Predictors of perceived unsupportive behaviours by spouses in women with breast cancer

Background: Unsupportive responses from relatives and spouses play a significant role in the psychological adjustment of breast cancer patients and their spouses, about whom little is known about them and their unsupportive responses predictors. Objectives: The aim of this study was to determine the predictors of perceived spouse unsupportive behaviours in women with breast cancer and their spouses. Material and methods: This is a cross-sectional study, in which 220 couples, including women with breast cancer and their spouses, participated in random samples in chemotherapy and cancer hospitals in Iran in 2020. In the present study, data was collected using a demographic checklist and the Unsupportive Partner Behaviour scale. The Kolmogorov-Smirnov test, ANOVA, independent t-Test, Hochberg post-hoc test and Chi-square test were used for group comparison. Univariate and multivariate linear regression methods were also used to assess the effect size. Results: Predictors of perceived unsupportive behaviours in women were: number of children (p = 0.047), life with relatives (p = 0.051), residence in suburbs (p = 0.006), marital status (p = 0.001), education and occupation of the spouse (p = 0.026), going to the hospital alone (p = 0.001), type of treatment received (p = 0.242), duration of diagnosis (p = 0.018) and type of residence (p = 0.051). Moreover, predictors of perceived unsupportive behaviours in men included: education and occupation of men (p = 0.035) and women (p = 0.050), type of treatment received (p = 0.050), employment of women (p = 0.030) and men (p = 0.009), residence in suburbs (p = 0.014), marital status (p = 0.019) and going to the hospital alone (p = 0.006). Conclusions: The variety of socio-economic, demographic and therapeutic factors were shown to be predictors of perceived unsupportive behaviours by spouses with breast cancer that can be modified by healthcare professionals in order to increase a couple’s mutual support

“Paramedics are only a driver,” the lived experience of Iranian paramedics from patient handover : a qualitative study

Background: Patient handover in the emergency department (ED) is a 2-way communication process between the paramedics and in-hospital emergency personnel, which can result in miscommunication and delivery challenges. This study aimed to explore the lived experience of paramedics on patient handover to the ED. Methods: Over a period of 5 months, an interpretative phenomenological analysis (IPA) was used to explore the lived experiences of 15 paramedics in Tabriz, Iran. Semi-structured interviews were conducted in the emergency medical stations using the Smith approach for data collection and analysis. The researcher used 4 criteria to ensure rigor, including credibility, dependability, confirmability, and transferability, according to Lincoln and Guba. Results: Three main themes emerged from the data analysis, including “the hole of hope,” “the boring issues,” and “paramedics are only a driver.” A further 11 sub-themes emerged under the main themes. Conclusion: The highlighted issues that need to be considered during the process are the presence of staff in front of the ED's door to welcome the patient, removal of structural defects and defective hospital equipment, the presence of medical supplies in emergency triage to prevent the paramedics from stumbling, and listening to paramedics by physicians and nurses to obtain the patients’ history. © The author(s)

Knowledge and Performance about Nursing Ethic Codes from Nurses' and Patients' Perspective in Tabriz Teaching Hospitals, Iran

Introduction: Nursing profession requires knowledge of ethics to guide performance. The nature of this profession necessitates ethical care more than routine care. Today, worldwide definition of professional ethic code has been done based on human and ethical issues in the communication between nurse and patient. To improve all dimensions of nursing, we need to respect ethic codes. The aim of this study is to assess knowledge and performance about nursing ethic codes from nurses' and patients' perspective.Methods: A cross-sectional comparative study Conducted upon 345 nurses and 500 inpatients in six teaching hospitals of Tabriz, 2012. To investigate nurses' knowledge and performance, data were collected by using structured questionnaires. Statistical analysis was done using descriptive and analytic statistics, independent t-test and ANOVA and Pearson correlation coefficient, in SPSS13.Results: Most of the nurses were female, married, educated at BS degree and 86.4% of them were aware of Ethic codes also 91.9% of nurses and 41.8% of patients represented nurses respect ethic codes. Nurses' and patients' perspective about ethic codes differed significantly. Significant relationship was found between nurses' knowledge of ethic codes and job satisfaction and complaint of ethical performance. Conclusion: According to the results, consideration to teaching ethic codes in nursing curriculum for student and continuous education for staff is proposed, on the other hand recognizing failures of the health system, optimizing nursing care, attempt to inform patients about Nursing ethic codes, promote patient rights and achieve patient satisfaction can minimize the differences between the two perspectives

مدیریت درد در اورژانس پیش بیمارستانی: ضرورتی مغفول در نظام سلامت ایران

Pain, as a complex neurophysiological and neuropsychological mechanism, is one of the most common experiences among patients in prehospital emergency service. Although, there is no accurate data regarding the prevalence of pain in prehospital settings like there is for hospital emergency departments, in developed countries, despite the contradictions in the results of the numerous studies, the evidence indicate the high prevalence of acute pain in prehospital emergency service ranging from 20% to 53%. Yet, unfortunately, in Iran there is no statistics available in this regard. The physiological (affecting cardiovascular, respiratory, endocrine and other systems) and psychological (anxiety, anger, aggression, and …) complications due to uncontrolled acute pain have many adverse effects on the clinical outcomes of medical and traumatic patients and impose immense direct and indirect financial burdens on the limited resources of healthcare systems. Therefore, effective pain management using various pharmaceutical and non-pharmaceutical methods both on the scene and during transportation has become a potentially indispensable necessity and considered as a potential key performance indicator according to the National Association of EMS Physicians.An extensive literature review also revealed remarkable improvements in the use of analgesics in prehospital emergency service of many developed countries and opioid analgesics (e.g., morphine sulfate, fentanyl and ketamine); nonsteroidal anti-inflammatory drugs (e.g., Ketorolac and ibuprofen); and Paracetamol and Nitric Oxide (inhalation gas) have been put on the list of prehospital emergency service for relieving patients’ pain, which can be used based on qualification/competencies, roles, responsibilities, and degrees (EMR, EMT, AEMT, paramedic) of the providers of prehospital care with approval of the consultant physician or through use of a combination of off-line and on-line medical protocols in this regard. The majority of recent studies in this field focus on the inadequacy of prehospital pain management as well as the comparison and combination of various analgesic drugs to enhance efficacy, effectiveness and quality of healthcare provision.درد، به عنوان یک مکانیسم پیچیده نوروفیزیولوژیک و نوروسایکولوژیک، یکی از شایع ترین تجارب مشترک بیماران در اورژانس پیش بیمارستانی می باشد. هر چند آمار دقیق شیوع درد در اورژانس پیش بیمارستانی همچون اورژانس های بیمارستانی در دست نیست، اما در کشورهای توسعه یافته، علیرغم ناسازگاری نتایج مطالعات متعدد، شواهد حاکی از شیوع بالای درد حاد در اورژانس پیش بیمارستانی بین 20 تا 53 درصد است. این در حالی است که متاسفانه در ایران آماری در رابطه با این موضوع موجود نیست. عوارض فیزیولوژیک (تاثیر بر سیستم قلب و عروق، تنفس، اندوکرین و...) و سایکولوژیک (اضطراب، خشم، پرخاشگری و ...) ناشی از درد حاد کنترل نشده، اثرات سوء بسیاری بر پیامدهای بالینی بیماران داخلی و تروما داشته و هزینه های مالی مستقیم و غیرمستقیم کلانی را بر منابع محدود نظام های مراقبت سلامت تحمیل می نماید. لذا، امروزه مدیریت موثر درد با استفاده از روش های مختلف دارویی و غیر دارویی در صحنه و حین انتقال در اورژانس پیش بیمارستانی، به عنوان یک شاخص عملکردی بالقوه کلیدی به ضرورتی غیرقابل انکار مبدل گردیده است.مرور گسترده متون نیز نشان داد که اخیرا پیشرفت های چشمگیری در بهره گیری از تجهیزات و داروهای ضد درد در اورژانس پیش بیمارستانی بسیاری از کشورهای توسعه یافته حاصل شده و داروهای ضد درد اپیوئیدی (مورفین سولفات، فنتانیل و کتامین)؛ داروهای ضد التهاب غیر استروئیدی (کتورولاک و ایبوپروفن)؛ آپوتل و گاز نیتریک اکسید برای تسکین درد بیماران در لیست داروهای اورژانس پیش بیمارستانی قرار گرفته  که استفاده از این داروها بر حسب شرح وظايف و مدارج علمي تحصيلي پرسنل پیش بیمارستانی، با هماهنگی پزشک مشاور و یا با بهره گیری از پروتکل هاي باليني آف-لاين در این عرصه میسر گردیده است. همچنین اکثر پژوهش های اخیر در این حوزه بر عدم کفایت مدیریت درد پیش بیماستانی و نیز مقایسه و ترکیب داروهای مختلف ضد درد جهت افزایش کارایی و اثربخشی و بهبود کیفیت متمرکز می باشد.

Hemodialysis patients perceived exercise benefits and barriers: the association with health-related quality of life

Background: Patients on hemodialysis have less exercise capacity and lower health-related quality of life than healthy individuals without chronic kidney disease (CKD). One of the factors that may influence exercise behavior among these patients is their perception of exercise benefits and barriers. The present study aimed to assess the perception of hemodialysis patients about exercise benefits and barriers and its association with patients� health-related quality of life. Methods: In this cross-sectional study, 227 patients undergoing hemodialysis were randomly selected from two dialysis centers. Data collection was carried out using dialysis patient-perceived exercise benefits and barriers scale (DPEBBS) and kidney disease quality of life short form (KDQOL-SF). Data were analyzed using SPSS software ver. 21. Results: The mean score of DPEBBS was 68.2 ± 7.4 (range: 24 to 96) and the mean KDQOL score was 48.9 ± 23.3 (range: 0 to 100). Data analysis by Pearson correlation coefficient showed a positive and significant relationship between the mean scores of DPEBBS and the total score of KDQOL (r = 0.55, p < 0.001). Moreover, there was a positive relationship between the mean scores of DPEBBS and the mean score of all domains of KDQOL. Conclusion: Although most of the patients undergoing hemodialysis had a positive perception of the exercise, the majority of them do not engage in exercise; it could be contributed to the barriers of exercise such as tiredness, muscle fatigue, and fear of arteriovenous fistula injury. Providing exercise facilities, encouraging the patients by the health care provider to engage in exercise programs, and incorporation of exercise professionals into hemodialysis centers could help the patients to engage in regular exercise

Perceived spouse unsupportive behaviors in women with breast cancer and their spouses

Introduction. Unsupportive responses from relatives, particularly spouses, play a significant role in the psychological adjustment of breast cancer patients and their spouses. Failure to meet the physical and psychological needs of breast cancer patients and their spouses can lead to anxiety, depression, and numerous marital problems. The aim of this study was designed to describe perceived spouse unsupportive behaviors in women with breast cancer and their spouses. Material and methods. This is a cross-sectional study. A total of 220 women with breast cancer along with their husbands participated in this study through random sampling. In the present study, data collection was performed using a demographic information checklist and a questionnaire. Results. The mean perceived women’s unsupportive behavior (20.73 ± 8.44) was higher than that of men’s (18.80 ± 5.83), which was statistically significant (P = 0.003). The mean score of perceived women’s unsupportive behavior in the categories of marital status, companion, place of residence, men’s and women’s occupation, and the type of residential house, and the mean score of perceived men’s unsupportive behavior in the category of current treatment were different. Conclusions. Women perceive their spouses’ behaviors as less supportive than their spouses’ perceptions of women’s behavior, which highlights the need for husbands to be more attentive to the impact of their behavior on their wives. Furthermore, talking with each other about problems is the most imperative factor in perceiving support by couples; accordingly, it can be concluded that couples who are reluctant to talk to each other concerning the problem perceive less mutual support

Effective chacteristics of Iranian nursing students in their relationship with clinical nurses

Introduction: The purpose of this study was to explore the characteristics of undergraduate nursing students, which may determine the nature of their relationship with clinical nurses. Relationships between nursing students and clinical nurses are critical to maximize student learning outcomes and produce skilled graduates for the future health workforce. Methods: This qualitative content analysis study was conducted from January to August 2016. Twenty nine semi-structured in-depth interviews were conducted with 20 undergraduate nursing students in Tabriz nursing and midwifery faculty. Interviews were recorded and transcribed verbatim (in Persian), and analyzed using conventional content analysis to identify themes. Results: Four key themes emerged: educational factors (cognitive knowledge and practical skills, and learning motivation); communication skills; perceived support (perceived support from nurses and educators); and psychological state (fear of the relationship and self-confidence). Self-confidence is an emphasized concept in nursing students' willingness and ability to relate with clinical nurses. Conclusion: The results of the study showed that educational, communicative and psychological factors are important determinants of student communication with nurses. However, self-confidence is the most important factor in establishing such relationship. Self-confidence could be further assessed to identify nursing students who need greater support or would benefit from greater educational interventions to achieve relational skills

A comparative study on the meaning in life of patients with cancer and their family members

Introduction: Overwhelming effects of cancer could be catastrophic for the patients and their family members putting them at risk of experiencing uncertainty, loss, and interruption in life. Also, it can influence their sense of meaning, a fundamental need equated with purpose in life. Accordingly, this study aimed to compare the meaning in life (MiL) of patients with cancer with and their family members. Methods: This descriptive comparative study was conducted on 400 patients with cancer and their family members admitted to university hospitals in Tabriz and Ardebil provinces, Iran. The participants were sampled conveniently and the Life Evaluation Questionnaire (LEQ) were used for collecting data which analyzed through descriptive and inferential statistics. Results: The mean score for the MiL of patients with cancer and their family members was 119 ± 16.92 and 146.2 ± 17.07, respectively. There is a significant difference between patients with cancer and their family members in terms of MiL (p<0.001). Conclusion: The MiL of patients with cancer is lower than their family members which indicates the necessity for further attention to the psychological process and its modification in Iranian healthcare systems

Promotion of knowledge, skill, and performance of emergency medical technicians in prehospital care of traumatic patients: An action-research study

Background: Annually, there is a high rate of mortality due to trauma. Prehospital emergency personnel are the first caregivers present beside trauma patients, and their dexterity to take care of trauma patients is of great significance in the vast majority of patients' survival. Materials and Methods: This study was action research with the participation of 125 prehospital emergency personnel from May 2016 to December 2018 in five stages (observation, reflection, planning, action, and evaluation) in Iran. Knowledge, skills, and performance of personnel were assessed before and after the action. Data collection tools included knowledge questionnaire and PERFECT skill assessment checklist by Objective Structured Clinical Examination method and researcher-made checklist for performance. Data were analyzed using SPSS-21 software. Results: The findings indicated that 67.82 and 84.4 of prehospital emergency staff have median to low knowledge and expertise in respect to trauma care, respectively. Their performance of necessary measurements for trauma patients was poor prior to training. There was a significant difference between the mean knowledge, skills, and performance of medical emergency technicians before and after the training course (P = 0.00). Conclusions: Participation of beneficiaries in planning for trauma patient's care is helpful. Establishment of prehospital trauma life support training in the medical emergency, training curriculum, and its instruction to prehospital emergency personnel while serving in trauma care will be of great benefit