فهرست مطالب heshmatolah heydari

This study aimed to assess the impact of nurses' training on the implementation of preventive measures for falls in hospitalized elderly individuals. A quasi-experimental study was conducted, involving 64 nurses employed at Ganjavian Hospital in Dezful, Iran. Convenience sampling was used to select the participants between April 15th and July 15th, 2020. The nurses were then randomly assigned to either the intervention or control group. Initially, a checklist was utilized to assess both groups' fall prevention activities for older patients. Subsequently, the intervention group received workshop training, while no specific intervention was provided to the control group. After a two-week period, the fall prevention behaviors were reassessed in both groups. Data analysis was performed using SPSS software version 16, employing independent t-tests, paired t-tests, chi-square tests, and analysis of covariance. Prior to training, the mean score for nurses' fall prevention behaviors was 12.31±4.12. Following the training, the mean score significantly increased to 26.78±3.41 (p<0.001). Furthermore, after controlling for underlying characteristics such as ward and job experience, as well as baseline values, significant changes in mean scores between the control and intervention groups were identified (p<0.001). Workshop training sessions tailored to nurses' needs can effectively enhance their implementation of fall prevention behaviors for elderly patients. Therefore, it is recommended to conduct similar comprehensive training interventions for nurses to mitigate falls and their associated complications among hospitalized elderly individuals.

Patients with cancer are among the groups that are vulnerable to the COVID-19 crisis. Identifying the factors affecting the process of healthcare provision can improve the health services provided to cancer patients. Therefore, this study aimed to explain stakeholders’ perception of the healthcare services provided to cancer patients during the COVID-19 pandemic. The present qualitative study was conducted using the conventional content analysis method in Iran in 2021. Participants included cancer patients, their families, and healthcare providers, who were selected via purposive sampling. Data were collected through 19 individual interviews and two focus groups and then analyzed using the method proposed by Graneheim and Lundman. Qualitative data analysis revealed seven main categories, including the disruption of care continuity, reduced quality of health services, poor provision of community-based services, lack of comprehensive care, lack of public education, predicting changes in cancer incidence and mortality trends, and ethical challenges. The COVID-19 pandemic has exposed cancer patients to many challenges, including limited access to health services. Therefore, there is a need to facilitate these patients’ access to safe healthcare services.

One of the basic steps to improve the quality of services provided to patients with COVID-19 is to recognize the dimensions of providing such services from the perspective of recipients. Accordingly, this study aimed to explain the COVID-19 patients’ experiences of healthcare system responsiveness during the disease course. The present qualitative study was conducted using the conventional content analysis method in Iran from April 2020 to April 2021. Participants in this study included COVID-19 patients who were selected via purposive sampling. Data were collected through 34 telephone and face-to-face interviews and analyzed according to the method proposed by Graneheim and Lundman. Qualitative analysis of the data led to the identification of impaired health system responsiveness as the main theme. The main theme consisted of two categories including the collapse of hospitals (with the subcategories of lack of resources and defects in process management) and providing low-quality care (with the subcategories of providing low-quality nursing services, lack of comprehensive care, and threats to patient safety). To provide quality care services to COVID-19 patients, the health system must consider improving its responsiveness to patient needs, expanding the physical space of healthcare centers, equipping hospitals with the accommodations and amenities required by patients, and providing conditions for the staff to be able to immediately respond to patient needs.

Families of patients with low consciousness have an important role in supporting them and should acquire the necessary capability for patient care.

This study aimed to examine the effect of family-centered interventions on the self-efficacy of the families of patients admitted to the intensive care units.

This research was a randomized clinical trial with a pretest-posttest design conducted in intensive care units of hospitals in Khorram abad City, Iran, in 2019-2020. Seventy family members of patients were selected by convenience sampling and were assigned to the intervention (n=28) and control (n=28) groups by stratified random blocks. The study data were collected through the self-efficacy questionnaire and Hospital Anxiety and Depression Scale. The intervention was carried out using a family-centered model. The collected data were analyzed using the statistical tests of the Chi-square, independent t-test, and paired t-test. Also, the generalized linear model was used to compare changes in self-efficacy scores of the two study groups after adjusting demographic, anxiety, and depression variables.

Data analysis showed that most samples were male (53.8%) with a mean age of 38.15±8.68 years. The results showed a significant difference in the mean scores of self-efficacy, anxiety, and depression between the intervention and control groups (P=0.001). The intervention significantly increased the Mean±SD of caregivers’ self-efficacy (40.14±14.35, P=0.001) in the intervention group. The results showed that the self-efficacy mean score of the intervention group was 36 scores higher than the caregivers’ self-efficacy of the control group (95% CI; 20.6-51.4, P=0.028).

The participation of family members of patients with low consciousness in the care of the patients in the intensive care unit has an effective role in the self-efficacy of caregivers of these patients.

During the COVID-19 pandemic, care for cancer patients may be disrupted for several reasons, leading to disease progression. Home-Based palliative care, if properly managed, can provide easy and safe access to care services for these patients. This study aimed to explore stakeholders’ perceptions of home-based palliative care for cancer patients during the pandemic.

This qualitative study was conducted using conventional content analysis in Tehran, Iran, in 2021. By purposeful sampling, 19 participants, including cancer patients receiving home-based care services from the Iranian Cancer Control Center (MACSA) and their families, as well as the homecare providers, were recruited. The study data were generated by conducting 19 semi-structured interviews and a focus group session and analyzed based on the method proposed by Lundman and Graneheim.

Qualitative analysis of the data revealed 5 main categories: “need for remote services”, “disease transmission reduction”, “management requirements”, “burnout”, and “reducing hospital workload.” 

The use of telemedicine, the existence of call centers, and the designing of appropriate guidelines, along with the help of qualified personnel, prevent the transmission of COVID-19 to cancer patients in-home palliative care and lead to the provision of comprehensive care to these patients. This approach to care helps avert staff burnout and reduces the number of occupied beds in hospitals.

The health system of each country are required to achieve the goals based on appropriate frameworks. Assessment of health system performance provides an opportunity to address the main mission through recognizing new needs and resolving existing gaps. This review study aims to investigate Iran’s health system performance in achieving its goals based on the World Health Organization (WHO)’s conceptual framework. 

This scoping review was conducted based on Arksey and O’Malley’s methodological framework. A search in international databases including Web of Science, Scopus, PubMed/Medline and in national databases such as SID, MagIran and IranDoc was conducted using the keywords “health system, Iran”, “disease burden”, “responsiveness” and “financial contribution”, which were used in both English and Persian separately for each variables of health promotion, responsiveness, and fair financial contribution. Retrieved articles were analyzed using qualitative synthesis method. 

Data extracted from articles categorized into the three groups of “Health” (with sub-categories of epidemiologic and demographic transitions), “Responsiveness” and “Fair financing and financial risk protection”. Synthesis of data revealed that the profiles of diseases has been changed over recent decades in Iran, which has resulted in epidemiologic and demographic transitions. In terms of responsiveness, services provided by the health system had not fulfilled patients’ expectations. Regarding fair financial contribution, synthesis of data showed that people had faced high health costs, with a high amount of out-of-pocket payment.

Iran’s health system has not yet achieved the goals recommended by the World Health Organization. Fundamental reforming is required in the health system of this country.

Considering the importance of hand hygiene in the nurses, this study has aimed to determine the effect of educational interventions based on Theory of Planned Behavior on nurses' intention to perform hand hygiene. In this randomized controlled clinical trial, subjects including 60 nurses were selected by using the convenience sampling method and then were located in the intervention or control groups by the simple random sampling. The intervention group received educational interventions based on the Theory of Planned Behavior through a four-session workshop. Instrument was Theory of Planned Behavior questionnaire with four subscales including attitudes, perceived behavioral control, subjective norms and hand hygiene intention. The questionnaire was filled in the two groups before, immediately after, and one month after intervention. The mean score of attitude, subjective norms, perceived behavioral control, and intention in the baseline of intervention group were 1.96 ± 0.62, 1.87 ± 0.68, 1.84 ± 0.72, and 3.96± 0.64 respectively.  Immediately after the intervention the mean score of these constructs changed to, 2.88 ± 0.68, 2.79 ± 0.79, 3.82 ± 0.69, and 3.78± 0.71 respectively, and the changes were statistically significant (P<0.001). Also education performed in the intervention group increased the scores of attitude, subjective norms, perceived behavioral control and intention in comparison with the control group and changes were significant statistically(P<0.001). The use of educational models could improve the nurses' intention to perform hand hygiene behaviors; therefore, it is necessary to consider this model by modifying the training patterns.

Covid-19 is a novel disease with many unknown clinical and managemental dimensions. To effectively diagnose, control, and treat the disease, it is required to divulge its clinical symptoms and their qualities. On the other hand, no one can better interpret the clinical symptoms than the caregivers infected by the disease. So, the aim of this study was to exploring the experiences of infected health-care providers about clinical manifestations of Covid-19 disease.

The present qualitative research was conducted using the conventional content analysis method in Iran from March to Jun 2020. Participants in this study included 18 infected health care providers with Covid-19, who were selected based on purposeful sampling method. The data was collected by phone call interviews and analyzed according Lundman and Graneheim approach.

Qualitative data analysis revealed 10 categories including respiratory disorders, fever and chills, body pain, fatigue, headache, skin disorders, gastrointestinal disorders, taste and olfactory disturbances, insomnia and also stress and anxiety. Patients with Covid-19 may experience specific or non-specific disorders. It is necessary to consider people with non-specific manifestations as suspicious cases and screen them with proper diagnostic tests. This can help to identify true positive patients and provide them with more effective health cares, and prevent further spread of the disease by isolating suspected individuals.

Community health nurses have an important role to play in promoting public health. This study attempted to explore the stakeholders’ perceptions of challenges in the public health nursing practicum in Iran. 

This qualitative study was carried out in some schools of nursing and health centers in Iran from October 2015 to September 2017. Twenty-three participants, including faculty members of public health nursing, nursing students, home nurses, experts in health centers, and nursing education policymakers were selected by purposeful sampling. Data were collected using individual interviews and were analyzed by Lundman and Graneheim’s method of content analysis. 

Three themes resulted from the data analysis, including organizational challenges (with sub-categories of “inappropriate implementation of the curriculum due to lack of authority”, “the treatment-centeredness of health care system”, and “limited fields for nursing practicum”), educational challenges (with sub-categories of “shortcomings of educational curricula” and “the duration and time of practicums”), and workforce challenges (with sub-categories of “the financial burden of public health nursing practicum”, “lack of job position for public health nurses”, and “factors related to the role of instructors”). 

Senior managers, community health center administrators, and educational planners can use the challenges and barriers raised in this study to make more appropriate planning for the training of nursing students in public health nursing practicum.

low-conscious Patients’ families should be having healthy mental, because of the have a crucial role in the supportive of patient, then this study aimed for determinant of impact the family- center interventions on anxiety and depression of low-conscious patient’s family hospitalized in the intensive care unit (ICU).

This study was a randomize clinical trial with before after design, that conducted in the Shohadaie Ashaier and Shahid Rahimi hospitals’ intensive care units in the Khorramabad city in 2019. 70 people of patients’ family selected by conventional method and allocated intervention and control groups by stratified randomized block design for sexual. Data gathered by the hospital anxiety and depression scale. Intervention conducted based family-centered model for intervention group. Data analyzed by SPSS software and statistical tests such as Chi Squared, independent and dependent T test and ANOVA test.

Data showed, between changes of score average of anxiety and depression in the control and intervention groups were significant deferential statistically(pvalu<0.001).  

  Participation of low-conscious Patients’ families, in the caring of their patients in the ICU could lead to reduce of anxiety and depression of patients’ family members.

Considering the position of home health care in the current world, the objective of this study was to design an applied model of providing home care services in Iran.

The mixed methods approach was employed in three stages in Iran from Feb 2015 to Sep 2016. During the first phase, the qualitative method of content analysis was used. Data were collected by conducting 26 individual interviews and holding one focus group session involving 7 people. Data analysis was based on Graneheim and Lundman’s approach to content analysis. In the second phase of the study, a literature review was carried out and at the end of this stage, a preliminary model was designed. The model was standardized in the third phase using the Delphi method with 23 participants in two rounds.

In the first and second stages of the study, various categories emerged including patient referral, agreement, determination of the needed level of care, care plans designing, provision of comprehensive services, documentation, service monitoring, inter-professional cooperation, issuance of death certificates at home, ethical considerations, and the evaluation of services. Then, in the Delphi phase, 20 (95.2%) of the experts confirmed the structure and content of the model and its applicability.

The designed model can be helpful in organizing the provision of integrated and comprehensive health services to clients at home, which can be effective in improving the clients’ health and enhancing their self-care and autonomy.

The World Health Organization (WHO) has introduced palliative care as a way to improve the quality of life of patients with incurable diseases and their families. This care begins with the diagnosis of the disease, and continues throughout the illness (1). Palliative care improves the quality of life of patients with life-threatening diseases and their families. Its purpose is to relieve suffering through the identification, evaluation, and relief of pain and other physical, psychosocial and spiritual problems (2).
Palliative care is required for many diseases. According to reports, every year about 40 million people in the world need palliative care, but only 14% of them receive it, of whom 78% live in low-income or middle-income countries. According to the World Health Organization, patients who require palliative care services, suffer from cardiovascular diseases (38.5%), cancer (34%), chronic pulmonary diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Other patients with diseases, such as dementia, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological diseases, congenital anomalies, and resistant tuberculosis may also need palliative care services (1). Palliative care can be offered to patients through various models, including hospital-based palliative care, hospice-based palliative care and home-based palliative care (3). Studies have shown that home-based palliative care has a very beneficial effect on the physical, mental, psychological, social and economic dimensions of patient’s life, and reduces the cost of health system, shortens the length of hospitalization, reduces hospital complications and prevents hospital readmission (4-6). This type of care also facilitates the continuity of post-discharge care and helps patient to easily benefit from the facilities of different centers (7). On the other hand, most people prefer to receive care at their homes with their families (8). Studies have shown that home-based palliative care is clinically and economically effective and leads to the satisfaction of patients and their families. Also, the World Health Organization in 2014 has introduced home-based palliative care as one of the main elements of the health systems all around the world (1). However, reports indicate that many countries in the world do not have palliative care programs in their health care system (7), and the lack of government support for palliative care services, lack of prepared professional staff to provide palliative services, limitation in access to narcotic analgesics, resource constraints, lack of policy-makers’ familiarity with palliative medicine, the negative attitude of society towards palliative care and socio-cultural issues have been mentioned as barriers to palliative care in the world (1, 9,10).
Iran’s health system is faced with increasing number of chronic patients and shortages of manpower and ICU beds in health centers. Most patients with life-threatening diseases in Iran are frequently admitted to hospital during the last days of their lives. Despite the shortage of hospital beds, especially in the critical care units, these patients occupy these beds and receive specialized medications until the end of their lives and eventually many of these patients die on ICU beds in hospital (11). While in many cases, hospitalization of incurable patients in critical care units does not have any positive effects on patients’ recovery, and is considered a futile care (12), which increases the costs of health system, poses financial burden on patient’s family, and leads to dissatisfaction and work burnout in healthcare staff (13). On the other hand, many of these patients prefer to spend the last days of their lives at home with their family and be in close contact with their relatives. Evidence suggests that palliative care in Iran is only offered in isolated and limited centers. Most patients are deprived of this kind of care, and home-based palliative care does not have any place in Iran’s health system (14). Patients with incurable conditions who require palliative care services are lost in the system, and in most cases do not receive proper and timely services they need (15). Also, the traditional attitude of healthcare staff towards the management of incurable conditions, the lack of transparency in the protection of healthcare staff against discontinuation of unnecessary treatments or unreasonable expectations of patients and their families, as well as social and cultural differences are barriers to the promotion of palliative care in Iranian society. Another problem in providing home-based palliative care services is the defect in the payment process and insurance coverage of end-of-life patients (16,17). Therefore, given the high prevalence of chronic and incurable illnesses, the increasing number of elderly population, limited critical care beds, shortages of human resources, limited financial resources and equipment in health centers, and taking into account the benefits of home-based palliative care, healthcare system authorities should consider this care method to be one of the important priorities of the health system so that patients can maintain their quality of life and also experience peace during the last days of their lives. Considering the limited research in this field, further research is required on the management of various dimensions of home-based palliative care in order to provide suitable models for the provision of home-based palliative care services in Iran.

Community-based nursing focuses on providing health services to families and communities in the second and third levels of prevention and this can improve the individuals, families and communities’ quality of life, and reduce the healthcare costs. The aim of this study was to explore the status of community-based nursing in Iran.
This qualitative study was conducted from March to November 2015, in Tehran, Iran, using the content analysis approach. The study setting consisted of Iran and Tehran Faculties of Nursing and Midwifery, Tehran, Iran. The purposive sampling method was used. Twenty faculty members and Master’s and PhD students were interviewed by using the face-to-face semi-structured interview method. Moreover, two focus groups were conducted for complementing and enriching the study data. The data were analyzed using the Graneheim and Lundman’s approach to content analysis. The trustworthiness of the study findings was maintained by employing the Lincoln and Guba’s criteria of credibility, dependability, and confirmability.
In total, 580 codes were generated and categorized into three main categories of conventional services, the necessity for creating infrastructures, and multidimensional outcomes of community-based nursing.
Introducing community-based nursing into nursing education curricula and creating ample job opportunities for community-based nurses seem clearly essential.

Nursing is a stressful profession. Perception of how coping to stress is crucial to management of stress. then aim to this study was determine relationship between emotional intelligence and coping style to stress in nurses. Method and material: In this cross-sectional analytic study, 90 people of employed nurses in the educational hospitals in jondishapour university of medical sciences were selected to using multi stage method. Data collected by standard questioners, such as emotional Intelligence Questionnaire Bar- On and Andler- Parker’s coping strategies to stressful situation and to self-playing method. Then data analyzed to spss software with descriptive and inferential statistics such as person relationship confidence, independent t test and one- way ANOVA. In front to the stress 74.5% of cases used problem-oriented coping strategies. both Cases to lower age and employment of service reached higher emotional intelligence score and that was significant statistically (p < 0.05). Pearson correlation coefficient indicates a meaningful positive correlation between emotional intelligence and problem-oriented coping strategies (r= 0.628 p<0.001). Pearson correlation coefficient had meaningful negative correlation (r = - 0.411) between the emotional intelligence and emotion- oriented coping strategies (p<0.001). Pearson correlation coefficient don’t have meaningful correlation between emotional intelligence and avoid-oriented coping strategies (p<0.778). emotional intelligence is correlative with copying of stress in nurses and need the manager of continues training encourage problem-oriented coping strategies.

The demand for hospitalization in intensive care units is increasing. The purpose of this study was “to investigate the causes and the consequences of hospitalization in the intensive care units”. All patients hospitalized from July 20, 2010 to July 20, 2011 in Shohaday-e Ashayer Hospital, Khorramabad, Iran, were recruited to this observational descriptive-analytic study by using the census technique. The data collection instruments were the Sequential Organ Failure Assessment (SOFA) scoring and a demographic questionnaire whose validity and reliability had been confirmed. Study data were analyzed by using the SPSS v. 19.0. The most common cause of hospitalization in intensive care units was traffic accidents (42.2%). About 62.2% of the study participants developed hospital-acquired complications, chiefly pneumonia (24%). Mortality rate among the study participants was 29.13%. There was a significant correlation between the length of hospital stay and the rate of hospital-acquired complications. The rate of hospitalization in intensive care units can be reduced through adopting strategies for preventing traffic accidents and brain strokes. Moreover, the rates of mortality and hospital-acquired complications can be decreased by shortening patients’ stay in intensive care units.

Internship through mentorship method improves clinical education in nursing. Due to numerous problems in implantation process of the mentorship plan, this study aimed to explore and explain strategies to improve the mentorship plan. This qualitative study with content analysis approach was performed in educational hospitals of Lorestan University of Medical Sciences in 2013. Eleven last semester nursing students and six head nurses were selected through purposive sampling. Data were collected using semi-structured in depth interview. Interviews were recorded, transcribed and then data were analyzed using qualitative content analysis by Lundman and Graneheim method. Data were classified into three main categories and nine subcategories: mentor-related factors (mentor’s personality traits and capabilities in clinical training); factors related to hospital personnel (justification for mentorship program, nurses as role models, and inter-professional relationship); and management factors (evaluation method, case-based division of labor in nursing, provision of welfare facilities for students, and proper planning for implementation of the internship). The mentorship plan can be enhanced by considering scientific and general qualifications of the mentor, the role of hospital personnel in professionalization of nursing students, and proper management in implementation of internship programs.

Diabetes is a major problem for health systems and physical activity is one of the most important modifiable and life style factors to management of diabetes. This study aimed to determine the status of physical activity (PA) in patients with type 2 diabetes based on Trans Theoretical model (TTM). This study was conducted on 393 diabetic patient’s type 2 diabetes in 2013 at the city of Khorramabad, participants were selected by convenience sampling method. Data were collected through a questionnaire consisted of 5 parts and were analyzed with using the statistical software SPSS-18 and Pearson correlation coefficients, chi-square test, t-test and ANOVA test. The P-value for statistical significance is defined as P < 0.05 In this study the majority of participants (48.9%, 192 patients) were in pre contemplation stage and only 15% of them were in the action and maintenance stages. Mean minutes of PA was 20.6±11.9 and the mean of PA in maintenance group was significantly higher than other groups. A negative significant relationship was found between the average daily PA and perceived benefits, and a positive significant correlation with processes of change, self-efficacy and decision balance. Frequency of PA in week had a positive significant correlation with self-efficacy. The majority of patients had no a plan to exercise in the next 6 months and physical activity levels of the patients were poor. Regarding the relationship between self-efficacy and decision balance with an average of exercise time in day and frequency of exercise in week provision of educational programs focusing on these structures can help to improve the level of physical activity.

The aim of this study was to determine the family members’ performance in confront with patient''s heart attack and its relationship with their knowledge in this filed. Heart attack is one of the most common، serious and fatal diseases. It is growing rapidly worldwide and is the most leading cause of mortality. The performance of people who deal with the heart attack patients in the early minutes، is important in prognosis of disease and his/her life and death. This correlational descriptive study was conducted on 300 family members of patients with heart attacks who hospitalized in teaching hospitals of Iran University of Medical Sciences. Data were collected by a questionnaire and continuous sampling. Validity of questionnaire was confirmed by content validity and its reliability were confirmed by test retest and by internal consistency (0. 92). The findings showed that there was good level of knowledge، but poor performance of the subjects in confront with patient''s heart attack. There was statisticaly significant correlations between performance and the knowledge (p=0. 004)، but no significant correlations between performance and the knowledge with level of education، age and gender. Despite of good level of knowledge in target community، none of them have good performance in the confront with heart attack patients; therefore it is recommended to educate the public on how to deal with heart attack patients and to perform more studies in this field in order to offer appropriate strategies to promote the knowledge and performance of family members and individuals in society.