Evidence Based Care
Volume:11 Issue: 2, Summer 2021

Acceptance of others' death is inherently difficult; therefore, throughout history, humans have avoided facing the reality of death. Mourning is a difficult experience in itself, and with Coronavirus 2019 (COVID-19), it may become more complicated. This study aimed to explain the experience of bereaved families of patients with COVID-19. This qualitative descriptive study used the conventional content analysis method. In total, 20 participants were purposefully selected and included in the study. The data were obtained through in-depth semi-structured interviews. Participants' contact numbers were extracted from the archives of deceased COVID-19 patients hospitalized in the COVID-19 wards of educational hospitals of Shahid Beheshti University of Medical Sciences from August 22, 2020, to May 21, 2021, Tehran, Iran. The interviews continued until the data saturation. The interview lasted between 35 and 40 minutes. MAXQDA software (version 10) was used to analyze information. The final theme of adaptation to the new world includes psychological symptoms (disbelief mourning and disease, and social stigma), role conflict (threatening context of multiple roles, bottleneck of mental and work hazards, and uncertain future), and miracle of belief and faith (inner peace with praying and distraction of thoughts).Implications for Practice: Given that one of the main concerns of the world following the COVID-19 pandemic is incomplete mourning and the resulting psychological disorders in the family, it is important to find a solution to support bereaved families to adapt to the new world without the deceased.

Pain is the most common complication of arterial blood sampling that leads to patient’s fear and anxiety, lack of cooperation, and dissatisfaction and reduces the success of sampling.

This study aimed to compare the effect of two methods of Hugo point massage with ice and without ice on pain intensity, anxiety, and the success of arterial blood sampling.

This experimental study was performed on 90 patients in Imam Reza Hospital in Mashhad, Iran, in 2020. Sampling was conducted using the convenience sampling method and 30 participants were randomly assigned to three groups. In the group of Hugo point massage with ice, the Hugo point was massaged with ice marbles for 5 min before sampling. However, in the group of Hugo point massage without ice, the massage was performed only by the thumb. Eventually, the routine method of sampling was applied in the control group.The intensity of pain and anxiety in patients was measured using the Visual Analogue Scale and six-item Spielberger Anxiety Scale, respectively. Moreover, the arterial blood sampling duration, the number of arterial blood sampling, and arterial blood sampling result were documented as well. Data were analyzed using SPSS software (Version 25) through Kruskal-Wallis, Chi-square, analysis of variance, and Wilcoxon tests.

The mean±SD pain intensity of patients in the group of Hugo point massage with ice (1.50±0.57) was significantly lower than that in the groups of Hugo point massage without ice (2.25±1.21) (P=0.019) and control (2.80±0.92) (P<0.001).The mean±SD score of anxiety after intervention in the group of Hugo point massage with ice (11.67±0.96) was significantly lower than that in the groups of Hugo point massage without ice (12.63±2.11) (P=0.040) and control (13.50±2.03) (P<0.001). No significant difference was observed among the three groups in terms of the mean±SD of blood sampling duration and the number of arterial blood sampling,Implications for Practice: Hugo point massage with ice is suggested to be used as an available, efficient, and cost-effective method before arterial blood sampling.

Labor pain is one of the most severe pains that women experience. Acupressure is a non-pharmacological method of pain relief without complications.

This study aimed to compare the effect of acupressure at SP6 and SP8 points on pain intensity and duration of the first stage of labor.

This clinical trial was performed on 150 women admitted to a hospital in Tehran, Iran, during 2020. They were randomly divided into control, SP6, and SP8 groups. In the control group, a neutral point was selected. In dilatations of 3-4, 5-7, and 8-10 cm of the cervix, the pressure was applied to each group for 20 min. Pain intensity was measured before the intervention and then 15 and 30 min after intervention in three groups, and the duration of the first stage of labor was recorded. The data were collected using demographic and obstetrics characteristics form, observation checklist, and Visual Analogue Scale. The data were analyzed using SPSS software (version 19).

The results showed that the mean pain intensity in the three stages of the intervention groups and the mean duration of the first stage of labor was significantly different from those in the control group (P<0.001). The Tukey post hoc test revealed that pain intensity and duration of the first stage of labor were significantly lower in the SP8 group (P<0.001).Implications for Practice: It is recommended that acupressure be used as a non-pharmacological method to reduce pain and duration of labor.

Breastfeeding is one of the most important aspects of the mental-cognitive development of the child. The most useful application of the PRECEDE model is to explain factors associated with behaviors.

This study aimed to investigate the effect of PRECEDE model-based education on the breastfeeding behavior of nulliparous mothers.

This randomized clinical trial was conducted on 90 mothers referring to the health centers in Gonabad, Iran, in 2017-18. The participants were divided into intervention and control groups using a table of random numbers. The data were collected through a questionnaire based on the PRECEDE model including predisposing factors, reinforcing factors, enabling factors, self-efficacy, as well as behavioral and social evaluation. Breastfeeding behavior was also assessed using the standard infant breastfeeding assessment tool (IBAFT). Data were analyzed in SPSS 21 through independent t-test and Mann-Whitney test.

No significant difference was observed between the intervention and control groups in terms of knowledge, attitude, reinforcing factors, and enabling factors (P<0.05) before the intervention. However, a significant difference was found between the two groups regarding knowledge, attitude, reinforcing factors, enabling factors, and breastfeeding behavior (P<0.001) after the intervention. The mean±SD of breastfeeding behavior showed a significant difference between the two groups (P<0.001).Implications for Practice: Due to the effectiveness of the PRECEDE model-based training in the breastfeeding behavior of nulliparous women, this educational content can be used to promote breastfeeding behavior in health centers and hospitals.

Heart failure (HF) is the common result of most heart disorders. The quality of life (QoL) of these patients is severely impaired and they need continuous care. Spiritual care is a type of nursing care that may affect the QoL of patients. The present study aimed to determine the effect of spiritual care program on QoL in patients with HF. This randomized controlled trial was performed at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran in August 2020. In total, 84 patients were selected through convenient sampling and randomly assigned to two groups using block balanced randomization. Iranian Heart Failure Quality of Life (IHF-QoL) questionnaire and Parsian and Dunning spirituality questionnaire were complemented by the two groups before and after 1-month follow-up. The intervention was performed for the intervention group in two virtual educational sessions (each 1.5 h) as well as a 1-month follow-up three times a week for 1 h per session via WhatsApp. Finally, the data of 74 patients were analyzed using SPSS software (version 22). The significance level was considered at P < 0.05. The groups were homogenous in terms of demographic characteristics. Dimensions of QoL in mental limitations (P<0.001) and self-care (P<0.01) were significant in the intervention group, compared to the control group. Therefore, the spiritual care program significantly increased the total score of QoL (P<0.01).Implications for Practice: Results of the study indicated that the spiritual care program greatly improved the total score of QoL and can be considered a part of the holistic care program.

Diabetes is one of the most common debilitating diseases in the elderly requiring reasonable blood sugar control to prevent complications. Telenursing has been presented as a cost-effective method to control blood glucose levels.

This study aimed to investigate the effect of tele-nursing on blood glucose control in the elderly with diabetes.  

This clinical trial study was performed on diabetic elderly referring to the diabetes clinic in Rafsanjan City, Kerman Province, Iran. The participants (n=80) were randomly selected and randomly divided into the intervention and control groups. The intervention group was followed up via phone for 3 months. However, the control group received the intervention provided in the clinic. In addition to demographic characteristics and variables of diabetic patients, the fasting blood sugar (FBS) and glycated hemoglobin (HbA1c) were measured at the baseline and 3 months after the interventions.

Before the intervention, the mean FBS and HbA1c of both groups showed no significant difference; nevertheless, there was a considerable difference after the intervention. Paired t-test showed that after the intervention, the amounts of FBS and HbA1c were reduced to 33.92±21.51 and 1.51±0.86, respectively. Implications for Practice: Our results indicated that the use of tele-nursing in elderly patients with diabetes was an effective strategy that led to increased self-care, and consequently, control of blood sugar.

Premature birth and postpartum hospitalization can hurt the father-newborn bonding and self-efficacy.

This study aimed to investigate the effect of fathers' involvement in premature newborns care on paternal-infant bonding and self-efficacy.

This nonrandomized clinical trial was conducted on 80 fathers of hospitalized newborns in the Neonatal Intensive Care Unit at Arash Hospital, Tehran University of Medical Sciences, Tehran, Iran, 2017. The samples were selected by the convenience sampling method and divided into two groups. Pre- and post-intervention outcomes were collected using the Parent-Infant Bonding Scale (originally the Mother-Infant Bonding Scale) and the Perceived Maternal Parenting Self-Efficacy tool. The gathered data were analyzed using independent t-test, paired t-test, repeated-measures ANOVA.

The mean±SD of the scores of the bonding score was reduced by 2.3±2.17 in the Control group and 5.27±2. 57 in the intervention group. A lower score represented a better bonding. The self-efficacy score increased in both groups; however, it was significantly higher in the intervention group, which was increased by 8.85±5.046, compared to 1.27±3.31 in the Control group.

Evidence-Based Practice (EBP) means combining the best available evidence with clinical experiences, as well as patients’ values and expectations. The findings of our previous systematic review, published in 2014, indicated that EBP faces numerous barriers.

The present study aimed to update the findings of the previous research by reviewing studies published after 2014.

The data were collected by searching the relevant keywords in PubMed, Cochrane, Scopus, and Google Scholar between 2014 and 2021. The articles were screened based on their titles, abstracts, and full texts, respectively. The data were extracted using a data extraction form consisting of the author, year, country, type of study, area of study, list of barriers, and their number in each study. Finally, the data was analyzed, summarized, and reported using content analysis by descriptive statistics, such as percentage and frequency.

Finally, 77 articles were included in the study. Only 13% of the studies were conducted in low and middle-income countries. The extracted barriers were categorized into five areas of specialized/hospital care, primary health care, rehabilitation care, medical education, and healthcare management and decision making. Based on the content-analysis results, barriers were divided into six main themes: system-level barriers, barriers related to the evidence, individual-related, communicational, resource, patient-related, and external barriers. Lack of time, support, and skills had the highest repetition, respectively.
Implications for Practice: The results of our previous study were updated, and further barriers were identified and reported. Policymakers and managers can use the results as a practical guide to expand and improve EBP and remove barriers.