The Perception of Cardiac Surgery Patients on Comfortable Resources: A Qualitative Study

Introduction: Comfort is a basic human need throughout life and an outcome of nursing. Therefore, it is necessary to understand the comforting needs of cardiac surgery patients, who experience the complications and problems of this surgery. This study was performed to explain the perception of cardiac surgery patients of comfortable resources. Method: This study was conducted with a qualitative, content analysis approach. The participants were 20 cardiac surgery patients. Data collection was performed through unstructured interview and purposive sampling, and continued until data saturation. Continuous analysis of data was performed concurrently with data collection and through a comparative method. Results: During the content analysis process, 4 themes emerged that indicated the nature and dimensions of the patients’ perception of comfortable resources. These themes included “Feeling a close and humanistic relationship with the nurse”, “Understanding the constant presence and monitoring of the nurse”, “Advocacy of family and peer patients”, and “Being in a safe environment”. Conclusion: The results of the current study showed that patients receive more comfort from human resources than environment and modern equipment. This issue shows the importance of highlighting the role of nurses and humanistic nursing care, despite the need for specialized nursing with modern technical facilities. Therefore, considering nurses and the standardization of human resources in health centers is more important than the physical standardization. This will result in nursing interventions being done with real understanding of the patients’ needs. Keywords: Patient perception, Comfortable resources, Qualitative content analysis, Cardiac surgery

رابطه بین دیسترس اخلاقی و ارزش‌های حرفه‌ای دانشجویان پرستاری

Background and Aim: Nursing students experience moral distress while facing complex moral problems, which has a harmful effect on nursing care. One of the factors which improve nursing performance is adherence to professional values. Therefore, this study was conducted with the aim of determining the relationship between moral distress and professional values in the nursing students of Mazandaran University of Medical Sciences. Methods: This descriptive correlational study included 210 nursing students from three nursing faculties of Mazandaran University of Medical Sciences, Mazandaran, Iran. The samples were selected through convenience sampling method. Data collection was done using 3 questionnaires: the demographic questionnaire, Hamric Moral Distress Scale-Revised (MDS-R) and Weis and Shank’s Nurses Professional Values Scale (NPVS). The data were analyzed through the descriptive and inferential statistical tests. SPSS software 25 was used. Ethical Considerations: In this study, the standards regarding moral principles, such as confidentiality, Personal consent and the participants’ freedom to continue or quit cooperation during the study process have been observed. Results: Based on the main purpose of the study, Spearman's test did not show a significant relationship between moral distress and professional values (P=0.251, r=0.08).The mean of moral distress in nursing students was (92.61±57.30) and their moral distress was low level. The mean of professional values in nursing students was (79.69±12.09), which was moderate. The students assigned the highest value to the dimension of care and the lowest value to the dimension of pragmatism. There was no significant relationship between moral distress and demographic characteristics and only gender (p=0.005) and place of residence (p=0.028) showed a significant relationship with professional values. Conclusion: Although no significant relationship was found between moral distress and professional values in the intern nursing students, the nursing students' attention to the care dimension of professional values reflects the students' attention to the importance of care as the main professional duty of nursing, which can affect their performance. Please cite this article as: Shafipour V, Mousavinasab N, Jouybari L. The Relationship between Moral Distress and Professional Values in Nursing Students. Faṣlnāmah-i akhlāq-i pizishkī, i.e., Quarterly Journal of Medical Ethics. 2022; 16(47): e10.زمینه و هدف: دانشجویان پرستاری در مواجهه با مشکلات پیچیده اخلاقی، دیسترس اخلاقی را تجربه می‌کنند که اثری آسیب‌زا بر مراقبت پرستاری دارد، یکی از عوامل بهبوددهنده عملکرد پرستاری پایبندی به ارزش‌های حرفه‌ای است. بنابراین این مطالعه با هدف تعیین رابطه دیسترس اخلاقی و ارزش‌های حرفه‌ای در کارورزان پرستاری دانشگاه علوم پزشکی مازندران انجام شد. روش: در این مطالعه توصیفی ـ همبستگی، ۲۱۰ دانشجوی پرستاری از سه دانشکده پرستاری از دانشگاه علوم پزشکی مازندران به روش در دسترس انتخاب شدند. جمع‌آوری داده‌ها توسط پرسشنامه جمعیت‌شناختی، دیسترس اخلاقی Hamric و ارزش‌های حرفه‌ای Weis و Shank انجام شد. داده‌ها با استفاده از آزمون‌های آماری توصیفی و استنباطی در نرم‌افزار SPSS 25 تجزیه و تحلیل شدند. ملاحظات اخلاقی: در این مطالعه موازین مرتبط با اصول اخلاقی شامل محرمانه‌بودن، رضایت شخصی و آزادبودن شرکت‌کنندگان در همکاری و یا عدم همکاری در روند پژوهش، رعایت گردید. یافته‌ها: بر اساس هدف اصلی مطالعه، آزمون اسپیرمن رابطه معناداری را بین دیسترس اخلاقی با ارزش‌های حرفه‌ای نشان نداد (۲۵۱/۰, P=۰۸/۰r=). میانگین دیسترس اخلاقی در دانشجویان پرستاری (۳۰/۵۷±۶۱/۹۲) و در سطح پایین قرارداشت. میانگین ارزش‌های حرفه‌ای در دانشجویان پرستاری (۰۹/۱۲±۶۹/۷۹) بود که در سطح متوسط قرار داشت. دانشجویان بالاترین ارزش را به بعد مراقبت و کمترین ارزش را به بعد عملگرایی دادند. بین دیسترس اخلاقی با مشخصات جمعیت‌شناختی رابطه معناداری دیده نشد و فقط جنسیت (۰۰۵/۰P=) و محل سکونت (۰۲۸/۰P=) رابطه معناداری را با ارزش‌های حرفه‌ای نشان دادند. نتیجه‌گیری: هرچند رابطه معناداری بین دیسترس اخلاقی با ارزش‌های حرفه‌ای در دانشجویان پرستاری دیده نشد، ولی توجه دانشجویان پرستاری به بعد مراقبت ارزش‌های حرفه‌ای بیانگر توجه دانشجویان به اهمیت مراقبت به عنوان اصلی‌ترین وظیفه حرفه‌ای پرستاران است که می‌تواند بر نحوه عملکرد آن‌ها تأثیر بگذارد

The effect of education on the anxiety of a family with a patient in critical care unit: a systematic review and meta-analysis

Background: Studies have shown that family members of patients in intensive care units experience high levels of anxiety. Contradictions in the results of the studies conducted regarding the effect of training on the anxiety level of such families, emphasize the necessity of employing other research methods to eliminate these ambiguities. Objective: This study applied meta-analysis to determine the effect of training on the anxiety level of families with patients in the intensive care unit. Methods: In order to find electronically published studies from 1990 to 2016, the articles published in journals indexed in the following databases were used: Elsevier, Scopus, ProQuest, ISI, Web of Science, PubMed, Google scholar and Cochrane. For data analysis Stata Software version 11 was used and the heterogeneity index of studies was determined through Cochran (Q) and I2 . Due to the heterogeneity, the random effect model was used to estimate the difference between the standardized mean of anxiety. Results: In this meta-analysis and systematic review article, eight articles were found to be eligible. The number of samples in the initial studies into a meta-analysis included 387 patients in the intervention group and 393 people in the control group. Standardized difference of the mean anxiety score in the intervention group was - 0.329 (CI 95%: -0.756-0.099) units less than that of the control group, indicating that this effect was not statistically significant. Conclusions: The results of this meta-analysis show that training will decline the anxiety level of a family with patients hospitalized in the intensive care unit, although the impact is not considerabl

Medication adherence and its predictors among patients with heart failure

Background: Medication adherence is a complex behavioral pattern affecting treatment success. A stepping stone to improve medication adherence is to determine its contributing factors. Objectives: This study intended to evaluate medication adherence and its predictors among patients with heart failure in Mazandaran Heart Center, Sari, Iran. Methods: This cross-sectional study was conducted on 300 patients with heart failure who were hospitalized from January to March 2015. Sampling was done through the census method. Data were collected using the Morisky Medication Adherence Scale and were analyzed using the Chi-square test and logistic regression analysis. Results: The mean score of treatment adherence was 5.82 ± 2.54. Medication adherence had a significant correlation with education level (P = 0.012), number of children (P = 0.013), comorbidity (P = 0.002), ejection fraction (P = 0.046), and the number of tablets used per day (P = 0.001). However, it was not significantly correlated with age, gender, employment status, place of residence, income level, and the number of hospitalizations for heart failure (P > 0.05). Logistic regression analysis showed that none of the demographic and clinical characteristics was a significant predictor of medication adherence. Conclusion: Medication adherence is affected by different factors such as education level, number of children, comorbidity, disease severity, and the number of tablets used per day. Nurses need to take these factors into account when developing care plans and patient education programs

Medication adherence and its predictors among patients with heart failure

Background: Medication adherence is a complex behavioral pattern affecting treatment success. A stepping stone to improve medication adherence is to determine its contributing factors. Objectives: This study intended to evaluate medication adherence and its predictors among patients with heart failure in Mazandaran Heart Center, Sari, Iran. Methods: This cross-sectional study was conducted on 300 patients with heart failure who were hospitalized from January to March 2015. Sampling was done through the census method. Data were collected using the Morisky Medication Adherence Scale and were analyzed using the Chi-square test and logistic regression analysis. Results: The mean score of treatment adherence was 5.82 ± 2.54. Medication adherence had a significant correlation with education level (P = 0.012), number of children (P = 0.013), comorbidity (P = 0.002), ejection fraction (P = 0.046), and the number of tablets used per day (P = 0.001). However, it was not significantly correlated with age, gender, employment status, place of residence, income level, and the number of hospitalizations for heart failure (P > 0.05). Logistic regression analysis showed that none of the demographic and clinical characteristics was a significant predictor of medication adherence. Conclusion: Medication adherence is affected by different factors such as education level, number of children, comorbidity, disease severity, and the number of tablets used per day. Nurses need to take these factors into account when developing care plans and patient education programs

Effect of home-based exercise on functional ability of hemodialysis patients: a systematic review and meta-analysis

Background: hemodialysis patients suffer from impaired functional ability. Several pilot studies have been conducted concerning the effect of home-based exercise on functional ability of hemodialysis patients; however, there have been observed some contradictions between the results of these studies. The aim of this study was, therefore, to determine the effects of home-based exercise on functional ability of hemodialysis patients using meta-analysis. Methods: In this review study, for the purpose of finding studies published electronically form 2000 to 2016, the papers published in journals indexed in the databases of “PubMed, Science Direct, Google Scholar Cochrane” were used. Also, to analyze the full text of these articles, Stata Software Version 11 was used. Heterogeneity index between the studies was determined using Cochran (Q) c and I2 tests. Since heterogeneity was observed between the studies, a random effect model was used to estimate the mean score of the standardized difference of a 6-minute walk test in order to measure the functional ability of hemodialysis patients in two experimental and comparison groups. Results: Four articles were finally selected in this meta-analysis. 68 patients were in the experimental group and 65 were in the control group. After the intervention, the mean score of the standardized difference of a 6-minute walk test in the experimental group with a confidence interval of 95% was 0.21 (-0.15, 0.57) units more than before the intervention, which was statistically not significant. Conclusion: The results of the meta-analysis showed that home-based exercise increased the functional ability of hemodialysis patients although this effect was not significant

Effect of home-based exercise on functional ability of hemodialysis patients: a systematic review and meta-analysis

Background: hemodialysis patients suffer from impaired functional ability. Several pilot studies have been conducted concerning the effect of home-based exercise on functional ability of hemodialysis patients; however, there have been observed some contradictions between the results of these studies. The aim of this study was, therefore, to determine the effects of home-based exercise on functional ability of hemodialysis patients using meta-analysis. Methods: In this review study, for the purpose of finding studies published electronically form 2000 to 2016, the papers published in journals indexed in the databases of “PubMed, Science Direct, Google Scholar Cochrane” were used. Also, to analyze the full text of these articles, Stata Software Version 11 was used. Heterogeneity index between the studies was determined using Cochran (Q) c and I2 tests. Since heterogeneity was observed between the studies, a random effect model was used to estimate the mean score of the standardized difference of a 6-minute walk test in order to measure the functional ability of hemodialysis patients in two experimental and comparison groups. Results: Four articles were finally selected in this meta-analysis. 68 patients were in the experimental group and 65 were in the control group. After the intervention, the mean score of the standardized difference of a 6-minute walk test in the experimental group with a confidence interval of 95% was 0.21 (-0.15, 0.57) units more than before the intervention, which was statistically not significant. Conclusion: The results of the meta-analysis showed that home-based exercise increased the functional ability of hemodialysis patients although this effect was not significant

Effects of Early Family-centered Sensory Stimulation on Disability and Rehabilitation of Stroke Patients

Background and purpose: Stroke is the most common and debilitating neurologic lesion in adults. Early family-centered stimulation have positive outcomes in stroke patients. The present study was designed to investigate the effect of early family-centered sensory stimulation on restoring function and recognition in stroke patients. Materials and methods: A clinical trial was done in 60 patients with impaired consciousness due to stroke (GCS=5-10) admitted in intensive care unit (ICU). The participants were assigned into control and experimental groups (n=30 per group) using randomized block design. The experimental group received sensory stimulations of the five senses in the first 48-72 hours after the stroke by family members for 14 days. The control group received ICU routine care. At days 5, 10, and 15, the consciousness level was assessed by GCS and FOUR and cognitive function was assessed by Disability Rating Scale. Results: Sensory stimulations significantly increased the mean score for cognitive function in the experimental group compared to the control group (P<0.001). The effect sizes of cognitive function at days 5, 10 and 15 were 0.45, 0.95, and 1.09, respectively. The effect sizes were small at day 5 and large at days 10 and 15. No significant differences were observed in the level of consciousness (P=0.601) and function (P=0.710). Conclusion: In current study, early family-centered sensory stimulation in patients with impaired consciousness due to stroke improved their cognitive function but did not significantly influence their disability score.   (Clinical Trials Registry Number: IRCT20151004024342N6