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   Table of Contents - Current issue
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July-September 2019
Volume 8 | Issue 3
Page Nos. 119-167

Online since Thursday, August 1, 2019

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REVIEW ARTICLE  

The effects of epinephrine, as a supplement for epidural and spinal anesthesia, on the duration of analgesia during childbirth and Apgar Score: A systematic review and meta-analysis p. 119
Zoleykha Asgarlou, Mohammad Mohseni, Omid Khosravizadeh, Shiler Ahmadi, Sepideh Gareh Sheyklo, Ahmad Moosavi
DOI:10.4103/nms.nms_56_18  
Background: Labor pain is one of the most severe pains that woman may experience during their lifetime. Objectives: This study aimed to systematically review and meta-analyze studies into the effects of epinephrine on the duration of analgesia during childbirth and Apgar score. Methods: This systematic review was conducted in 2018. Data were collected through searching online databases, namely the PubMed, Scopus, Google scholar, SID, Medlib, Magiran, and Iranmedex. Inclusion criteria were an interventional design, comparison of the effects of epinephrine with other modalities on the duration of analgesia and Apgar score, and publication from January 1990 to October 2018 in English or Persian in peer-reviewed journals. Meta-analysis was performed using the fixed and the random effects models with a 95% confidence interval (CI). The Q and the I2 statistics were used to assess heterogeneity, while the funnel plot and the Egger's test were used to evaluate the possibility of publication bias. Results: The standardized mean difference between the epinephrine and the comparison groups respecting the duration of analgesia was 0.65 (95% CI: 0.32–0.98). This difference was statistically significant (P < 0.05). The between-group standardized mean differences respecting the total, 1 min, and 5-min Apgar scores were −0.33 (95% CI: −0.97–0.30), −0.26 (95% CI: −1–0.47), and −0.54 (95% CI: −1.79–0.70), respectively. None of these differences was statistically significant (P > 0.05). Conclusion: Epinephrine increases the duration of analgesia without causing serious side effects.
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ORIGINAL ARTICLES Top

The effects of time use training on the level of stress among the mothers of female children with intellectual disabilities p. 126
Sanaz Arzhangi, Meimanat Hosseini, Samaneh Hosseinzadeh, Mansoureh Zagheri Tafreshi
DOI:10.4103/nms.nms_27_18  
Background: The parents of children with intellectual disabilities may have problems in effective use of their time and hence, suffer from varying levels of stress. Objectives: This study aimed to evaluate the effects of time use training on stress among the mothers of female children with intellectual disabilities. Methods: In this experimental study, eighty mothers of school-age female children with intellectual disabilities were selected through cluster random sampling from two schools in the west of Tehran, Iran. They were randomly allocated either to a control or an intervention group. A six-hour time use training workshop was held for participants in the intervention group, while their counterparts in the control group did not receive any time use training. Data on participants' time use and stress were collected before and six weeks after the intervention using the Mothers' Time Use Questionnaire and the Questionnaire on Resources and Stress, respectively. The Chi-square, paired-sample t, and independent-samples t tests were used for data analysis. Results: The mean score of time management quality in the intervention group significantly increased from 42.10 ± 6.46 to 46.80 ± 6.98 (P = 0.003) and the mean score of stress in this group significantly reduced from 29.3 ± 4.46 to 26.38 ± 5.67 (P = 0.007). However, none of these mean scores significantly changed in the control group (P > 0.05). Conclusion: The mothers of children with intellectual disability may benefit from time use training programs.
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Effectiveness of the clinical teaching associate model in clinical nursing education p. 132
Rozita Cheraghi, Madineh Jasemi, Farideh Namadi
DOI:10.4103/nms.nms_7_18  
Background: Nurses need to have high levels of clinical competence for the provision of quality care to patients. The use of modern teaching methods can help nursing students develop their clinical competence. Objectives: This study aimed to evaluate the effects of the Clinical Teaching Associate (CTA) model on clinical skills and satisfaction with clinical education among nursing students. Methods: This two-group posttest-only trial was conducted on 120 nursing students recruited through the census method from Tabriz Faculty of Nursing and Midwifery, Tabriz, Iran. They had just taken the oncology nursing clinical education course. Participants were randomly allocated to a control group to receive clinical education through routine teaching method and an intervention group to receive clinical education through the CTA model. At the end of the course, participants' clinical skills and satisfaction were assessed using a checklist and a questionnaire, respectively. The study data were analyzed using the measures of descriptive statistics and independent-samples t-tests. Results: The mean score of overall clinical skills in the intervention group was significantly greater than that of the control group (75.54 ± 4.24 vs. 65.46 ± 5.32; P = 0.003). Moreover, the mean score of overall satisfaction with clinical education in the intervention group was significantly greater than that of the control group (98.16 ± 1.23 vs. 84.41 ± 1.52; P < 0.001). Conclusion:This study shows the positive effects of the CTA model on nursing students' clinical skills and satisfaction. Therefore, it can be used to improve learning outcomes among nursing students.
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The effects of using intraoperative care documentation forms on the number of reported errors p. 137
Fatemeh Maraki, Mehri Doosti Irani, Leila Akbari, Akram Aarabi
DOI:10.4103/nms.nms_76_18  
Background: Reporting intraoperative errors can help reduce the incidence of more errors. However, some errors remain unreported. A key strategy to improve error reporting is quality care documentation. Objectives: The aim of this study was to determine the effects of using intraoperative care documentation forms on the number of reported errors. Methods: This single-group pretest–posttest interventional study was conducted on 65 operating room technicians and nurses recruited from the operating rooms of Alzahra and Kashani Teaching Hospitals, Isfahan, Iran. A researcher-made error-reporting questionnaire was used to assess the rate of reported and unreported errors both 1 week before and 2 months after the study intervention. During the study intervention, participants were asked to perform intraoperative care documentation for 2 successive months using five researcher-made intraoperative care documentation forms. Data were analyzed through the McNemar's and Wilcoxon tests and the Spearman's correlation analysis. Results: The mean score of intraoperative care documentation had a direct correlation with the number of written-reported errors (P = 0.044) and an inverse correlation with the number of unreported errors (P = 0.047). The number of written-reported errors significantly increased (P = 0.009), whereas the number of unreported errors significantly decreased after the study intervention (P = 0.017). Conclusion: Intraoperative care documentation can significantly increase the rate of error reporting. Therefore, the intraoperative care documentation forms developed in this study can be used to improve operating room staff's documentation and error-reporting practice.
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Effect of acupressure in Pericardium 6 acupoint on nausea and vomiting after general surgery p. 143
Jamshid Eslami, Isan Darvishi, Abed Ebrahimi, Marzieh Akbarzadeh
DOI:10.4103/nms.nms_4_18  
Background: Nausea and vomiting are of the most common postoperative complications. Postoperative nausea and vomiting (PONV) can increase the patients' length of hospital stay, healthcare costs, and perioperative morbidity. Objective: The current study aimed to evaluate the effects of acupressure in preventing PONV in patients who have undergone general surgery with spinal anesthesia. Methods: This single-blind clinical trial was performed on 70 patients who had undergone general surgery and randomly assigned to an intervention and a control group. In the intervention group, the acupressure wristbands were fastened to one of the patients' wrist so that the pressing buttons were placed on the Pericardium 6 acupoint. In the control group, the wristbands without pressing buttons were loosely fastened on the desired point. The severity and episodes of nausea and vomiting were measured intraoperatively, 1, 3, and 7 h postoperatively. The data were analyzed via repeated measures analysis, t, and Chi-square tests. Results: Over time, the intervention significantly decreased the mean of nausea episodes (P < 0.001), nausea severity (P < 0.001), and vomiting episodes (P < 0.001) in the intervention group. In the comparison of the two groups, the repeated measures analysis showed that although after the intervention the values of all the three variables was lower in the intervention group than that of the control group, but these difference were only statistically significant in the episodes and the severity of nausea. Conclusion: The acupressure significantly reduced the severity and episode(s) of postoperative nausea, but it did not affect vomiting.
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The impacts of nursing staff education on perceived abuse among hospitalized elderly people: A field trial p. 149
Mansour Dianati, Ismail Azizi-Fini, Zeinab Oghalaee, Hamidreza Gilasi, Fatemeh Savari
DOI:10.4103/nms.nms_40_18  
Background: Growing elderly population has increased the number of hospitalized older adults and heightened concerns over elder abuse during hospitalization. Objectives: This study sought to examine the impacts of a nursing staff education program on hospitalized older adults' perceived abuse. Methods: This field trial was conducted in 2017 in the Internal Medicine Wards of a University Hospital in Kashan, Iran. Initially, 431 older adults with discharge order were conveniently recruited during 2 months to complete the study questionnaires. Then, all 88 nurses in the study setting were provided with educations about elder abuse. After that, another 310 older adults were consecutively recruited to complete the study questionnaires. Data were collected using an elder abuse questionnaire. Higher mean scores showed lower levels of elder abuse. The Mann–Whitney U, the Chi-square, and the Fisher's exact tests were conducted for data analysis. Results: Before the intervention, the mean scores of the physical, psychological, and neglect subscales of elder abuse were 4.34 ± 0.71, 3.84 ± 0.60, and 3.31 ± 0.72, respectively. After the intervention, these scores significantly increased to 4.56 ± 0.66, 4.67 ± 0.53, and 4.19 ± 0.67, respectively (P = 0.001). The total score before the intervention was 3.79 ± 0.54 that significantly increased to 4.45 ± 0.56 after the intervention too (P = 0.001). Conclusion: Nursing staff education is effective in significantly reducing perceived abuse among hospitalized older adults. Therefore, developing and implementing regular abuse-related education programs for nurses are recommended.
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Iranian nurses' perceptions of the conditions of the families with terminally ill patients: Family in limbo p. 155
Reza Norouzadeh, Monireh Anoosheh, Fazlollah Ahmadi
DOI:10.4103/nms.nms_73_18  
Background: Understanding the conditions of terminally-ill patients' family members is the first step in reducing their emotional distress. Objectives: The aim of this study was to explore nurses' perceptions of the conditions of terminally ill patients' families. Methods: This qualitative content analysis study was conducted in 2016–2017. Participants were 24 nurses purposively recruited from 14 hospitals in Tehran, Iran. Data were collected through semi-structured interviews and analyzed through conventional content analysis. Results: Participants' perceptions were categorized into two main categories, namely, behavioral and emotional turmoil and perceived worries. The two subcategories of the first category were family turmoil after receiving bad news and family members' violent behaviors after receiving bad news. The second category included four subcategories, namely, feeling guilty, worries about patient's fate, worries about the aggravation of patient's conditions, and financial worries. The main theme of the study was family in limbo. Conclusion: Terminally ill patients' family members are in limbo due to behavioral and emotional turmoil and different worries. Nurses can use the findings of this study to help terminally ill patients' family members undergo a healthy grief.
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Association between general sense of mastery and income in White- and African-American adults p. 162
Shervin Assari
DOI:10.4103/nms.nms_47_18  
Background: Some research has shown that general sense of mastery (i.e., sense of control over the forces that impact one's life) does not have universal causes and consequences in racial groups. For instance, sense of mastery better predicts depression and mortality for non-Hispanic Whites (NHWs) than that of African-Americans (AAs). Objectives: The objective of this study was to test the heterogeneity in the association between the sense of mastery and income by race in a nationally representative sample of NHW and AA adults. Methods: This study included a total of 3570 AA and 891 NHW adults who were enrolled to the National Survey of American Life. Variables included race/ethnicity, age, gender, socioeconomic status (SES and household income), and sense of mastery. Linear regression models were applied in the overall sample and also by race. Results: Overall, high sense of mastery was associated with high household income. In race-specific models, higher levels of sense of mastery were associated with high household income in AAs but not NHWs. Conclusions: Racial differences exist in how sense of mastery and income are correlated. It is not clear whether high income generates more sense of mastery for AAs or high sense of mastery is more essential for generating high income for AAs. Policy makers and clinicians should be aware that SES and sense of mastery are differently linked in AAs and NHWs.
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