مقالات رزومه دکتر محسن شهریاری

Chronic mental illnesses (CMI) are long lasting and reoccurring and require continuous care as well as an integrated and collaborative approach to organize the care. This study sought to examine whether family centered collaborative care is an acceptable treatment option for individuals with CMI.

From the years 2000 to 2021, ten electronic databases relating to family centered collaborative care for mental illness were searched adopting Preferred Reporting Items for Systematic Reviews and Meta Analysis checklist. Twenty seven relevant articles and a thesis from among 6956 studies retrieved, were assessed their quality appraisal through four standardized tools. The studies were rated as good, moderate, or poor. Studies were calibrated, different opinions were discussed, and extracted data were done.

Evidence included 11 randomized controlled trials (from 19 articles), one randomized control trial, three mixed methods studies (from 3 articles and 1 thesis), and a qualitative study (from 4 articles). The quality of seven studies was good, 15 were moderate quality, and seven were poor quality. According to moderate to high quality qualitative research, family centered collaborative care was considered an acceptable intervention; though a few studies supported it.

The findings demonstrated that family involvement in the care of patients with CMI affects no recurrence of the disease, and no re hospitalization of patients with this disorder. As a result, engaging family members in the care process can have a positive impact on the health and well being of these patients.

Hypertension is a major global health problem and a risk factor for cardiovascular disease. An unhealthy lifestyle can increase the risk of hypertension and psychological disorders, thereby heightening the risk of cardiovascular disease.

The study aimed to evaluate the effects of lifestyle education on depression, anxiety, stress, and perceived family support among hypertensive patients undergoing coronary angioplasty.

This randomized clinical trial recruited 60 hypertensive patients undergoing angioplasty at the coronary care units of an educational hospital in Isfahan, Iran, in 2015. Then, 30 subjects were randomly allocated to each intervention and control group. The patients in the intervention group and their family members were provided with group lifestyle education in six sessions held in three successive weeks, accompanied by one-month follow-up telephone contacts. Data were collected before, immediately after, and one month after the intervention using a demographic questionnaire, the 21-item Depression, Anxiety, and Stress Scale with Cronbach’s alpha values of 0.80, 0.83, and 0.87, and a researcher-made family support questionnaire. Data analysis was done using the paired-sample t, independent-sample t, chi-square, Mann-Whitney U, and repeated-measures analysis of variance tests.

The study groups did not significantly differ respecting demographic characteristics, and the pretest mean scores of depression, anxiety, stress, and perceived family support (P > 0.05). However, significant between-group differences were observed at both posttests, respecting the mean scores of depression, anxiety, stress, and perceived family support (P < 0.05). Moreover, while these mean scores did not significantly change in the control group (P > 0.05), the mean scores of depression, anxiety, and stress significantly decreased, and the mean score of perceived family support significantly increased in the intervention group across the three measurements (P < 0.05).

Lifestyle education effectively reduced depression, anxiety, and stress and improved perceived family support among patients with hypertension and angioplasty. Nurses can use such interventions to improve patient outcomes.

Although clinical guidelines help in the prevention, diagnosis, and management of hypertension, individuals with hypertension often remain undiagnosed, or once diagnosed, may not receive adequate care and treatment.

In this study, we explored physicians’ perspectives of the factors influential in implementing the Iranian Recommendations on Prevention, Evaluation, and Management of Hypertension (IRPEM-HTN).

A qualitative descriptive study was conducted using the purposeful sampling method to enroll 30 physicians from October 2016 to May 2018. The physicians working in private offices or university-affiliated health centers/hospitals in the province of Isfahan, Iran, were included in this study one year after participating in the IRPEM-HTN program. The data were gathered through semi-structured interv iews. The transcribed data were thematically analyzed, and the rigor was ensured following the procedure outlined by Braun and Clark.

This themes identified were: 1) macro- and meso-contextual factors, emphasizing that a) policies at all levels affect guideline adherence, and b) environmental-contextual factors affect guideline adherence, 2) micro level factors, emphasizing that c) attributes of the guideline affect guideline adherence, and d) clinician- and patient-level factors affect guideline adherence. Micro-, meso- and macro-level factors influenced guideline implementation.

The attitudes, awareness, knowledge, and capacity of clinicians, as well as a broader socio-cultural context should be taken into account for guideline implementation.

Increasing of hospitalization rates of Coronary Artery Disease (CAD) management have created major challenge for the health system. Poor adherence to treatment is one of the main reasons for treatment failure, prolongation of treatment, and increase care costs. The aim of this research was to determine the effect of educational intervention based on Pender’s Health Promotion Model (HPM) on adherence in patients with CAD.

This randomized controlled clinical trial was held in an educational hospital in Isfahan, Iran, February 2018–May 2019. Data were collected from 64 patients with CAD, before, 1 and 3 months after the intervention. The instrument used included treatment adherence questionnaire and a checklist Pender’s HPM. The study group received dietary, exercise, and medication education based on Pender’s HPM in four sessions which were held in 4 weeks. The control group received the routine educational program of the hospital. The data was analyzed using descriptive statistics, repeated measures ANOVA, independent t, Chi‑square, and Mann–Whitney tests via SPSS software.

The mean score of treatment adherence was significantly different between two groups in one (z = 5.28, df = 2, p < 0.001) and three (z = 4.51, df = 2, p < 0.001) months after the intervention. The mean (SD) of treatment adherence in the study group was 139.82 (27.44) 3 months after the intervention.

Educational intervention based on Pender’s HPM is more effective on treatment adherence than the routine method in the patients with CAD. It is recommended to integrate the Pender’s HPM as a nursing care program for these patients.

Hypertension (HTN) is one of the most prevalent risk factors for arteriosclerosis and coronary artery disease (CAD). Its side effects can be decreased through the use of some methods and interventions. The present study was conducted with the aim to evaluate the effects of a lifestyle management on blood pressure, heart rate, and body mass index (BMI) of patients with HTN who have undergone angioplasty.

This clinical trial was conducted on 2 groups in 3 stages in an educational hospital in Isfahan, Iran, in 2014. The study participants consisted of 60 patients with HTN who had undergone angioplasty. The participants were randomly allocated to the study and control groups. The intervention was implemented in 6 educational sessions during 3 weeks, and then, follow-up was conducted through phone calls in the study group. The collected data were analyzed using independent t-test, chi-square, Mann-Whitney U test, and ANOVA in SPSS software.

Repeated measures ANOVA results indicated that the effect of time (P < 0.001) and group (P = 0.027) on systolic blood pressure (SBP) was significant. The effect of time (P = 0.015) and group (P = 0.040) on diastolic blood pressure (DBP) was also significant. In terms of BMI, both effects of time (P = 0.010) and group (P = 0.034) were significant. However, the effect of time (P = 0.899) and group (P = 0.900) on heart rate was not significant.

The lifestyle management program implemented in the present study was effective on decreased DBP, SBP, and BMI in patients with HTN who had undergone angioplasty. Thus, nurses could implement this program as a part of their care provision program for patients.

The present study was conducted to determine the relation between nurses’ moral distress and the ethical climate in selected hospitals of the Iranian Social Security Organization (ISSO). This descriptive-analytical correlational study was conducted in 6 hospitals under the coverage of the Iranian Social Security Organization in 2016. Three hundred nurses were selected by convenience sampling method. Data were gathered using Corley’s Standard Moral Distress and Olson’s Hospital Ethical Climate Scales. Data were analyzed using SPSS software version 19. The mean score of the nurses’ moral distress was 1.94 ± 0.66, which is considered moderate. The mean score of ethical climate was 88.97, indicating desirable ethical climate in these hospitals. The frequency score of moral distress had a unilateral reverse correlation with the total score of ethical climate as well as its dimensions, including colleagues, patients, hospitals and physicians. The score of the intensity of nurses’ moral distress also had a unilateral reverse correlation with the total score of ethical climate and the scores of the hospital and physicians dimensions. These results emphasized the importance of creating a positive ethical climate to decrease moral distress as well as the need for professional interventions to increase support in moral issues.

Although respecting human dignity is a cornerstone of all nursing practices, industrialization has gradually decreased the attention paid to this subject in nursing care. Therefore, the present study aimed to investigate nurses’ commitment to respecting patient dignity in hospitals of Isfahan, Iran.

This descriptive‑analytical study was conducted in hospitals of Isfahan. Overall, 401 inpatients were selected by cluster sampling and then selected simple random sampling from different wards. Data were collected through a questionnaire containing the components of patient dignity, that is, patient‑nurse relationships, privacy, and independence. All items were scored based on a five‑point Likert scale. The collected data were analyzed using descriptive statistics and Chi‑square tests. P < 0.05 were considered significant in all analyses.

Most patients (91%) scored their relationships with nurses as good. Moreover, 91.8% of the participants described privacy protection as moderate/good. Only 6.5% of the subjects rated it as excellent. The majority of the patients (84.4%) believed their independence was maintained. These subjects also approved of taking part in decision‑making.

According to our findings, nurses respected patient dignity to an acceptable level. However, the conditions were less favorable in public hospitals and emergency departments. Nursing authorities and policy makers are thus required to introduce appropriate measures to improve the existing conditions.

Appropriate nutritional support is effective on achievement of expected outcomes in intensive care unit (ICU) patients. Although several studies have suggested different conclusions about the effectiveness of tube feeding methods, there is no specific program of nutritional support for patients who have been hospitalized. There is a possibility for complications due to an inadequate nutrition. The aim of our study is to compare the effects of enteral feeding through the bolus and continuous methods on blood sugar and prealbumin level among the ICU inpatients.

Fifty subjects were selected by convenient sampling from April to Aug 2013 in the ICU wards of Alzahra Hospital, Isfahan, Iran, and randomly assigned to study and control groups in this clinical trial. The subjects in the study group received infusion pump feeding while the control group received bolus feeding for 72 h. Blood sugar was checked for every 4 h for 72 h and the prealbumin level was assessed on the first and the fourth day in two groups.

In the study group, the mean blood sugar significantly decreased on the fourth day, compared with the first (P = 0.03, F = 3.85) and third (P = 0.01, F = 3.15) day. In the control group, the mean blood sugar increased from the first day. It was significantly higher in the control group on the second day (P = 0.02, F = 3.55), compared with the study group. In the study group, there was a significant difference in the mean prealbumin before and after intervention (P = 0.048, t = 1.97), but no significant difference was observed in the control group. There was a significant difference between two groups after intervention (P = 0.04, t = 2.05).

The obtained results showed that supportive nutrition through a continuous method had an effect on critical patients' blood sugar control and made a better nutritional status for these patients through an increase of prealbumin level. Positive effects of this feeding method can result in appropriate outcomes for patients' recovery and reduce the complications.