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   Table of Contents - Current issue
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April-June 2021
Volume 10 | Issue 2
Page Nos. 65-135

Online since Tuesday, April 20, 2021

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REVIEW ARTICLE  

Job burnout among nurses in Iran: a systematic review and meta-analysis Highly accessed article p. 65
Roohollah Askari, Hossein Fallahzadeh Abarghouei, Majid Heidarijamebozorgi, Zahara Keyvanlo, Mohammad Kargar
DOI:10.4103/nms.nms_48_20  
Background: Job burnout is a major problem among nurses. The three dimensions of job burnout include emotional exhaustion (EE), depersonalization (DP), and low personal accomplishment (PA). Objectives: The aim of this study was to determine the mean of job burnout among nurses in hospitals affiliated to Medical Sciences Universities in Iran. Methods: This was a systematic review and meta-analysis. An online search was performed in the PubMed, Web of Sciences, Scopus, Google Scholar, Scientific Information Database, Medlib, Iranmedex, Magiran, Civilica, Noormags, and Irandoc databases. The search keywords were “burnout,” “job burnout,” “occupational burnout,” “nurses,” “nursing staff,” and “Iran.” Critical appraisal of eligible studies was performed using the Critical Appraisal Skills Program checklist. The first author's name, publication year, sample size, and the mean scores and standard error values of the different dimensions of job burnout were extracted from each included study. The random-effects and the fixed-effect models were used for the meta-analysis. The Cochran's Q test, the I2 index, and the Egger's regression analysis were used. Results: Nineteen studies with a total sample of 3926 nurses were included in the meta-analysis. The overall means of the EE, DP, and low PA dimensions of job burnout were 21.19 (95% confidence interval [CI]: 19.28–23.11), 7.85 (95% CI: 6.26–9.43), and 28.89 (95% CI: 27.10–30.67), respectively. The I2 index values of these dimensions were, respectively, 96.6%, 99.4%, and 97.8%, indicating high heterogeneity among the studies. The Egger's regression analysis showed that there was no evidence of publication bias in the studies (P = 0.08). Conclusion: Job burnout among nurses in Iran is moderate in the EE and the DP dimensions and high in the low PA dimension. Strategies are needed to improve nurses' work conditions, fulfill their needs, and thereby, reduce their job burnout.
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ORIGINAL ARTICLES Top

Comparing the effects of hot compress and hot ginger compress on pain associated with breast engorgement p. 73
Maryam Monazzami, Sedigheh Yousefzadeh, Hasan Rakhshandeh, Habibollah Esmaily
DOI:10.4103/nms.nms_24_20  
Background: Breast engorgement (BE) is a physiologic condition in the postpartum period characterized by painful swelling of the breasts. BE-associated pain is the second main cause of exclusive breastfeeding failure in the early weeks of childbirth. Objectives: This study aimed to compare the effects of hot compress and hot ginger compress on BE-associated pain. Methods: This randomized clinical trial was conducted in 2018 on 76 breastfeeding women with BE conveniently recruited from Imam Reza hospital, Mashhad, Iran. Participants were randomly allocated to a control group to receive hot compress (n = 38) and an intervention group to receive hot ginger compress (n = 38). Study intervention was implemented in both groups thrice daily for 2 consecutive days. A Visual Analog scale was used for the assessment of BE-associated pain before and after the study intervention. Data were analyzed using the Mann–Whitney U, the independent-samples t, the Wilcoxon, and the Chi-square tests as well as the analysis of covariance. Results: The mean score of BE-associated pain in the right and the left breasts significantly reduced by, respectively, 6.25 ± 1.76 and 6.06 ± 1.76 points in the intervention group (P < 0.05) and by 3.21 ± 1.02 and 3.48 ± 1.21 points in the control group (P > 0.05). The decreases in the mean scores of the right and the left BE-associated pain in the intervention group were significantly greater than the control group (P < 0.05). Conclusion: Hot ginger compress is more effective than hot compress in reducing BE-associated pain among breastfeeding women.
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The effect of curcumin ointment on the quality of life of older adults with knee osteoarthritis: A randomized placebo clinical trial p. 79
Neda Jamali, Mohsen Adib-Hajbaghery, Alireza Soleimani
DOI:10.4103/nms.nms_62_20  
Background: Knee osteoarthritis (KO) is one of the most common health problems affecting the quality of life (QOL) in older adults. Objective: Because improving the QOL is one of the important therapeutic goals, this study aimed to investigate the effect of curcumin ointment on the QOL in older adults with KO. Methods: This double-blind randomized clinical trial was performed from February 20, to June 22, 2019, on 72 older adults with KO referring to the office of a physician in Kashan, Iran. The individuals with eligibility criteria were recruited sequentially and were randomly assigned to two groups of 36 to apply either curcumin 5% ointment or Vaseline ointment twice daily for 6 weeks around the knee. The Osteoarthritis Knee and Hip Quality of Life questionnaire was used to measure the patients' QOL at the beginning of the study, and at the end of the 4th and 6th weeks. The Fisher's exact test, independent samples t-test, Friedman test, and repeated-measures analysis were used for data analysis. Results: The mean baseline QOL scores in the intervention and the placebo groups were 55.98 ± 8.12 and 58.75 ± 7.86 (P = 0.160) which then changed to 59.21 ± 7.98 and 60.01 ± 8.23 at the end of the 4th week and to 65.83 ± 8.81 and 60.26 ± 7.25 at the end of the 6th week, respectively. Repeated-measures analysis showed that over time, the use of curcumin ointment could significantly increase the mean QOL score in the intervention group (P = 0.001). Conclusion: Topical administration of 5% curcumin ointment can significantly improve the QOL in older adults with KO. Therefore, this ointment might be considered a complementary therapy to improve the QOL of patients with KO.
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The effects of a care plan based on the roy adaptation model on depression among nursing home residents p. 86
Nishteman Alidoost, Omid Naseri, Aylin Jahanban, Masumeh Hemmati Maslakpak, Banafshe Maghsoudi, Esmaiel Maghsoodi
DOI:10.4103/nms.nms_51_19  
Background: Depression is one of the most common mental disorders among nursing home residents. Nursing models are among the therapies with potential effects on depression. Objectives: This study aimed to determine the effects of a care plan based on the Roy's Adaptation Model (RAM) on depression among nursing home residents. Methods: This quasi-experimental study was conducted on sixty older adults selected from four nursing homes in Urmia, Iran. Participants were randomly allocated to a control and an intervention group. A care plan based on the RAM was designed and implemented for participants in the intervention group. The plan included individualized and group educations based on participants' maladaptive behaviors in the four modes of the RAM. During the intervention, participants' maladaptive behaviors and their stimuli were determined and measures were taken for their management. The intervention lasted for 1.5 months, followed by a 1-month supervision. Before and after the intervention, depression was assessed using the Geriatric Depression Scale. Data were analyzed through the independent- and the paired-sample t and the Chi-square tests. Results: The pretest and the posttest mean scores of depression were 5.78 ± 3.51 and 6.11 ± 3.64 in the control group and 6.81 ± 3.64 and 2.86 ± 2.50 in the intervention group. The between-group difference respecting the pretest mean scores of depression was not statistically significant (P = 0.21), whereas the posttest mean score of depression in the intervention group was significantly less than the control group (P < 0.001). Although the mean score of depression in the control group did not significantly change (P = 0.32), it significantly decreased in the intervention group (P < 0.001). Conclusion: The care plan developed in this study based on the RAM is effective in significantly reducing depression among nursing home residents. Therefore, it can be used for depression management in nursing homes.
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Comparing the effects of education through compact disk and social media on knowledge and practice regarding the assessment of preterm infant behavior among nurses in neonatal intensive care units p. 92
Leila Valizadeh, Mohammad Asghari Jaffar Abadi, Parvaneh Agha Jari, Parstoo Jalili
DOI:10.4103/nms.nms_10_20  
Background: Nurses in neonatal intensive care units (NICUs) need adequate professional knowledge and skills for providing quality developmental care to premature newborns. Objectives: This study aimed to compare the effects of education through compact disk (CD) and social media (SM) on knowledge and practice regarding the assessment of preterm infant behavior (APIB) among nurses in NICUs. Methods: This quasi-experimental study was conducted on fifty NICU nurses. They were randomly allocated to a CD and a SM group. The intervention for both the groups was the same and consisted of education about APIB. Participants' APIB-related knowledge and practice were assessed before and after the intervention using a researcher-made knowledge questionnaire and the APIB checklist, respectively. Data were analyzed through the Chi-square, the independent-samples t, and the paired-samples t-tests as well as the analysis of covariance. Results: The pretest mean scores of knowledge and practice were, respectively, 9.72 ± 4.95 and 207.64 ± 109.49 in the SM group and 9.16 ± 5.94 and 209.88 ± 110.46 in the CD group. After the study intervention, these values significantly increased to 14.80 ± 1.80 and 361.96 ± 38.24 in the SM group (P < 0.05) and 12.46 ± 2.10 and 295.44 ± 53.30 in the CD group (P < 0.05). Although there were no significant differences between the groups regarding the pretest mean scores of knowledge and practice (P > 0.05), the posttest mean scores of knowledge and practice in the SM group were significantly greater than the CD group (P < 0.05). Conclusion: SM-based education is more effective than CD-based education in improving APIB-related knowledge and practice among NICU nurses.
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The effects of Orem's self-care theory on self-care behaviors among older women with hypertension: A randomized controlled trial p. 99
Shahrbanoo Nasresabetghadam, Mehri Jahanshahi, Zahra Fotokian, Mahboobeh Nasiri, Mahmoud Hajiahmadi
DOI:10.4103/nms.nms_9_20  
Background: Lifestyle modification and self-care have potential effects on hypertension management among older women. Objectives: The aim of this study was to assess the effects of using Orem's Self-Care Deficit (OSCD) theory on self-care behaviors among older women with hypertension. Methods: This clinical trial was conducted in 2018–2019. A 70-year-old woman with hypertension were conveniently recruited from healthcare centers in Ramsar, Iran, and randomly allocated to a control and an intervention group. Participants in the intervention group received self-care education based on the OSCD theory. The control group received no intervention. Data were collected using a personal characteristics questionnaire, a researcher-made self-care need assessment checklist, and the Hypertension Self-Care Activity Level Effects questionnaire. The Wilcoxon and the Mann–Whitney U-tests were used to analyze the data. Results: There were no significant differences between the groups respecting the pretest mean scores of medication adherence, weight control, physical activity, and nutrition-related self-care behaviors (P > 0.05). However, after the intervention, the between-group difference respecting the mean scores of these behaviors were statistically significant (P < 0.001). Conclusion: The OSCD theory is effective in promoting self-care behaviors among women with hypertension. Therefore, its use is recommended to improve hypertension management and quality of life and reduce treatment-related costs in these patients.
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Coronavirus: Nursing students' knowledge and risk perception of clinical practice during the pandemic p. 107
Ogechi Helen Abazie, Margaret Ihunanya Okwuikpo, Aderonke Julienne Adetunji, Chigozie Ihuoma Nweke
DOI:10.4103/nms.nms_76_20  
Background: The attendance of nursing students in clinical settings is an inherent element of the nursing education, and it is the same even with the coronavirus disease 2019 (COVID-19) pandemic. Globally, more than 260 nurses have been killed by the COVID-19 disease and the number is still increasing. Objective: The study assessed nursing students' perception of clinical practice amidst coronavirus pandemic in southwest Nigeria. Methods: This is a cross-sectional study that utilized a multistage sampling method to select 300 respondents from the selected nursing institution in southwest Nigeria. The questionnaire is made up of three sections namely, sociodemographic variables, knowledge of COVID-19, and students' perception of clinical practice. Data were collected with Google Form and analyzed using descriptive and inferential statistics. Result: The mean age of the respondents was 22.16 ± 3.11 years and the mean year exposed to clinical practice was 2.73 ± 0.91 years. Majority (71%) had good knowledge of coronavirus, with mean ± standard deviation (SD) 16.16 ± 1.84, while 57.7% had a positive perception of clinical practice during coronavirus pandemic, with a mean ± SD of 3.62 ± 1.22. There was no significant difference between knowledge and perception of clinical practice post coronavirus pandemic, P = 0.088. There is a significant relationship between nursing students' perception of clinical practice with coronavirus and nursing institution (P = 0.001) and level of study (P = 0.001). Conclusion: The study showed that nursing students were willing to continue with their clinical practice even with coronavirus patients in the wards.
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The outcomes of humanistic nursing for critical care nurses: A qualitative study p. 114
Zeynab Zamaniniya, Mojgan Khademi, Tahereh Toulabi, Kourosh Zarea
DOI:10.4103/nms.nms_32_19  
Background: Despite the importance and the necessity of humanistic approaches to care, there are limited studies into their outcomes for nurses. Objectives: The aim of this study was to explore the outcomes of humanistic nursing for critical care nurses (CCNs). Methods: This qualitative study was conducted through conventional content analysis. Data were collected through semi-structured interviews with 16 CCNs purposively selected from hospitals in Ahvaz, Iran. Trustworthiness of the data was ensured using Lincoln and Guba's criteria. Results: The outcomes of humanistic nursing were grouped into three main categories, namely personal growth and self-actualization, protection of personal dignity, and greater satisfaction and comfort. Each of these categories had three subcategories which were development of abilities, self-concept and self-worth, spiritual transcendence; greater popularity, improved social status of nursing, appreciation, respect, and support for nurses; and happiness, satisfaction, and motivation, respectively. Conclusion: Humanistic approaches to care help fulfill the needs of both patients and nurses. The findings of this study provide a deeper understanding about how to reinforce humanistic behaviors and can be used in nursing education and practice.
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Barriers to end-of-life care delivery to home-dwelling terminally-ill older patients: A qualitative content analysis p. 121
Manijeh Dehi, Kian Norouzi, Farahnaz Mohammadi, Reza Negarandeh
DOI:10.4103/nms.nms_108_19  
Background: In the last days of life, home-dwelling terminally-ill older patients have complex care needs. End-of-life (EOL) care for these patients is usually delivered at home. However, there is limited information about the barriers to EOL care delivery to home-dwelling terminally-ill older patients. Objectives: This study is aimed to explore the barriers to EOL care delivery to home-dwelling terminally-ill older patients. Methods: This qualitative study was conducted in 2017–2018. Ten family caregivers and ten health-care providers were purposively selected. The main inclusion criterion was the experience of EOL care delivery to home-dwelling terminally-ill older patients. Data were collected through semi-structured interviews and were analyzed through conventional content analysis. In total, 23 interviews were held with twenty participants. Results: The barriers to EOL care delivery to home-dwelling terminally-ill older patients were categorized into the following three main categories and ten subcategories: inappropriate community-based healthcare context (subcategories: lack of public home care services, lack of palliative/hospice care services, legal/ethical dilemmas, and wrong cultural beliefs leading to wrong EOL care), unsupportive healthcare providers (subcategories: limited preparation for EOL care delivery, negligence towards appropriate home care delivery, and indifference to patients' and their families' rights), and inappropriate family conditions (subcategories: families' lack of care-related knowledge and skills, families' poor financial status, and tension in families). Conclusion: There are different familial, financial, professional, organizational, and social barriers to EOL care delivery to home-dwelling terminally-ill older patients. Culturally-appropriate policies and strategies are needed for operationalizing EOL care, integrating it into the public health-care system, and preparing healthcare providers and family caregivers for its delivery.
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Association between quality of work life and stress among nurses in a tertiary care hospital in Saudi Arabia p. 130
Ahmed Khalid Ali, Sami Abdo Radman Al-Dubai, Mohammed Adeeb Shahin, Amira Ibrahim Mohamed Al-Othmali, Duoaa Seddiq Abdoh, Zeidan Abdu Zeidan
DOI:10.4103/nms.nms_73_20  
Background: Quality of work life (QWL) influences the performance and commitment of employees in health-care organizations. Objectives: This study aimed at assessing the QWL and its associated factors among nurses in a tertiary care hospital in Al-Madinah, Saudi Arabia. Methods: This cross-sectional study was conducted among 212 nurses at Madinah Cardiac Center in Al-Madinah in Saudi Arabia using the Brooks and Anderson's quality of nursing work life survey and the stress subscale of the Depression, Anxiety and Stress Scale. The t-test, analysis of variance, Pearson correlation coefficient, and multiple linear regression were conducted to analyze the data. Results: Most participants (65.1%) had high QWL and one-third (33%) had severe stress. Factors that independently predicted QWL were monthly income (P = 0.007), number of working hours per week (P = 0.041), and stress level (P = 0.001). Conclusion: Most participants had high QWL. Minimizing stress and improving the work environment are necessary to improve the QWL of nurses.
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