Evidence Based Care
Volume:14 Issue: 2, Summer 2024

Fatigue is the most common complaint among patients with rheumatoid arthritis, leading to decreased productivity and reduced quality of life.

The present study was conducted with aim to compare the effect of sole reflexology and stretching exercises on fatigue of rheumatoid arthritis patients.

This clinical trial study was conducted on patients with rheumatoid arthritis in Yasuj city of Iran during 2017-2018. Participants were selected through convenience sampling method but randomly allocated to one of the three groups using randomized block allocation. Multidimensional fatigue questionnaire was used to collect data at two times of pre and post interventions. The interventions were performed during 30 minutes per session for three sessions per week over one month.

Mean scores of global fatigue before the interventions in the sole reflexology group was 80.72±8.61, in stretching exercise group 81±7.30, and in control group (76.43±8.17), however, these values for post intervention were reported to be 68.72±8.59, 50.95±5.73, and 76.82±7.43, respectively. Intergroup comparison showed significant differences between the sole reflexology and stretching exercise groups with the control group (p<0.001); also the two intervention groups significantly differed (p<0.001).

Implications for Practice: 

Both sole reflexology and stretching exercises could improve fatigue of patients with rheumatoid arthritis, but this improvement was higher by stretching exercises than sole reflexology.

Human resource provision in the COVID-19 pandemic crisis is a challenge for nursing managers. The outbreak of the COVID-19 pandemic has made a major challenge of staff for health organizations.

The present study was conducted with aim to provide managerial methods in crisis management in the field of the COVID-19 pandemic.

This study was conducted during the COVID- 19 pandemic in Shariati Hospital. Facing the crisis was done in two steps: "reorganization of the physical environment of the hospital" and "reorganization and provision of the staff". Step 1: integrating the medical wards from 17 wards to 5 wards and classification of units into three levels of care. Step 2: “Transfer of high-risk staff from the hospital to other centers”, “Classification of operational and middle-level managers”, “Providing appropriate staff based on levels of patient care needs”, “Review of job descriptions of head nurses at the crisis stage”, “Working shift scheduling, reviewing the staff planning” and “Rehabilitation of the staff”.

Shariati Hospital had 151 beds, 88 of which were used during the COVID crisis. A total of 88 nurses resigned from the hospital because of high risk conditions, and 117 nurses began cooperating with the hospital on permanent shift or voluntary basis.

Implications for Practice: 

Early response to the crisis in terms of reorganizing medical departments and predicting staff needs in the hospital could lead to staff protection and provision of appropriate staff ratio. Based on this study, crisis management can be done in similar situations.

Immediate evaluation and management of brain trauma patients improves disease outcomes and reduces the neurobehavioral consequences of the injury. Emergency nurses are expected to manage patients based on the best available evidence.

The present study was performed with aim to develop and implement an evidence-based care package for the management of brain trauma patients.

This semi-experimental study was conducted on 60 nurses in the emergency departments from November 2022 to May 2023. The subjects were randomly assigned to intervention (n=30) and control (n=30) groups. The data collection tool included a demographic questionnaire and a brain trauma management checklist. The intervention included 4 training workshops based on the comprehensive evidence-based care package during two weeks. Both groups were assessed through a checklist before and after the intervention during 8 weeks.

There was a significant difference between the two groups in the mean scores of care management before the intervention (p<0.001). In addition, the variables of employment status and education level were not the same in the two groups. Therefore, the pretest score, employment status, and education level were included in the model as a covariate, and their effect was adjusted. The mean score of care management after the intervention in the intervention group was 12.3 points higher than that of the control group (p<0.001).

Implications for Practice: 

Evidence-based care package improved the management of brain trauma patients, so it can be considered a simple and affordable solution to implement evidence-based practice and overcome the existing obstacles.

Handling, transferring, and handing off trauma patients impose risks on patients and transfer teams. Therefore, pre-hospital staffs require a high skill to perform these processes simultaneously in critical situations.

The present study was performed with aim to examine the role of demographic factors and skills of pre-hospital staff in the handling and movement of trauma patients to hospitals.

This cross-sectional study was performed by the proportional stratified random sampling method on 151 pre-hospital emergency staff. For data collection, in addition to a demographic information questionnaire, the researcher completed a valid and reliable checklist based on 300 hours of direct observation for assessing staff skills. The data were analyzed by SPSS software (version 20) using descriptive and inferential statistics. p<0.05 was considered statistically significant.

The mean score of staff skills was 77.80±7.84. The lowest scores were related to the stage of “transfer to hospital” (72.04±8.41) and the dimension of “using body mechanics” (67.57±10.42). There was an inverse correlation between staff body mass index and the mean score of staff skills (r= -0.19, p<0.05). Besides, the staff’s skill mean score was correlated with patients’ age (r=0.18) and weight (r=0.16) (p<0.05).

Implications for Practice: 

Retraining courses covering driving, managing pediatric patients, healthy diet and exercise, proper use of equipment, and body mechanics should be implemented for pre-hospital staff. Also, authorities should take measures to control infection and improve patient handoff.

Facing with emergencies in operating rooms can lead to nurses' fatigue and physical discomfort. The evidence shows that aromatherapy can effect on fatigue and physical discomfort.

This study was performed with aim to investigate the effect of aromatherapy with R.Damascena essential oil on fatigue and physical discomfort in operating room nurses.

This randomized controlled clinical trial was conducted in 2023 on 60 operating room nurses in Qom University of Medical Sciences, Qom, Iran. Participants were divided into two equal intervention and control groups using the random blocking method. The intervention group received R.Damascena essential oil and the control group received normal saline as a placebo. In the intervention group, two drops of essence and in the control group, two drop of normal saline were applied to cotton ball, and the participants were asked to attach it to their clothes or scarf at a distance of ten centimeters below the chin and inhale it for 10 min. Fatigue and physical discomfort were assessed before and after aromatherapy.

After the intervention, the mean intensity of fatigue and physical discomfort significantly reduced with a mean decrease 18.38% (t=6.62, p<0.001) and 27.75% (t=5.19, p<0.001), respectively. There was significant difference between the intervention and control groups regarding fatigue (t=-2.78, p=0.007) and physical discomfort (t=-3.47, p=0.001).

Implications for Practice: 

Aromatherapy with R.Damascena can reduce fatigue and physical discomfort in operating room nurses. Therefore, it is recommended to use aromatherapy along with other interventions to improve fatigue and physical discomfort.

The coronavirus disease 2019 (COVID-19) caused many adverse effects, including increased stress in patients.

The present study was conducted with aim to determine the effect of an online self-care training program on perceived stress in COVID-19 patients.

This randomized control trial study was fulfilled by recruiting 132 COVID-19 patients, referred to two hospitals in Isfahan, Iran, 2021. The patients were selected using the purposive sampling method and were then randomly allocated into experimental and control groups (n=63 in each group). The online self-care training program was presented to the experimental group in six 30-minute sessions over two weeks. The data were collected through an individual characteristic form and the Perceived Stress Scale (PSS) at three stages before, immediately, and one month after the intervention. P<0.05 was considered statistically significant.

The mean scores of perceived stress before, immediately, and one month after the intervention in the experimental group were 30.51±6.31, 24.59±4.66, and 26.57±3.82, respectively and in the control group were 29.78±4.81, 29.4±4.57, and 29.11±4.73, respectively. Moreover, no significant difference was observed between the two groups at the pre-intervention stage (p=0.467), while the mean scores of perceived stress in the experimental group were lower compared with the control group immediately (p<0.001) and one month after the intervention (p=0.001).

Implications for Practice:

 The online self-care training program led to a reduction in perceived stress in COVID-19 patients. Thus, implementing this self-directed program may be considered as a safe and useful method to relieve perceived stress in similar conditions.

The prevalence of COVID-19 has caused stress, especially among nurses. On the other hand, the use of effective coping styles during the COVID crisis reduces stress in individuals.

The present study was conducted with aim to investigate the effect of coping styles training program on coping strategies for stress in nurses.

This experimental study was conducted on nurses working in COVID-19 departments in April 2021. After obtaining informed consent, 80 participants were randomly divided into intervention and control groups. In the intervention group, training sessions were held as webinars for 3 sessions, each lasting 2 hours over three weeks. The Stress Coping Styles Questionnaire designed by Endler and Parker was completed by participants before and after the intervention. Data were analyzed by SPSS software (version 16) and one-way analysis of variance and paired t-test. p<0.05 was considered statistically significant.

After implementing the intervention, problem-focused coping styles increased among nurses working in COVID departments, while emotion-focused and avoidance-focused coping styles decreased after training sessions.

Implications for Practice: 

Training the stress coping methods can lead to effective use of coping styles during crises such as COVID-19 among nurses working in COVID departments.

Malnutrition is so common among hospitalized patients, especially those in intensive care units (ICUs). Providing adequate nutritional support for these patients is of utmost significance.

The present study was conducted with aim to investigate the nutritional status of patients hospitalized in the ICUs of Iranian hospitals.

This systematic review was performed according to recommendations from the Cochrane Handbook. A search was conducted on Medline, Web of Sciences, PubMed, Scopus, and SID databases to find the articles on nutritional support for ICU patients hospitalized in Iran until April 9, 2023, using the keywords of "intensive care unit" OR "ICU" AND "nutritional support" and "Iran".

Finally, 19 original, cross-sectional, prospective cohort, and retrospective articles conducted on human samples were entered in this study. Except for one study, all articles reported that the dietary intake was significantly lower among ICU admitted patients. Nutrition Risk in Critically Ill score, Acute Physiology and Chronic Health Evaluation (APACHE II), Nutritional Risk Screening-2002 (NRS), and Subjective Global Assessment (SGA) measurement tools were used to predict the rate of malnutrition among the patients. Recorded reports indicate low calorie and nutrient intake among patients during ICU stay.

Implications for Practice: 

The analyzed hospitals have unsuitable and inadequate nutritional care services. In addition, the patient's intake of calories, protein, and other daily nutrients was significantly lower than the recommended amount leading to a cascade of undesirable patient outcomes.