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Background: Common clinical problems after surgery include nausea, vomiting and ileus that many patients complain of after their surgery. These complications can delay the patient's discharge from hospital. Nowadays, to reduce drug side effects, the use of complementary medicine, including reflexology, has received a great deal of attention. Aim: To compare the effect of hand and foot reflexology massages on the severity of nausea, vomiting and ileus in patients after abdominal surgery. Methods: This is a clinical trial study that was conducted between 2013 and 2015 in the emergency surgical departments of Imam Reza (AS) and Ghaem (AS) hospitals in Mashhad. The samples of this study included 90 women with cholecystitis and appendicitis who met the inclusion criteria. In this study, patients were randomly divided into 3 groups of hand reflexology massage, foot reflexology massage and control. To check the digestive status, gastrointestinal sounds were checked every hour using a clinical stethoscope. Also, information on gas and feces elimination was collected and recorded every hour. The intervention was performed 1 and 12 hours after the surgery. In both groups of hands and foot reflexology massages, after general massage of the hands and feet, the areas related to the abdominal distension and removal of the ileus were pressed. It should be noted that, the duration of massage for each person was 10 minutes (20 minutes in total). Data were analyzed by SPSS software version 16 using Chi-square, Fisher’s exact test, two-way ANOVA, Kruskal-Wallis test and repeated measures ANOVA. Results: There was no statistically significant difference in the mean score of severity of nausea before the intervention between the three groups (p = 0.90), but after the intervention a significant difference was observed in the mean score of severity of nausea between the three groups (p=0.002). Also, the result of ANOVA test with repeated measure showed a statistically significant difference in the mean score of nausea by group and stage (p

Purpose: This study aimed to compare the effect of reflexology massage of the soles on feet and hands on the intensity of pain in patients after cholecystectomy and appendectomy in women. Methods: This study was a clinical trial pre-test-post-test design with three groups of women who underwent cholecystectomy an appendectomy in Mashhad, Iran. Pain intensity was assessed 1, 4, 12, and 24 hours after the intervention. The intervention was performed within the first hour and 12 hours after surgery for 10 min for each hand or foot. The control group only received routine interventions. One way ANOVA with Tukey’s post hoc test was used to analyze the mean difference in the groups. The significance level was set at

Background: Caring for brain dead patient is one of the most troublous duties of an Intensive Care Unit (ICU) nurse. This study aimed to determine nursing challenges based on recent literature and identify the strategies to overcome these challenges. Materials and Methods: In this systematic review, the standard systematic review guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used with articles published in PubMed, Science Direct, Scientific Information Database (SID), and Google Scholar databases during 2000–2018 on the keywords “brain dead OR brain death” and “nurses OR nursing.” After the primary search, 212 articles were found. Eventually, 21 articles were selected for the final evaluation. Results: According to the results, the challenges included the concept and diagnosis of brain death, religious, and cultural beliefs opposing organ donation, lack of knowledge about the care process, interactions with the families. The proposed strategies were providing medical and nursing interventions to maintain a brain dead patient for organ donation, providing working conditions that maintain nurses' health, and increase the quality of care. Conclusions: Nurses play an important role in the care process of brain dead patients; therefore, recognizing their challenges can be the first step in increasing holistic care and maintaining organ vitality for transplantation. It is suggested that nursing authorities commence special educational programs with the aim to increase the knowledge of nurses about the care process of brain dead patients.

Background: Chest tube insertion is recommended after cardiac surgery, and inserted annually for a large number of these patients. In addition to its benefits, the chest tube may have risks that are mismanaged. One of these risks is the possibility of pleural effusion, which can occur in high rates. Therefore, we conducted a systematic review to properly manage the chest tube and reduce its complications. Methods: This systematic review of cohort study asked the question: Is there enough evidence to determine the right time to remove the chest tube? We searched ISI Web of Science, PubMed, Scopus and Embase from 1 January 2015 to 30 September 2019 to identify retrospective or prospective cohort studies. Results: Three studies recommended early chest tube removal and two studies late removal. Of course, early and late removals in the studies had different meanings and time frames that were examined). Conclusion: More evidences and studies are needed to determine the right timing and management of the chest tube removal but our systematic review based on the available evidences revealed that if the chest tube removal occurs about 24 hours postoperatively, and with less than 100 ml drainage within the last 8 hours, it will reduce the risk of pleural effusion and improve many other outcomes.

Background: Stroke is the most common debilitating neurological disease in adults. Therefore, rehabilitation is a major consideration to reduce costs and relief disabilities. Biofeedback, a newly recommended method is claimed to be able to improve the consequences following stroke by enhancement the understanding of the psychological functions of the body. Objectives: The purpose of this study was to investigate the effect of biofeedback on the motor– muscular situation in rehabilitation of stroke patients Methods: The present study was a randomized clinical trial that was started in May 2016 and completed in September 2016. The sample of this study included all the patients with stroke attending the physiotherapy center of Imam Raza hospital in Mashhad, Iran. The participants were randomly divided into 2 groups (case and control group) after considering the inclusion and exclusion criteria. In the intervention group, biofeedback (2 times a week for 15 sessions, each session lasting 20 minutes) was performed.Before the intervention demographic information questionnaire was complete by all participants. Then a check list of main variables such as hands muscle strength, muscle stiffness (spasticity), balance and ability to walk was complete by a physician. In the 7th session of the exercise and in the end of intervention (14th session), again, the main variables of the check list were reassessed by the researcher. The statistical analysis was done by Statistical Package for the Social Sciences (SPSS) software version 16. Results: the mean score of balance evaluation in pre-intervention had not any significant differences (p=0.503), but in post intervention evaluation, this score in intervention group versus control group showed significant differences (p=0.014).the mean score of muscle strength,Results showed that by eliminating the effects of muscular strength before the intervention, this variable in both intervention and control groups after the intervention, had improvement and significant difference (p=0.005).Comparison the average spasticity, showed that spasticity evaluation score before and after intervention had no significant difference between the two groups (p=1.00) Conclusion: Considering the findings of this study, the biofeedback therapy is a promising treatment modality in improvement the motor– muscular condition following stroke.

Aim This study aimed to clarify the role of nurses in planning and implementation of nursing interventions related to smoking cessation. Background and introduction Nearly half of all smokers die from smoking-related illnesses. Quitting smoking can reduce these problems. Smoking cessation interventions include various types helping smokers successfully quit. Studies suggest that hospitalization can be a golden opportunity for nurses helping patients to quit smoking because of No Smoking regulations. Method A systematic review of the literature was carried through Web of Knowledge, ProQuest, Medscape, MedlinePlus, Ovid SID, Magiran, PubMed, and Science Direct databases between 1990–2015 on the subject of interest by keywords: role of nursing in smoking cessation, nursing intervention in smoking cessation, smoking cessation, smoking quitting and interventions planned by nurse. Result Nineteen papers were systematic examined, dealing with smoking cessation interventions by nurses. Totally, 17 studies used counselling for quitting smoking. Most studies involved other methods such as manuals, pamphlets, brochures training or printed educational materials, audio and video file. Some studies used nicotine replacement methods for patients such as nicotine skin tags, chewing nicotine or bupropion. Moreover, 17 studies were conducted by telephone at patients' follow-up after hospital discharge. Conclusion Nurses' interventions for smoking cessation play an important role in helping patients quit smoking successfully. There are a variety of interventions that nurses can employ according to the patient's condition and diagnosis of different diseases. Implication for nursing and health policy Quitting smoking can reduce lung cancers and other health problems. Nurses play an important role in helping patients to quit smoking.

Background Inflammatory bowel diseases (IBD) are among the most common disorders that cause poor quality of life and impose a lot of social and economic burden on patients and their family. Therefore, identifying the main concerns of these patients in the management of the disease is very important for designing a specific care plan. The aim of this study was to explaining the concerns of patients with IBD in the process of disease management. Methods This research was carried out using thematic analysis method. Sixteen patients with at least one year of IBD were interviewed individually by semi-structural questions. Their main concerns in the management of the disease were analysed. Results The main concerns of patients with IBD were categorised into four main groups as follows: mental (negative attitude toward disease, encounter with disease, tolerance of tough condition, maladaptation, acceptance and denial of disease), behavioural (avoidance of situations, out-of-home planning, physical activity, diet, seeking information, seeking the best treatment), socioeconomic (weak support, high cost of treatment, confidentiality of the disease), and biomedical (supplying medicine and experiencing surgery). These concerns have a substantial impact on patients’ ability regarding the reconciliation of their living with disease. Conclusion By identifying the concerns of patients with IBD in their disease management process, nurses can develop care programmes and interventions to meet the essential needs of these patients.

Inflammatory bowel disease (IBD), including Crohn's and ulcerative colitis diseases, is characterized by clinical periods of remission and relapse. Excessive care stress can have long-term negative physical and psychological consequences not only for caregivers but also for the recipients of care. This integrative review aims to identify, describe, and synthesize the results of current available research focused on the burdens of IBDs on family caregiver. An integrative review was performed using Whittemore and Knafl methodology. A systematic search of electronic databases including Web of Science, PubMed, Embase, and Scopus from January 2000 to October 2019 was conducted. Articles were included if published in English and focus on IBD burden on family caregivers. Of 730 records, 16 articles with quantitative, qualitative, and Q methodology study designs were eventually included in the review. The synthesis of these articles led to the identification of four key types of effects: biopsychosocial, daily life activities, physical health, and financial. The chronic and relapsing nature of IBD exposes family caregivers to considerable risk. Thus, the care burden of IBD patients' caregivers needs to be evaluated continuously and relieved through family-centered interventions.

BACKGROUND: Standardization of documentation has enabled the use of medical records as a primary tool for evaluating health care functions and obtaining appropriate credit points for medical centres. However, previous studies have shown that the quality of medical records in emergency departments is unsatisfactory.AIM: The aim of this study was improving the nursing care documentation in an emergency department, in Iran.MATERIAL AND METHODS: This collaborative action research study was carried out in two phases to improve nursing care documentation in cooperation with individuals involved in the process, from February 2015 to December 2017 in an affiliated academic hospital in Iran. The first phase featured virtual training, an educational workshop, and improvements to the hospital information system. The second phase involved the recruitment of human resources, the implementation of continuous codified training, the establishment of an appropriate reward and penalty system, and the review of patient education forms.RESULTS: The interventions improved nursing documentation quality score of 73.20%, which was the highest accreditation ranking provided by Iran’s Ministry of Health and Medical Education in 2017. In other words, this study caused a 32% improvement in the quality of nursing care documentation in the hospital.CONCLUSION: The appropriate practices for improving nursing care documentation are employee participation, managerial accountability, nurses’ adherence to documentation standards, improved leadership style, and continuous monitoring and control.

Background:Researches has shown that the quality of nursing documentation services in the world, including Iran, is far from existing standards. Understanding the barriers to improving the documentation of nursing services is essential for the first step. The aim of this study was to identify barriers to improving the nursing documentation services using the experience of nurses in the emergency department of one of the Iranian hospitals.Materials and Methods:This study is based on content analysis in accordance with the style of Graneheim in 2017 in the emergency department of one of the Iranian hospitals. This qualitative study was performed on 20 participant from different nursing grades including 17 nurses, 1 head nurse, and 2 members of the accreditation committee. The data were collected through semi-structured interviews and using interview guide and field note.Results:Research data have been explained in four main themes of qualification of documentation including sub-categories of the need for effective training, the need for training in the standards of documentation, and the necessity of skills in reporting; job burnout including sub-categories of job stress and work pressure; perceived control including sub-categories of planned control and effective monitoring and control; intra-organizational coordination including sub-categories of improving health information system and documentation management time, legal barrier for documentation including sub-categories of escaping from the law and legal liabilities.Conclusion:In this study, 599 primary codes were extracted and the main themes documentation competency, job burnout, perceived control, intra-organizational coordination, and legal barrier extracted.

Purpose To describe Iranian mothers' perspectives regarding hemodialysis for their children. Design and Methods This qualitative study was conducted using the hermeneutic phenomenological approach. The sample consisted of 11 mothers, among whom five were interviewed once and six were interviewed twice, for a total of 17 interviews. The data were then analyzed using van Manen's (1997) method. Results Five themes emerged from the data: mothers enclosed by child care, emotional and psychological tension, acceptance and contrivance, the entire family being a victim of a sick child, and self-devotion. Conclusion The results indicated that the mothers of children undergoing hemodialysis experience multiple stresses in the physical, emotional–psychological, social, and economic dimensions. Practical Implications Nurses are the healthcare team members who most frequently interact with mothers of children undergoing hemodialysis. They are therefore positioned favorably to provide the information and emotional support needed by these mothers. Nurses are also among the frontline professionals who can provide services designed to assess the physical, psychological, and economic requirements of these mothers and their families.

Background Patients undergoing mechanical ventilation in intensive care units are in a special position of suffering, and discovering their experiences in the painful situations of the intensive care unit can contribute greatly to improve the quality of nursing care for them. Objective The present study was performed aiming to explain the experience of conscious patients receiving mechanical ventilation in the intensive care units of the causes of suffering. Methods This is a qualitative content analysis study conducted in Iran in 2017. Participants of this study included 15 conscious mechanically ventilated patients in the intensive care unit. Semi-structured interviews and observations were used to collect data. For sampling, first, the purposeful and then theoretical methods (guided by the created categories) were used and the procedure continued until saturation of the data. The text of the handwritten notes of recorded interviews were analyzed using conventional qualitative content analysis. Results Four subclasses of "unpleasant consequences of disease", "bitter elixir of therapy", "an inconvenient environment" and "understanding the threat to family safety and comfort" all under the general category "enclosed in the synergistic rings of suffering" were extracted from the profound descriptions of contributors. Conclusion Mechanically ventilated patients in the intensive care unit are enclosed in the rings of suffering, so that each of these rings imposes a great deal of pain and suffering on the patient and have a synergic and intensifying effect on each other. Therefore, design and application of strategies and nursing care is essential to reduce the severity of the suffering and discomfort of these patients.

Background Changes in neuronal activity by cathodal transcranial direct current stimulation (tDCS) of the sensory cortex can relieve acute pain. Studies have demonstrated high correlation between burn pain and anxiety in burn patients. The aim of this study was to assess the effect of tDCS on pain anxiety in patients with severe burn. Methods In a controlled randomized clinical trial, 60 subjects who were hospitalized during the year 2014 in the Department of Burn and Reconstructive Surgery of Imam Reza Hospital of Mashhad were selected as the sample for this study. The patients were randomly assigned to one of the two groups. A cathodal stimulation group that received real 1.0 mA tDCS over sensory cortex lasted 20 min and the control group received sham tDCS. Pain anxiety was obtained by self-report pain anxiety questionnaire before and after stimulation. It was also completed immediately after burn dressing. The data were analyzed by performing the Chi-square, Fisher's exact, independent samples t , paired samples t , Mann-Whitney and Wilcoxon tests using SPSS 11.5 software. Results Pain anxiety score reduced significantly in the real tDCS compared with sham group (23.4 ± 3.8 versus 29.3 ± 2.0, p ≤ 0.001). After stimulation there was a decrease in pain anxiety score in real tDCS group ( p = 0.010). Conclusion According to our study, cathodal cortical stimulation with tDCS is associated with significant reduction in pain anxiety in burn patients.

This qualitative research study with a content analysis approach aimed to explore families’ experiences of an organ donation request after brain death. Data were collected through 38 unstructured and in-depth interviews with 14 consenting families and 12 who declined to donate organs. A purposeful sampling process began in October 2009 and ended in October 2010. Data analysis reached 10 categories and two major themes were listed as: 1) serenity in eternal freedom; and 2) resentful grief. The central themes were peace and honor versus doubt and regret. The findings indicated that the families faced with an organ donation request of a brain-dead loved one experienced a lasting effect long after the patient's demise regardless of their decision to donate or refusal to donate. In conclusion, this study highlights the importance of family support and follow-up in an efficient healthcare system aimed at developing trust with the families and providing comfort during and after the final decision.