hamideh hakimi

Gastrointestinal tube feeding is one of the most important and beneficial methods of nutrition in patients admitted to the intensive care unit. There is still no consensus on the best nutritional method that will lead to fewer complications. This study aimed to investigate the disadvantages of different methods of tube feeding in patients admitted to the adult intensive care unit.

The present study is a review study conducted in 2022. Articles published in the English language databases including Web of Science, Scopus, Science Direct, and PubMed, between 2000 and 2022 were used.

In the initial search phase, 2893 articles were obtained. In the next step, after the review of titles and abstracts, 760 articles remained. Finally, based on inclusion criteria and full text review, 14 related articles were selected. Disadvantages of tube feeding methods were classified into four categories: "respiratory complications", "gastrointestinal complications", "metabolic complications" and "bed occupancy".

Based on the results of this study, in terms of complications, intermittent and continuous methods are safer and more preferable than the bolus method. However, low-speed bolus feeding has fewer side effects.

The emergence of the Internet and its development led to the expansion of virtual education. The development of virtual education in recent years has had a tremendous impact on the improvement of education and the establishment of educational justice in different parts of the world. Despite its advantages, virtual education is also associated with some challenges. The present study aimed to investigate para medicine students’ experiences of virtual education. This qualitative study was conducted using conventional content analysis. The participants were 25 students in various fields of para medicine who were selected using purposive sampling. The study took place at universities in the north of Iran. The data were collected using semi-structured in-depth interviews and focus groups from January to April 2022. The collected data were analyzed using Graneheim and Lundman’s qualitative content analysis method. The core category identified in this study was from helplessness to interaction which was divided into three main categories (challenges and desperation, deprivation of mutual interaction and learning, and resilience and adaptation) and fourteen subcategories. The main theme extracted from the interviews with the participants was from helplessness to interaction. When a person has numerous failures, cannot control environmental conditions, and feels the ineffectiveness of their activity and response, they will experience a sense of vulnerability. Thus, the person has to accept the conditions and interact with them. In other words, interaction is a skill that improves the ability to quickly learn new skills and behaviors in response to the conditions. Thus, identifying challenges and realizing the weaknesses, strengths, opportunities, and threats governing the existing virtual education environment can help to turn many threats into opportunities, promote virtual education, and support teachers and students to improve the quality and quantity of the teaching-learning process in the COVID-19 and post-COVID-19 era.

Treatment satisfaction is one of the main factors of assessing care quality in patients with chronic diseases. Some factors may influence treatment satisfaction and improve or impair clinical outcomes. This study aimed to determine the relationship between fear of hypoglycemia and satisfaction with treatment in patients with type 2 diabetes treated with oral antidiabetic drugs.

This cross-sectional study was carried out in one of the hospitals of Qazvin Province, Iran, in 2021. The research sample was 390 patients with type 2 diabetes who used oral antidiabetic drugs, selected through convenience sampling. The data were collected using the hypoglycemic fear survey (HFS) and the diabetes medication satisfaction (DiabMedSat) questionnaire. Then, the obtained data were analyzed using the independent t-test, one-way analysis of variance, and multiple linear regression in SPSS software, version 26. Statistical significance was set at P<0.05.

Patients’ Mean±SD age was 53.4±11.49 years, and most (57.4%) were female. Treatment satisfaction score was lower in females (β=-0.12, P<0.007) and patients with diabetes complications (β=-0.138, P<0.005). Patients with college education had higher treatment satisfaction (β=0.173, P<0.001). Patients with very severe (β=-0.29, P<0.001) or severe hypoglycemia (β=-0.157, P<0.034) experienced lower treatment satisfaction than those with mild hypoglycemia. Low treatment satisfaction scores were associated with fear of hypoglycemia (β=-0.39, P<0.001).

In this study, fear of hypoglycemia was associated with a decreased level of satisfaction with treatment. As a consequence, patients with type 2 diabetes must be assessed for hypoglycemia fears and their adverse effects. Also, to prevent complications caused by not taking antihyperglycemic drugs, nursing managers and clinical nurses are recommended to prepare appropriate programs to implement psychological interventions to reduce the fear of hypoglycemia.

Moral intelligence is one of the dimensions of intelligence that can provide a framework for the correct functioning of humans and is theoretically considered as a predictor of behavior. The aim of this study was to investigate the relationship between moral intelligence and demographic characteristics of nurses working in intensive care units.

The present study is a descriptive-correlational one conducted in 2009. The study population included 112 nurses working in the ICU wards of public hospitals in Amol city who were selected by census method. For data collection, demographic information form and standard moral intelligence questionnaire were used. Analysis was done using SPSS version 19 software and descriptive and analytical statistics, calculation of mean, standard deviation, Pearson correlation test, and Independent T-test were performed.

The results showed that the mean score of moral intelligence in the nurses working in ICU was 80.20±7.40 and very good. The highest score was related to the honesty and the lowest score was related to the compassion. The results of the Pearson’s correlation test showed that there was a positive and significant relationship between the general score of moral intelligence and the variables of marital status (P=0.03), age (P=0.02), work experience (P=0.02), and work experience in the ICU (P=0.02). There was also a positive and significant relationship between honesty, responsibility, and compassion with the variables of age, marital status, and work experience in the ICU. There was also an inverse relationship between the overtime hours and the dimensions of the moral intelligence questionnaire. There was not a significant relationship between the overall score of moral intelligence with gender and with participation in the ethics seminar. On average, married people had higher responsibility, forgiveness, and moral intelligence than single people.

Considering the particular conditions of the special care units and the necessity of the presence of capable nurses in these units, it is superlative that married nurses with older age, higher work experience, and more work experience work in these units. It is also the responsibility of the managers and planners of the treatment units to reduce the working hours of the nurses working in these units and to carry out a correct assessment of needs before holding in-service training programs to help improve the moral intelligence of these nurses.

Aspiration-induced pneumonia is responsible for 15-20% of hospital infections and a 39% increase in   costs. Besides, it is one of the ten leading causes of death in   the USA. It can be prevented by choosing the feeding method. This study aimed to assess the incidence of respiratory aspiration using the tube feeding method of intermittent drip bag. This one group only post-test study was conducted on 36 ICU   trauma patients. The patients were fed using the tube feeding method of intermittent drip bag for three days, each time with 150 to 300 cc liquid nourishing solution for 30 to 60 minutes with three-hour intervals. To detect respiratory aspiration, 0.5 cc of methylene blue 1% was added to 500 cc of the liquid. In case the patients needed suction, whenever the blue color of methylene blue was observed in the lung secretions during suction of the respiratory tube, incidence of respiratory aspiration was ascertained. The data were collected using Demographic information registration form and Clinical Information Registration Questionnaire. Then, the data were analyzed using SPSS V19 and descriptive and analytic statistics. The results revealed no incidence of respiratory aspiration via the tube feeding method of intermittent drip bag during   three consecutive days. The present study indicated no respiratory aspiration   observed using the tube feeding method of intermittent drip bag, this method can be utilized in the centers that are not equipped with feeding pump. Moreover, using feeding bags instead of feeding pumps plays a key role in reducing related costs.

The recommended position for measuring Intra-Abdominal Pressure (IAP) is the supine position.However, patients put in this position are prone to Ventilator-associated pneumonia. This study was done toevaluate the relationship between bed head angle and IAP measurements of intubated patients in the intensivecare unit.

In this clinical trial, seventy-six critically ill patients under mechanical ventilation were en-rolled. IAP measurement was performed every 8 hours for 24 hours using the KORN method in three differentdegrees of the head of bed (HOB) elevation (0◦, 15◦, and 30◦). Bland-Altman analysis was performed to identifythe bias and limits of agreement among the three HOBs. According to World Society of the Abdominal Com-partment Syndrome (WSACS), we can consider two IAP techniques equivalent if a bias of <1 mmHg and limitsof agreement of - 4 to +4 were found between them. Data were analyzed using SPSS statistical software (v. 19),and the significance level was considered as 0.05.

The prevalence of intra-abdominal hypertension was18.42%. Mean ± standard deviation (SD) of IAP were 8.44 ± 4.02 mmHg for HOB angle 0◦, 9.58 ± 4.52 for HOBangle 15◦, and 11.10 ± 4.73 for HOB angle 30o (p = 0.0001). The IAP measurement bias between HOB angle 0◦andHOB angle 15◦was 1.13 mmHg. This bias was 2.66 mmHg between HOB angle 0◦and HOB angle 30◦.

Conclusion:

 Elevation of HOB angle from 0 to 30 degree significantly increases IAP. It seems that the measurement ofIAP at HOB angle 15◦was more reliable than 30◦.

Readmission of patients with Acute Coronary Syndrome (ACS) causes many problems for them and their family. This study aimed to improve the quality of care provided to patients with ACS and discover solutions to reduce the rate of readmission among them.

This participatory action research study was done based on Streubert and Carpenter approach. This study included 45 participants (31 patients and 14 stakeholders) and carried out in a hospital affiliated to Isfahan University of Medical Sciences, Iran, from 2013 to 2014. Solutions with high and moderate feasibility, flexibility, and suitability were implemented in each cycle until reaching <15% readmission rate. Data were analyzed using SPSS (V.16) and running descriptive and inferential statistics.

In this study, several actions were performed in each cycle such as assigning a free and 24‑h telephone line was patients to contact nurses and face‑to‑face patient’s education. Second cycle actions included active participation of all nurses in the education of patients and involvement of families in patient care. By carrying out the first action cycle, the readmission rate reached 35%, which was not favorable. By completing the second action cycle, the readmission rate reached 12%, which was desirable and significantly lower than the first cycle.

Discovering possible solutions with the participation of stakeholders in therapeutic settings that have feasibility, flexibility, and suitability can lead to improved care quality and reduced readmission rate in patients with ACS, especially if the families of the patients also participate in action cycles.

Nurses working in intensive care units (ICUs) are sometimes faced with ethical decision making which requires ethical sensitivity and moral intelligence. The purpose of this study was to investigate the relationship between moral sensitivity and moral intelligence in nurses working in intensive care units.

This cross-sectional correlational study was conducted in 112 nurses working in adult ICUs who were selected by census sampling in Amol, Iran 2019. The Moral Sensitivity Questionnaire and Moral Intelligence Questionnaire were administered and data were analyzed applying descriptive and analytical statistics.

No significant relationship was found between moral intelligence and moral sensitivity (r= 0.14, P= 0.15). But, there was a significant positive relationship between moral intelligence and the dimension of knowing how to communicate with the patient as one of the areas of moral sensitivity (P<0.05).

According to current study, high levels of moral intelligence would help nurses in having better relationships with patients. Therefore, developing appropriate programs are suggested to improve ethical sensitivity in nurses.

Iranian elderly population is increasing, and a high percentage of this population suffers from diabetes. Considering that the concept of active aging has not been developed in the context of chronic diseases that are common in aging (such as diabetes), the purpose of this study was to analyze the concept of active aging in diabetic elderly patients based on a hybrid model.

Three stages of hybrid model (theoretical, field work and final analysis) were used in this study. In the theoretical phase, 35 articles (published in 1990-2016) from scientific databases were analyzed. In the field work phase, 10 participants were interviewed and then a qualitative content analysis was performed. In the final phase, the findings of the two previous stages were merged and analyzed.

The definition of active aging for the diabetic elderly is a comprehensive, dynamic, multidimensional and culturally dependent process that requires a sense of satisfaction, happiness, well-being, security, and physical and mental health, that is achieved through social participation, providence of appropriate health and employment services, awareness of diabetes, and financial, emotional, family, and governmental support that brings subjective and objective benefits to the international, national and individual levels (such as adaptation to illness, a sense of worth and self-esteem). In order to achieve this, paying attention to the whole life span from childhood to old age is needed.

The results of this study suggest that health, security, satisfaction, participation, access to health services, support and knowledge of diabetes play an important role in activating elderly people with diabetes in Iran.

  Sleep disturbances are one of the most common behavioral problems in childhood. Sleep problems have an even greater prevalence in children with epilepsy and are one of the most common comorbid conditions in childhood epilepsy. The present study was a descriptive- correlation study with the general goal of determining the effects of epilepsy on sleep habits of epileptic children in Hamadan, Iran, in 2014. Sampling was done using convenience sampling techniques. Data was collected by using The Early Childhood Epilepsy Severity Scale (E-Chess) and Children’s Sleep Habits Questionnaire (CSHQ). It was analyzed by using SPSS (20) and descriptive and inferential statistics. The mean score of sleep habits were 55/08 ± 6/71. Bedtime resistance (12/14 ± 2/93), parasomnias (11/02 ± 1/84) and sleep anxiety (8/29 ± 2/46) were the most frequent sleep disorders in the studied sample. Based on Pearson’s r, there were significant positive bidirectional relationships between bedtime resistance (rs = 0.129, p < 0.019), parasomnias (rs = 0.298, p < 0.005), sleep disordered breathing (rs = 0.295, p < 0.005), CSHQ total score (rs = 0.144, p < 0.022) on the one hand, and children’s epilepsy severity on the other. Sleep problems should not be overlooked, and a comprehensive review of the sleep habits of this group of patients should be conducted.

Anxiety and depression are among the most common psychological symptoms in patients with life-threatening illnesses, and have a close relationship with hospitalization in specialized care units. This study aimed at evaluating anxiety and depression and their related factors in patients admitted to Intensive Care Units (ICUs). This is an analytical cross-sectional study conducted on 135 patients hospitalized in ICUs (neuro ICU and general ICU) of Poursina Medical Education Center in Rasht City, Iran. The patients were selected by convenience sampling method. The study data were collected using a checklist surveying demographic, clinical and psychosocial characteristics of the patients, and Hospital Anxiety and Depression Scale (HADS). Then, the obtained data were analyzed by Mann-Whitney U and Kruskal-Wallis tests in SPSS V. 18. The Mean±SD anxiety and depression scores of the study patients were 6.12±9.3 and 7.10±2.3, respectively. There was a significant relationship between short-term hospitalization and anxiety (P=0.03), and a high score of depression was observed in those with middle-school education (P=0.03) and non-invasive ventilation (P=0.01). Moreover, administration of sedatives (P=0.001) and tracheostomy ventilation (P=0.04), showed a significant correlation with depression. Anxiety and depression (symptoms of mood disorders) among ICU patients were relatively high and the duration of hospitalization was significantly associated with anxiety. Moreover, the administration of sedative drugs had significant correlation with depression. In addition, the type of received mechanical ventilation was associated with both disorders. Routine screening of anxiety and depression by nurses in ICUs is useful for early treatment, and can prevent long-term complications of these disorders.

Injuries caused by burnt incidents are common in infants, and it is the most common and the third reason of mortalities in this age group. Based on differences in social, environmental, and cultural conditions in communities, investigating risk factors in each region are important. Hence, the present study aims to investigate the related factors to burning of 1-6 years old children.
This study is a descriptive, cross-sectional study and its sample includes 350 burned children between 1-6 years old. The data were collected from patients who were admitted to five hospitals. 175 out of all samples were in burnt group and 175 of them were in healthy group. Sampling method in both groups were sequential. To collect data, a questionnaire in three sections of demographic, familial, and environmental questions were conducted. Data has been analyzed with Mann-Whitney-U, Chi-Square, and Fisher Exact test and modeled by Multinomial Logistic Regression in SPSS 16.
Data analysis revealed statistical significant differences between two groups among individual factors such as age distribution and among familial factors such as mother’s age, father’s education, among environmental factors such as size of the house, number of bedrooms, kitchen format, unavailability of flammable things, washing agents (p=0.001).
Based on the results, most burnings happened when infants were being fed and when all members of family were present. Burnt incidents were proved to happen more in low educated families. So, by effective training courses, risks of more burning events can be decreased and prevented.