted in southeast Iran. In-depth, semi-structured interviews were used for data collection, and probing questions were added when necessary. The duration of the interviews was between 40 and 65 min. According to Lindseth and Norberg, in the naive understanding phase, we read the interviews several times for achieving naive understanding. In the structural analysis phase, the whole text is divided into meaningful units. Finally, the researchers formulated a comprehensive understanding of the contextualization of the text. Results: Four main themes emerged including 1) pleasing experiences along with flying and seeing light, 2) the experience of transport to the beyond, 3) out-of-body experience, and 4) reviewing life and memories in a religious context. Conclusions: Iranian Muslim CPR survivors, reported NDEs, much similar to those reported by survivors in Western countries with different theistic religions. This means that medical professionals dealing with these patients need to be aware of such experiences in Iranian Muslims.
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The viewpoint of Iranian gynecologists and midwives on the expectations of pregnant women: A content analysis study p. 419
Mahboubeh Hajifoghaha, Fatemeh Nahidi, Masoumeh Simbar, Malihe Nasiri
DOI:10.4103/ijnmr.IJNMR_182_19  
Background: Prenatal care providers play an important role during pregnancy. Because healthcare providers provide comprehensive support to pregnant women, they must pay attention to pregnant women's expectations and efforts to meet their expectations. Understanding of pregnant women's expectations is associated with continuation of care and improving the health of the community. The present study is carried out to investigate the viewpoints of Iranian gynecologists and midwives on the expectations of pregnant women. Materials and Methods: This qualitative study was carried out on 10 prenatal care providers in Shiraz in 2018. Sampling method was purposive. Sampling continued until data saturation. Structured, face to face and in-depth interviews were used for data collection. Implementation and coding of interviews were performed simultaneously with data collection. The data were analyzed using conventional content analysis approach. The Lincoln and Guba criteria were used to increase the trustworthiness of the data. Results: Two main categories were emerged after analyzing of the data. The main category of “competent prenatal care providers” consisted of three subcategories: professional skills, communication skills, and individual characteristics. Another main category was the “appropriate pregnancy and childbirth centers” that included two subcategories of personnel-facilities and management system. Conclusions: According to the results, prenatal care providers have been aware that women during pregnancy period expect to have competent providers. Also, they tend that receive pregnancy care and delivery from appropriate pregnancy and childbirth centers.
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Effects of open and closed tracheal suctioning on pain in mechanically ventilated patients p. 426
Fatemeh Khayer, Somayeh Ghafari, Mahmoud Saghaei, Ahmadreza Yazdannik, Vajihe Atashi
DOI:10.4103/ijnmr.IJNMR_135_18  
Background: Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients. Materials and Methods: The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t-test, and Chi-squared test. Results: The pain score was significantly higher in the open suctioning group during (t = 2.59, p = 0.01) and 10 min after suctioning (t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning (t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning (p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning (p < 0.001). Conclusions: The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.
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Psychometric properties and factor structure of the persian version of revised prenatal distress questionnaire in second and third trimesters p. 431
Maria Esfandiari, Mahbobeh Faramarzi, Hemmat Gholinia, Shabnam Omidvar, Fatemeh Nasiri-Amiri, Somayeh Abdollahi
DOI:10.4103/ijnmr.IJNMR_160_19  
Background: There are no proper tools for measuring pregnancy-specific stress in Iranian population. The aim of this study was psychometric evaluation of the Persian version of Revised Prenatal Distress Questionnaire (NuPDQ) for the first time in Iranian society. Materials and Methods: In a descriptive-analytic study, 269 pregnant women completed the NUPDQ at Obstetrics clinics of Mazanderan Province, Iran. The reliability of the 12-item NuPDQ and 17-item NuPDQ was reevaluated using Cronbach's alpha and internal consistency. Concurrent validity was assessed using the Spielberger state-anxiety Inventory. Moreover, exploratory factor analysis was used to assess the structural factors of the questionnaire. Results: Factor analysis revealed that the 12-item NuPDQ consisted of four areas in the second trimester including medical and financial problem, physical symptoms, infant health, and parenting with the explained variance of 64.15%. The Persian version of 17-item NuPDQ consisted of 5 areas in the third trimester, including medical and financial problems, physical symptoms, infant health, parenting, and labor and delivery with an explained variance of 61.94%. In addition, interclass correlation coefficient in all 4 areas and overall scale score exceeded 0.90. Finally, the reliability was high based on Cronbach's alpha of 0.78 for 12-item NuPDQ and 0.79 for 17-item NuPDQ. Conclusions: The Persian version of 12-item NuPDQ in the second trimester and 17-item NuPDQ in the third trimester, as well as all the extracted subscales, had a good validity and reliability for assessing pregnancy-specific stress in Iranian society and can be used in clinical practice.
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Challenges and strategies of needs assessment implementing in diabetes self-management education in Iran: A qualitative study p. 437
Fahimeh Kashani, Parvaneh Abazari, Fariba Haghani
DOI:10.4103/ijnmr.IJNMR_10_20  
Background: Many diabetes educators in Iran do not have the necessary skills and competence for performing a needs assessment, and thus, cannot provide Diabetes Self-Management Education (DSME) to suit individual educational needs and conditions. The purpose of the present study was to explore and analyze needs assessment implementation in DSME and evaluate the barriers and the appropriate strategies from educators' viewpoints. Materials and Methods: The present qualitative study was conducted using a conventional content analysis approach with semi-structured and in-depth interviews and using a purposeful sampling method on 20 nurses, physicians, and endocrinologists. The data of this study were collected from April to October 2018. The interviews were analyzed using the content analysis method of Graneheim and Lundman. Results: Qualitative data analysis resulted in the emergence of two main categories of educational challenges of needs assessment and managerial challenges of needs assessment and four subcategories (lack of structured educational planning, lack of needs assessment practical patterns, managers' insufficient support and supervision, and managers' insufficient attention to motivational factors). Conclusions: Educational strategic planning, managers' obligation and support in designing practical patterns, and supervision tools to evaluate educators' performance in the needs assessment domain can result in the promotion of DSME needs assessment, the efficiency of plans, and the promotion of society's health.
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LETTER TO THE EDITOR Top

Cesarean section or normal vaginal delivery? The importance of the training programs for mothers and community p. 444
Tahereh Shams Ghoreishi, Zoleykha Asgarlou
DOI:10.4103/ijnmr.IJNMR_33_20  
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