Journal of Hayat

Factors affecting medication non-adherence from the perspectives of patients with hypertension and healthcare providers in Mahan health centers, Kerman: A qualitative study

Hamid Sharifi

Background & Aim: Medication non-adherence remains a significant problem in managing the global epidemic of hypertension. This study aimed to explore the factors affecting medication non-adherence from the perspectives of both patients with hypertension and healthcare providers in Mahan health centers, located in Kerman province.
Methods & Materials: This qualitative study utilized a conventional content analysis method within healthcare centers in Mahan city in 2022. A total of 29 participants were included in the study, selected through purposive sampling. Data were collected through in-depth semi-structured interviews, with all interviews being recorded, transcribed verbatim, and utilized as the primary data for analysis. The trustworthiness of data was evaluated in accordance with the criteria established by Guba and Lincoln criteria.
Results: Three categories of factors contributing to medication non-adherence among patients with hypertension were identified: ""nature of the disease and treatment," "individual and family factors," and "organizational factors." Factors related to the "nature of the disease and treatment" included the asymptomatic and chronic nature of hypertension as well as fatigue stemming from continuous drug use. "Individual and family factors" encompassed fear and internal doubts, a desire for non-pharmacological treatments, and inadequate family support. "Organizational factors" comprised high treatment costs and access to specialized services, insufficient support from treatment and care teams, and inadequate disease monitoring.
Conclusion: Various factors across a spectrum of influences contribute to medication non-adherence in patients with hypertension. It is crucial for healthcare providers to engage in consistent patient education regarding the nature of the condition and the importance of medication adherence to enhance compliance among patients.

Comparative evaluation of pressure massage at Hegu point versus Kunlun–Taixi pressure points on physiological parameters and crying duration induced by intramuscular vitamin K injection in premature infants: A clinical trial study

Hanieh Goodarzi

Background & Aim: Intramuscular injections represent a painful procedure for premature infants. This study aimed to compare the effects of pressure massage at Hegu point versus Kunlun–Taixi pressure points on pulse rate, arterial oxygen saturation, and crying duration following intramuscular injection of vitamin K in premature infants.
Methods & Materials: A randomized, single-blind clinical trial was conducted on 100 premature infants admitted to the neonatal intensive care unit between 2020 and 2021. Participants were selected through convenience sampling and then randomly assigned into four groups of 25 individuals each: Hegu point massage, Kunlun–Taixi points simultaneous massage, placebo and control. Prior to the vitamin K injection, the intervention groups received targeted pressure point massage, the placebo group received nasal tip massages, and the control group received standard care. Pulse rate, arterial oxygen saturation, and crying duration were recorded before, during and after the intramuscular injection using a pulse oximeter and chronometer. Data were analyzed using two-way repeated measures analysis of variance in SPSS software version 24.
Results: Significant differences were observed in average pulse rate (P=0.013) and average arterial oxygen saturation (P=0.028). The group receiving simultaneous massage at Kunlun–Taixi points exhibited the lowest mean pulse rates during (149.24±7.78) and after (144.16±8.64) the injection, as well as the highest mean arterial oxygen saturation percentages during (88.36±9.37) and after (88.04±8.33) the injection.
Conclusion: Simultaneous massage of Kunlun–Taixi pressure points reduced changes in pulse rate and arterial oxygen saturation induced by intramuscular injection in premature infants. It is recommended to use this simple and low-priced method to reduce the physiological responses to injection-related pain in premature newborns.
Clinical trial registry: IRCT20210630051743N1

The relationship between job satisfaction and happiness among nurses working in hospitals affiliated to Tehran University of Medical Sciences

Parvin Mahmoodi

Background & Aim: In the health care system, manpower recognized as a key factor for development, has an important role in community health. Ensuring the quality of service delivery necessitates the maintenance and enhancement of job satisfaction among service providers. One influential aspect of job satisfaction is the individual’s happiness. This study aimed to determine the correlation between job satisfaction and happiness among nurses working in hospitals affiliated to Tehran University of Medical Sciences.
Methods & Materials: This descriptive-correlational study was conducted with a sample of 362 nurses from hospitals affiliated to Tehran University of Medical Sciences. Sampling was performed using a quota sampling method. The data collection tools included a socio-demographic characteristics questionnaire, a Job Satisfaction Questionnaire, and a Happiness Questionnaire. Data were analyzed using Kendall Tau-b correlation and Pearson correlation, with SPSS software version 26.
Results: The mean score for nurses' job satisfaction was 217.40, while the mean score for happiness was 69.27, with both scores indicating an average level. The results of the study revealed a significant positive relationship between job satisfaction and happiness (r=0.614, P<0.05), indicating that happier nurses tend to have higher job satisfaction, whereas lower job satisfaction is associated with decreased happiness.
Conclusion: Nurses’ job satisfaction and happiness are not at optimal levels. However, a positive correlation between the two has been identified. Therefore, healthcare system administrators and officials should focus on creating essential infrastructure and planning initiatives to enhance nurses’ job satisfaction, ultimately fostering greater happiness among nursing staff.

The effectiveness of Mandala therapy in reducing rumination among medical science students

Flora Rahimaghaee

Background & Aim: Rumination is a prevalent issue among medical science students, potentially affecting their academic performance. This study aims to evaluate the effectiveness of Mandala therapy in reducing rumination among medical science students at the Islamic Azad University, Tonekabon branch.
Methods & Materials: This quasi-experimental study employed a pre-test, post-test design with a control group. A total of 40 medical students from the Islamic Azad University, Tonekabon branch, who exhibited signs of rumination participated in the study in 2023. Participants were selected through convenience sampling and randomly assigned to either the experimental group (20 participants) or the control group (20 participants). The intervention consisted of four 60-minute sessions of Mandala therapy. Data were collected using the Nolen-Hoeksema and Morrow's rumination questionnaire. Descriptive statistics and analysis of covariance (ANCOVA) were performed using SPSS version 26 to analyze the data.
Results: Demographic analysis indicated no significant differences between the experimental and control groups concerning gender, age, or semester (P<0.001). The ANCOVA results revealed that the Mandala Therapy intervention significantly reduced the rumination scores of the experimental group compared to the control group (P<0.005).
Conclusion: The results suggest that rumination levels in the experimental group decreased significantly following the intervention compared to the control group. Therefore, Mandala therapy may serve as an effective non-pharmacological approach for mitigating rumination among medical science students.

Effect of the ABCDE bundle on the risk of complications in patients undergoing mechanical ventilation

Mohammad Rajabpour

Background & Aim: With advancements in treatment and an increase in the prevalence of diseases, the number of patients requiring mechanical ventilation in intensive care units (ICUs) continues to rise each year. The ABCDE bundle is a multi-component, evidence-based approach designed to improve patient outcomes in the ICU. This study aimed to determine the effect of the ABCDE bundle on the risk of pressure ulcers, deep vein thrombosis and delirium in patients undergoing mechanical ventilation.
Methods & Materials: This randomized, single-blind clinical trial was conducted between September 2021 and January 2022. The sample included 100 patients undergoing mechanical ventilation in the ICU department of Imam Reza Hospital in Mashhad, who were randomly assigned to either the intervention or control group using block randomization. The intervention group received the ABCDE bundle over a period of 7 days. The control group received routine care. The criteria for assessing complications included the risk of pressure ulcers and deep vein thrombosis (DVT), evaluated at the end of the intervention and on days 0, 1, 3, 5, and 7. The study utilized several assessment tools: the COMHON Index for pressure ulcers, the Wells Deep Vein Thrombosis Scale, and the Delirium Evaluation Tool in the Intensive Care Unit (CAM-ICU). Data analysis was performed using SPSS software version 20, employing chi-square, Mann-Whitney, and independent t-tests.
Results: A decrease in the average pressure ulcer risk score was observed in the intervention group on day seven (P<0.05). In this group, the incidence of delirium fell decreased from 64.4% to 13.3% (P<0.05), indicating a statistically significant reduction. Additionally, the risk score for deep vein thrombosis in the control group significantly increased on day seven compared to the intervention group (P<0.05).
Conclusion: The use of the ABCDE bundle significantly reduces the risk of pressure ulcers, deep vein thrombosis, and delirium in patients undergoing mechanical ventilation and represents an effective strategy that can be implemented by nurses and other trained healthcare professionals.
Clinical trial registry: IRCT20190625044000N1

Effect of ECG drawing assignments on nursing students' learning and perspectives at Qom University of Medical Sciences

Ashraf Khoramirad

Background & Aim: Electrocardiography (ECG) is the most widely utilized diagnostic tool in medicine. However, nursing students often have problems with interpreting ECGs, highlighting the need for revised training methods. This study aimed to assess the effect of ECG drawing assignments on nursing students' learning and their perspectives on this teaching method in the context of a critical care nursing course.
Methods & Materials: This quasi-experimental study involved 52 fifth-semester BSc nursing students enrolled in the fall and spring terms at Qom University of Medical Sciences. For the fall group, traditional lectures and Q&A sessions were conducted during the first half of the semester, followed by an assignment requiring students to draw common ECGs in the second half. In contrast, for the spring group, students drew ECGs during the first half of the semester. Learning outcomes were assessed through a written test, while students’ perspectives on the drawing assignments were evaluated using a questionnaire. Data were analyzed using SPSS software version 22, employing Mann-Whitney and Wilcoxon tests to compare groups.
Results: The mean score from the perspective questionnaire regarding ECG drawing was 14.86±3.34 (maximum score of 18). In most cases, students had positive or relatively positive views towards this teaching method. A significant difference was observed between the course exam scores of students when they engaged in drawing ECGs compared to when they did not (P<0.001).
Conclusion: Drawing ECGs can be helpful in enhancing learning outcomes in the critical care nursing course and may increase students’ motivation to learn.

The effect of elastic stockings and leg elevation on the prevention of hypotension during plasmapheresis

Zahra Khalili

Background & Aim: Hypotension is a common complication associated with plasmapheresis. Elevating the legs and using elastic stockings are nursing interventions aimed at preventing hypotension. The objective of this study was to compare the effects of elastic stockings and leg elevation on the prevention of hypotension during plasmapheresis.
Methods & Materials: This randomized crossover clinical trial was conducted on 35 patients undergoing plasmapheresis at Beheshti Hospital in Hamadan from 2020 to 2021. Patients were selected based on convenience sampling and then allocated to four different methods in four sessions using random permuted block designs: elastic stockings (A), leg elevation (B), a combination of elastic stockings and leg elevation (C), and a control group (D). Blood pressure was monitored before, during (every half hour), and half an hour after the completion of plasmapheresis. Data analysis was performed using SPSS version 24, applying repeated measures ANOVA with a significance level of 0.05.
Results: During plasmapheresis, systolic blood pressure decreased over time in all four methods (P<0.001). Blood pressure measurements in intervention methods A, B, and C were higher than in the control group (P<0.001). Among the intervention methods, blood pressure in method C was higher than in methods A and B, while method B was higher than method A (P<0.001).
Conclusion: The use of elastic stockings in combination with leg elevation is more effective in preventing hypotension. Therefore, it is recommended as an easy and cost-effective method for preventing hypotension in patients undergoing plasmapheresis and for nursing staff to implement.
Clinical trial registry: IRCT20191020045166N1

The relationship between moral distress, resilience, and job burnout among nurses

Tahereh Baloochi Beydokhti

Background & Aim: Nurses, due to the demands of their profession, are frequently exposed to high-stress clinical situations, such as the COVID-19 pandemic, which can lead to moral distress and affect their resilience, ultimately contributing to job burnout. This study aims to investigate the relationship between moral distress, resilience, and burnout among nurses.
Methods & Materials: In this descriptive, cross-sectional study, 188 nurses working in hospitals affiliated with the Birjand University of Medical Sciences during the years 2021-2022 were selected through simple random sampling. The data collection tools included demographic information, the Moral Distress Scale, the Davidson Resilience Scale, and the Maslach Burnout Inventory. Data were analyzed using descriptive and inferential statistics in SPSS software version 21.
Results: The results indicated that the nurses experienced low moral distress (30.28±12.59), high resilience (63.70±13.44), and high levels of burnout (54.98±12.30). A direct and significant relationship was found between moral distress and burnout, while a weak and significant inverse relationship was observed between moral distress and resilience (P<0.001).
Conclusion: Given the significant relationship between moral distress, resilience, and burnout, it is recommended that policymakers develop strategies to enhance resilience, which could lead to a reduction in moral distress and burnout among nurses.