seyede fatemeh gheiasi

 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.

 Sleep disorders are one of the most common complications in patients undergoing open-heart surgery. Cognitive-behavioral therapy (CBT-I) is used as a way to improve sleep quality.

 This study aimed to determine the effect of a nurse-led CBT-I on sleep quality among patients undergoing open-heart surgery.

 This prospective randomized clinical trial was conducted on 90 patients undergoing open-heart surgery in both intervention and control groups (N = 45). The control group received routine care. The intervention group received 10-12 sessions of nurse-led CBT-I. The demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. The data was analyzed in SPSS v. 22 software using X2, independent sample t test, analysis of covariance (ANCOVA), and paired t test.

 The majority of samples were in the age range of 31 - 40 years (33.33%) and male (53.33%). The results of the independent t test showed that the mean total PSQI score in the 2 groups before the intervention was not significantly different (P = 0.245). Also, the results of ANCOVA showed that the mean total PSQI score after the intervention has a significant difference in the 2 groups (P = 0.0001).

 Nurse-led CBT-I intervention helps to improve the sleep quality of patients after open-heart surgery by reducing their automatic thoughts that affect behavior. Thus, it is recommended that training in nurse-led CBT-I be included in the nurses' academic training program, as well as in continuing education programs for nurses working in heart surgery wards.

Emergency medical technicians (EMTs) are healthcare professionals caring for COVID-19 patients. The prolonged pandemic may lead to fatigue and threaten caregivers’ mental health. Therefore, this study aims to investigate the level of stress, depression, and anxiety among EMTs in Zanjan during the third year of the COVID-19 outbreak.

This cross-sectional study was conducted on 194 EMTs from Zanjan University of Medical Sciences, Iran, between June 2021 and September 2021. participants were selected using random cluster sampling. Data collection involved using a demographic questionnaire and Depression, Anxiety and Stress Scale-21 Items (DASS-21). Data were analyzed using SPSS version 24.

All participants in the study were male, with a mean age of 33.46 ± 7.25. The mean and standard deviation of depression, anxiety, and stress were 3.12 ± 3.03, 2.24 ± 2.38, and 4.16 ± 3.27, respectively. A significant association was found between the mean score of anxiety and the number of missions and between the mean score of stress and the number of tasks, age, and work experience (P < 0.05).

The level of depression, anxiety, and stress among EMTs was within the normal range. The prolonged pandemic may have helped EMTs adapt to this critical situation. However, it is essential to note that this study was conducted on a limited group of EMTs, and socio-cultural contexts influence psychological characteristics. Therefore, further research in this field is necessary in the future. 

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.

Transversus abdominal plane block is used in management of pain in patients undergoing abdominal surgery. This study aimed at investigating the effect of ultrasound-guided transversus abdominis plane block on postoperative pain control in patients undergoing laparoscopic cholecystectomy.

This double-blind randomized clinical trial was performed in 60 patients undergoing laparoscopic cholecystectomy. General anesthesia was induced in all patients. At the end of the operation, a subcostal transverse abdominis plane (SCTAP) block was performed in the intervention group, while the control group received no intervention. In all samples, pain intensity based on Visual Analogue Scale (VAS) and the dose of opioid and anti-emetics drugs were assessed at recovery, 2, 4, 8, 12, and 24 hours after the surgery. Data analysis was performed in SPSS 24 applying independent t-test and chi-square.

The number of patients with VAS<4 was significantly higher in intervention group compared with the control group at recovery (96.4%), 2 (96.4%), 4 (89.2%), and 8 (57.1%) hours after the surgery (P<0.05), but, data showed no significant difference between the intervention group and control group at 12 and 24 hours after surgery (P>0.05). Findings showed significant differences in mean opioid administration during 8 (4.4 ± 11.9) and 24 hours (38.3 ± 21) after surgery between the intervention group and the control group (P<0.001). The mean use of metoclopramide was not found to be significantly different between the two groups at 8 and 24 hours after surgery (P> 0.05).

Current study showed that ultrasound-guided SCTAP block could reduce postoperative pain and opioid administration after laparoscopic cholecystectomy.

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.

The present review study was conducted with the aim of exploring what nurses should know about interactions of diet containing vitamin K with warfarin. Background. Warfarin is one of the most widely used oral anticoagulants. Dietary interactions, mainly due to vitamin K, are a common concern when consuming warfarin. In the meantime, the nurse, as the first person in the care chain and the main person in charge of patient education, can play an important role in reducing these interactions, which is a challenge for patients.

The present review study was conducted through searching out library as well as databases such as PubMed, Cochrane Library, Web of Science, Scopus, Up-to-date, OVID, CINAHL, Magiran and SID using Persian keywords of warfarin, dietary interactions, vitamin k diet, patient and nurse education and their English equivalents in the period 1999 to 2021. Out of a total of 30 articles found, 8 articles were reviewed after screening the articles.

The findings of this study showed that the amount of vitamin K intake in the diet should be kept constant. This is 90 to 120 micrograms per day. Patients should be properly and continuously educated about vitamin K in various foods and supplements. In the meantime, the role of the nurse as one of the pillars of patient education is very important and fundamental.

Due to the role of the nurse in educating these patients, it is recommended that education about dietary interactions be used using authoritative sources. It is possible with methods such as preparing a clinical guide, making a video and designing an application, and including tables of vitamin K levels in foods.

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.