Administration of pro re nata medications by the nurse to incapacitated patients: An ethical perspective

Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 23/07/2021.Available online: https://journals.sagepub.com/doi/10.1177/14777509211034146acceptedVersio

PRN Medicines Optimization and Nurse Education

Medicines management is a high-risk and error prone process in healthcare settings, where nurses play an important role to preserve patient safety. In order to create a safe healthcare environment, nurses should recognize challenges that they face in this process, understand factors leading to medication errors, identify errors and systematically address them to prevent their future occurrence. ‘’Pro re nata’’ (PRN, as needed) medicine administration is a relatively neglected area of medicines management in nursing practice, yet has a high potential for medication errors. Currently, the international literature indicates a lack of knowledge of both the competencies required for PRN medicines management and the optimum educational strategies to prepare students for PRN medicines management. To address this deficiency in the literature, the authors have presented a discussion on nurses’ roles in medication safety and the significance and purpose of PRN medications, and suggest a model for preparing nursing students in safe PRN medicines management. The discussion takes into account patient participation and nurse competencies required to safeguard PRN medication practice, providing a background for further research on how to improve the safety of PRN medicines management in clinical practice

Smoking among male medical sciences students in Semnan, Islamic Republic of Iran

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Nurses' strategies to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit: A systematic review and meta-analysis

AIM: To synthesize and integrate current international knowledge regarding nursing strategies for the provision of emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit. METHODS: A systematic review and meta-analysis was undertaken. Four English-language databases including EMBASE, PubMed (including MEDLINE), Scopus, and Web of Science were searched from January 2010 to October 2021. Original quantitative studies that were written in English and focused on nursing strategies for the provision of emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit were included. Eligibility assessment, data extraction, and methodological quality appraisal were conducted independently by the review authors. A narrative synthesis of the review results and a meta-analysis were performed. RESULTS: Twenty studies that were published from 2010 to 2021 were included in the review. Three categories concerning the review aims were identified: 'nursing strategies related to mothers' emotions and infant-mother attachment', 'nursing strategies related to mothers' empowerment', and 'nursing strategies related to mothers' participation in care process and support'. Eight interventional studies that reported mothers' stress as the study outcome were entered into the meta-analysis. Interventions consisted of the educational programme, spiritual care, telenursing, parent support programme, skin-to-skin care, and guided family centred care. Significantly lower maternal stress was found in the intervention group compared with that of the control group (g: -1.06; 95% confidence interval: -1.64, -0.49; Z = 3.62, p < 0.001). CONCLUSION: This review identified and highlighted key nursing strategies used to provide emotional and practical support to the mothers of preterm infants in the neonatal intensive care unit. They included family centred care, skin-to-skin care, parent support and education programmes, interpersonal psychotherapy, spiritual care, newborn individualized developmental care and assessment programme, and telenursing

PRN Medicines Management for Psychotropic Medicines in Long-Term Care Settings: A Systematic Review

Many medications are prescribed and administered PRN (pro re nata, as needed). However, there are few integrative reviews to inform PRN psychotropic medication use in long-term care facilities and nursing or care homes. Accordingly, this integrative systematic review aimed to improve our understanding of PRN medicines management with a focus on psychotropic medications (antipsychotics, sedatives, anxiolytics, and hypnotics) in long-term care settings. Keywords relating to PRN in English, Norwegian, and Spanish were used, and articles published between 2009 and 2019 were retrieved. Based on the inclusion criteria, eight articles were used for data analysis and synthesis. This review offers a description of PRN prescription and administration of psychotropic medications in long-term care. Variations were observed in the management of PRN psychotropic medications based on residents’ underlying health conditions and needs, duration of use, and changes between medications and doses. Neither the reasons for PRN prescription and administration nor the steps taken to identify and manage any associated adverse reactions or adverse drug events were reported. Further initiatives are needed to improve PRN medicines management to explore factors that affect PRN prescription and administration and to develop appropriate PRN guidelines to prevent harm and improve the safety of people living in long-term care facilities

The effects of aerobic, resistance, and combined exercises on the plasma irisin levels, HOMA-IR, and lipid profiles in women with metabolic syndrome: A randomized controlled trial

Background/objective: Irisin is suggested to be an exercise beneficial effects mediator. This study aimed to examine the effects of the aerobic exercise (AE), resistance exercise (RE), and combined exercise (CE) on the plasma levels of irisin and some metabolic and anthropometric indices. Methods: Sixty overweight women with metabolic syndrome were assigned equally into four groups: AE, RE, CE, and control. The study variables were measured before and 24 h after the intervention period. Results: None of the study groups showed statistically significant changes in the serum irisin. However, muscle mass significantly increased in the RE and CE groups. Also, a significant decrease was observed in the body fat percentage in all groups. In addition, compared with the control group, the homeostatic model assessment of insulin resistance in the AE (p = 0.021), RE (p = 0.039), and in the CE (p = 0.003) groups reduced significantly. According to the analysis of indices� changes, serum irisin was significantly correlated with the body fat percentage (r = 0.532) and HOMA-IR (r = 0.424). Conclusions: The systematic exercise program for 8-weeks did not change circulating irisin and no statistically significant difference was observed between the exercise methods. Also, serum irisin seemed to be associated with the glycemic status, body fat and weight independent of exercise activity. RCT registration code: IRCT20180806040721N2. Registry name: Iranian Registry of Clinical Trials. © 2020 The Society of Chinese Scholars on Exercise Physiology and Fitnes

Effect of the exercise programme on the quality of life of prostate cancer survivors: A randomized controlled trial

Aim: The aim of this study was to investigate the effect of the exercise programme on the quality of life of prostate cancer (PCa) survivors. Methods: A randomized controlled, parallel trial was conducted from April 2017 to January 2018 on 80 PCa survivors. They were randomly assigned to intervention and control groups (n = 40 in each group). The exercise programme was designed based on the self-management approach (SMA). The intervention group participated in a 12-week exercise programme consisting of one session of group exercise and three sessions of individual exercise per week using exercise facilities in the community. Data were collected using the quality of life questionnaires and the follow-up checklist. Results: In the intervention group, statistically significant improvements in physical, role, emotional, social and sexual functions were reported. Also, the patients in this group reported reduced fatigue, insomnia, constipation, diarrhoea, urinary, bowel and hormonal treatment-related symptoms in comparison with before the exercise programme (p < 0.05). Conclusions: Nurses are suggested to plan for improving the participation of PCa survivors in exercise programmes using exercise facilities in the community in order to reduce the complications of treatment and improve their quality of life. © 2020 The Authors. International Journal of Nursing Practice published by John Wiley & Sons Australia, Lt

Effect of the exercise programme on the quality of life of prostate cancer survivors: A randomized controlled trial

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Physicians’ and nurses’ decision making to encounter neonates with poor prognosis in the neonatal intensive care unit

This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020. Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173This is an Accepted Manuscript of an article published by Sage in Clinical Ethics on 03/06/2020.Available online: https://journals.sagepub.com/doi/abs/10.1177/1477750920927173acceptedVersio

Normalizing suffering: A meta-synthesis of experiences of and perspectives on pain and pain management in nursing homes

Older people who live in nursing homes commonly suffer from pain. Therefore, relieving suffering among older people thatstems from pain demands knowledge improvement through an integration of international knowledge. This study aimed tointegrate current international findings and strengthen the understanding of older people’s experiences of and perspectiveson pain and pain management in nursing homes. A meta-synthesis study using Noblit and Hare’s interpretative metaethnographyapproach was conducted. Empirical research papers from journals were collected from various databases. Thesearch process and appraisal determined six articles for inclusion. Two studies were conducted in the US and one each inIceland, Norway, the UK, and Australia. The older people’s experiences of pain as well as perspectives on pain managementfrom all involved (older people, their family members, and healthcare staff) were integrated into a theoretical model usingthree themes of ‘‘identity of pain,’’ ‘‘recognition of pain,’’ and ‘‘response to pain.’’ The metaphor of ‘‘normalizing suffering’’was devised to illustrate the meaning of pain experiences and pain management in nursing homes. Society’s commonattitude that pain is unavoidable and therefore acceptable in old age in society*among older people themselves as well asthose who are responsible for reporting, acknowledging, and relieving pain*must change. The article emphasizes that painas a primary source of suffering can be relieved, provided that older people are encouraged to report their pain. In addition,healthcare staff require sufficient training to take a person-centered approach towards assessment and management of painthat considers all elements of pain