مقالات رزومه دکتر سیده فاطمه غیاثی

 A supraclavicular brachial plexus block (SCBPB) is a safe alternative to general anesthesia in upper limb surgeries. We compared the effect of adding magnesium sulfate (MS) and low-dose dexamethasone (LDD) to ropivacaine in SCBPB in elective upper limb surgeries. 

 The ultrasound-guided SCBPB was done on 55 candidates for elective upper extremity surgeries in 3 groups by using 200 mg MS + 24 mL ropivacaine 0.5% (MS Group), 4 mg dexamethasone + 24 mL ropivacaine 0.5% (LDD Group), and 1 mL normal saline + 24 mL ropivacaine 0.5% (NS Group). The sample was investigated for the sensory and motor block onset, motor and sensory block duration, analgesia duration, total opioid consumption, and the Visual Analog Scale (VAS) during sensory return.

 The onset of motor and sensory block was faster in the MS group compared to the LDD and NS group (P<0.05). The sensory block duration was longer in the LDD group compared to the MS and NS groups. The duration of motor block and analgesia in the LDD group was significantly longer than the NS group (P<0.05). However, this difference was not significant regarding the MS group (p>0.05). The LDD and MS groups were not different in terms of total opioid consumption and VAS at the time of sensory return. However, both groups had significant differences with the NS group (P<0.05).

 The LDD prolonged the motor and sensory block duration and analgesia compared to MS.

One of the most common preventive methods of Surgical Site Infection (SSI) is preoperative skin preparation. Selecting the skin antiseptic before surgery is an important step that can reduce SSI risk.

The present study was performed with aim to compare the effect of 7.5% povidone-iodine (PVP-I) and 70% alcohol versus 0.2% chlorhexidine (CHG) and 70% alcohol on the microbial count of the surgical site in the abdominal surgery.

This double-blind randomized clinical trial study was conducted between March 2017 and July 2018 at the educational-therapeutic centers of Iran University of Medical Sciences. The patients aged ≥18 years who underwent elective abdominal surgery were randomly assigned into two groups to have their skin cleaned before surgery with CHG-alcohol or PVP-I-alcohol. Also, before skin prep, after the primary prep and after the secondary prep, microbial cultures were taken. Data analysis was performed using SPSS (version 16) and Chi-square, Fisher's exact, Kolmogorov-Smirnov, Wilcoxon and U-Mann-Whitney tests. P<0.05 was considered statistically significant.

The microbial counts mean differences before and after skin preparation with PVP-I-alcohol were significant (P<0.05). Also, the microbial counts mean differences before and after skin preparation with CHG-alcohol were significant (P<0.05). Overall, both antiseptic groups significantly reduced microbial counts. Although the skin preparation with CHG-alcohol was better than the PVP-I-alcohol solution, the difference between the two groups was not significant (P>0.05).

Implications for Practice: 

This study did not demonstrate an overall superiority of 2% CHG over 7.5% PVP-I skin preparation solution or vice versa. Both groups can be used to prepare patients' skin before abdominal surgery due to the affordability conditions and availability.

Nursing care tries to provide appropriate and synchronized measures through obtaining the views of the patients in such a way that while improving the quality of care, patient safety is maintained. This study aimed to determine the correlation between missed care nursing and satisfaction in patients with heart failure in 2020-2021.

This descriptive correlational study was conducted on 282 patients with heart failure admitted to the CCU ward of Ayatollah Mousavi Hospital in Zanjan. Participants were included in the study by convenience sampling. The study tools included demographic and clinical information questionnaires, patient-reported missed nursing care (MISSCARE Survey-Patient) and patient satisfaction with nursing care (PSI: Patient Satisfaction Instrument). Data were analyzed using independent t-test, ANOVA and Pearson's correlation coefficient in SPSS 16 software.

The mean ± SD of the total score of missed nursing care from the patients' point of view was 60.43 ± 7.40. The mean ± SD of the total patient satisfaction score was 56.21 ± 11.84. Pearson's correlation coefficient showed a significant and inverse correlation between patients' satisfaction scores and missed nursing care scores (P <0.001, r=0.555).

According to patients' reports, the level of missed nursing care was higher than average. The level of patients satisfaction was low in all dimensions. By reducing the level of missed nursing care, the satisfaction level of patients increased. Therefore, it is recommended to pay attention to the development and improvement of nursing care quality in the context of reducing missed nursing care and increasing patient satisfaction

Retaining skilled nurses is paramount in providing quality nursing care for patients and thus improving their satisfaction. This study aimed to determine the intention to stay (ITS) in the profession of nurses and its related factors.

This multicenter cross-sectional study was conducted on 263 nurses working in teaching hospitals affiliated with Zanjan University of Medical Sciences, Iran, from September 2020 to February 2021. Participants were selected by simple randomization. A researcher-made ITS questionnaire was used to collect data, which were then analyzed using descriptive statistics, independent t test, analysis of variance (ANOVA), and Pearson correlation via SPSS version 16.

The findings revealed that 109 participants (41.45%) of the nurses intended to stay in their profession. The total mean ± SD score of ITS for the nursing profession was 60.44±12.39 out of 100. From the participants' perspective, 5 factors of high responsibility and commitment (86.01±13.71), professional competence (77.95±13.66), feeling useful in nursing (77.79±18.23), the importance of being employed for me (74.83±20.01), and the possibility of learning skills and acquiring new information by continuing nursing (74.30±18.22) had the highest average score. There was a statistically significant relationship between ITS and the demographic variables of education level, job position, marital status, working shift, age, and the number of children of participants (P < 0.05).

The frequency of nurses with ITS in the profession is a cause of concern, sounding the alarm for the Iranian nursing system. The findings of this study could be useful for health care policymakers to increase nurses' intention to stay in the profession and, as a result, improve retention rates.

Nurses are a vital element of the health care delivery system, and their shortage has a negative effect on the quality of patient care.

This study was performed aimed to investigate nurses' intention to leave the profession (ITL) and its related factors.

This cross-sectional study was performed on 265 nurses working in the teaching hospitals of Zanjan University of Medical Sciences, Iran, from September 2020 to February 2021. Data was collected using demographic and researcher-made ITL questionnaires. Data were analyzed by SPSS (version 16). P<0.05 was considered statistically significant.  

Among the 265 nurses surveyed, 154 (58.55%) intended to leave the profession. The total score of intention to leave the profession was 60.21±14.46. From the perspective of nurses, "lack of welfare facilities," "high workload," "high working hours," "lack of proper management processes," and "low income" have higher priority for the intention to leave the profession. There was a statistically significant relationship between the type of shift work (p<0.05) and the amount of income (P<0.001) with intention to leave the profession. Age, gender, and income were identified as the predictors of the nurses' intention to leave the profession (P<0.05). 

Implications for Practice:

 The intention to leave the profession is alarmingly high among Iranian nurses. Managers and policymakers can consider the factors identified in this study to diminish the nurses' intention to leave the profession.

Emergency medical technicians (EMTs) at the forefront of the health system face Covid-19 cases. In such situation, they may have doubts about their abilities or priorities and may not make the right decisions. They need moral courage to survive this global crisis's stress and strengthen their decision-making power. The present study aimed to investigate the moral courage and its related factors in EMTs during the Covid-19 pandemic. This cross-sectional study was performed in 2021 on 194 EMTs of Zanjan University of Medical Sciences. Sampling was done by the cluster random method. A demographic information questionnaire and standard moral courage questionnaire were used to collect data. Data were analyzed using independent t-test, ANOVA, Pearson correlation coefficient and Logistic regression. P<0.05 was considered statistically significant. The mean total score of moral courage was high in 88.1% of EMTs (433.31± 49.70 out of 510). The mean score of moral courage in the dimensions of moral self-actualization was 228.98±32.46, risk-taking was 159.04±15.68, and the ability to defend the right was 45.28±7.70. There was statistically significant relationship between the mean score of total moral courage and marital status, age, work experience, and number of working hours (p <0.05).Implications for Practice: The findings of this study showed that EMTs had a high level of moral courage, so it is possible to maintain this important ethical virtue through reinforcements, planning, effective training, and organizational support, and consequently increase the quality of pre-hospital care.

One of the important strategies to provide quality care is to motivate healthcare workers.

This study aimed to determine the components of job motivation among operating-room and anesthesia staff.

This cross-sectional study was performed on 152 operating-room and anesthesia staff working in Zanjan hospitals and by the convenience sampling method. Data were collected using demographic and job motivation questionnaire. Data were analyzed using SPSS 16 software and Pearson correlation coefficient and Mann-Whitney test.

The mean (SD) job motivation power was 25.2(11.9) which was relatively desirable. In the operating-room staff, the strongest relationship between the dimensions of motivation and total motivational power was related to the autonomy dimension (r=0.7), and the weakest relationship was associated with the identity dimension (r=0.3). In the anesthesia staff, the strongest relationship was associated with the dimensions of autonomy and feedback (r=0.6), and the weakest relationship was associated with the identity dimension (r=0.001) and total motivational power (P<0.001). Also, the mean (SD) skill variety dimension in operating-room staff was 3 (0.6), which was higher than that in the anesthesia staff was equal to 2.7(0.5) (P=0.015); but the mean score in other dimensions and the total score of motivational power between the two groups had no statistically significant difference (P>0.05).

Given the low score of the job identity dimension, it is better for policy-makers and managers of the health system to take measures to strengthen this dimension of job motivation as one of the priorities of the healthcare system.

Fear of falling (FOF) acts as an inhibitory factor for the activities of daily living and causes disability and dependence in the elderly suffering from heart failure (HF). This study aimed to determine FOF among the elderly with HF and its related factors. This cross-sectional study was performed on 445 elderly patients with heart failure who were referred to the HF clinic of Tehran Heart Center affiliated with Tehran University of Medical Sciences, Tehran, Iran, from March to July 2018. Participants in this study were selected randomly. Data collection was conducted using demographic characteristics form and Falls Efficacy Scale-International questionnaires. Data were analyzed using STATA software (Version 14). The mean FOF among participants was 36.7 out of 64 scores (ST=0.27 and CI: 95%). The level of FOF was moderate in 61% of the participants. Based on the obtained results, FOF had no statistically significant correlation with gender, education, smoking, and marital status (P>0.05); however, it had a statistically significant correlation with age, HF class, residence, medications, and the history of falls (P<0.05). It is recommended that health caregivers should develop a comprehensive care program that takes into account such factors as age, HF class, residence, medications, and history of falls to prevent and reduce the FOF. Therefore, given the importance of the issue of FOF in older adults with HF, a comprehensive care program and educational, counseling, and welfare interventions should be developed in a way to prevent and reduce FOF.

Diabetes is one of the most common disorders in old age and affects the quality of life of the elderly.

This study aimed to evaluate the quality of life in the elderly with diabetes and determine the factors associated with it.

This cross-sectional study was performed on 130 elderly with diabetes referred to endocrinology clinics affiliated to Zanjan University of Medical Sciences. Sampling was done in an easy and accessible way. Data collection tools included a demographic information questionnaire and a 36-item short-form survey (SF36). Data analysis was performed using SPSS 16 software. For descriptive statistics, mean ± standard deviation and frequency (percentage), and analytical statistics, Kruskal-Wallis and Mann-Whitney tests were used.

 The majority of participants in the study were female (56.2%), in the age range of 60-74 years (68.5%), and married (70%). The mean total score of quality of life was 46.33±16.45. The mean score of total quality of life was statistically significantly related to age, marital status, place of residence, employment status, duration of diabetes, and level of education (P<0.05). However, there was no statistically significant relationship with gender (P=0.436).

The quality of life of the elderly was lower than standard. Older age, loneliness, longer duration of diabetes, rural living, unemployment, and illiteracy were associated with decreased quality of life of the elderly with diabetes; Therefore, it is suggested that policymakers consider the factors identified in this study in future planning to improve the quality of life of elderly with diabetic.

Job satisfaction is a significant factor in increasing the efficiency of staff, enhancing the quality of medical services, and achieving organizational goals.

The aim of this study was to determine and compare the level of job satisfaction among anesthesia and operating room staff.

This descriptive-comparative study was carried out on 152 anesthesia (71 individuals) and operating room staff (81 individuals) in Zanjan hospitals. Sampling was accomplished by census method. Job satisfaction was assessed using the JSS (Job Satisfaction Survey) in nine areas (Pay, Promotions, Supervision, Coworkers, Fringe Benefits, Contingent Rewards, Nature of Work, Operational Procedures and Communications). Data analysis was performed using SPSS 16 software. Descriptive and analytical statistics, including Fisherchr('39')s exact test and Mann-Whitney test, were analyzed as well.

Most of the participants were female (69.1%), under 30 years old (48.7%), and with a bachelorchr('39')s degree (75%). In general, job satisfaction of the majority of staff was moderate (75%). The mean job satisfaction in the areas of operational procedures (P=0.005), communication (P=0.027), and total score (P=0.042) in operating room staff was significantly higher than anesthesia staff; however, there was no statistically significant difference in other areas (P> 0.05).

Job satisfaction of anesthesia staff was lower in terms of operational procedures, communication, and total score; therefore, it is suggested that managers and authorities take this issue into account and take appropriate measures to improve the job satisfaction of staff in the mentioned areas.