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Background & Aim: Post cesarean ileus is a common complication that induces abdominal distention, delays feeding, and increases hospitalization. Multiple studies showed that false nutrition increases the bowel movement. This study aimed to investigate the effect of gum chewing as false nutrition on the bowel movement and prevention of post cesarean ileus.

Methods & Materials: In this randomized controlled trial, a total of 400 patients who were hospitalized in Mashhad Zeinab hospital were divided into two 200-patient groups. The groups were matched for age, gravity and duration of surgery. In the intervention group, gum chewing was started after surgery, 3 times/day until the regular diet was initiated. In the control group, patients underwent routine care by restricting oral intake until the bowel function was returned. The outcomes were time of the first bowel sound, flatus passage, defecation, ambulation of patients post cesarean, initiation regular diet, and hospitalization. Statistical analysis was performed using unpaired t-test and fisher^&aposs exact probability test.

Results: The mean age, parity and operation time were similar in the two groups. All patients in the intervention group tolerated gum chewing immediately after surgery. The results showed the followings among the intervention group vs. control group, respectively: post operative time intervals to bowel sounds (14.7 hours vs. 16.6 hours P=0.569), time intervals between surgery and abdominal distention (16.59 hours vs. 14.21 hours P=0.01), first post operative defecation (28.16 hours vs. 32.21 hours P=0.000), post operative time interval to onset diet (19.3 hours vs. 16.54 hours P=0.000), post operative time interval to ambulation (20.14 hours vs.17.58 hours P=0.000), post operative lengths of ileus (31.13 hours vs. 30.35 hours P=0.5), hospitalization (1.84 days vs. 1.92 days P=0.02).

Conclusion: Gum chewing after cesarean section is safe and well tolerated and reduces post operative ileus, shortens mean duration of first defecation, decreases the time of returning to regular oral diet, shortens the time of patient ambulation and hospital discharge. Gum chewing is offered as a physiologic and inexpensive method to prevent or reduce post cesarean ileus.

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Background & Aim: Nurses are informed from patients needs using effective mutual communications. This study aimed to explore the communication strategies between nurses and patient.

Methods & Materials: This study had a qualitative approach with the content analysis method. Participants included 23 nurses, patients and their families in medical and surgical wards of Imam Khomeini hospital of Tehran University of Medical Sciences. Data were collected using interviews and observations. The first and second interviews were conducted unstructured. The semi-structured interviews were then conducted according to the derived concepts from the first and second interviews. We used observation in order to gain a deeper understanding and verifying data from interviews. The observations focused on the interactions between nurses and patients during mutual communications.

Results: A final theme was emerged through the data analysis: adaptation of nurses&apos attitudes and performances. This theme derived from three main categories: caring according to acute needs of patients, creating a professional realm, and participation. The caring according to acute needs of patients included subcategories such as identifying patients&apos acute needs and nurses&apos communication behavior. Creating the professional realm implicated on the clarifying roles and maintaining of privacy communication. Participation was defined as the audience and content.

Conclusion: The findings showed that nurses, in response to the underlying conditions of nursing care, assimilate their attitudes and performances to be able to meet their professional needs and their patients&apos needs. In fact, the main character of nurse-patient communication is nurses&apos active role and patients&apos passive role.

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Background & Aim: One of the important issues that affects the quality of hemodialysis is recirculation. Some researchers have suggested that the direction and distance of needle cannulation can affect the amount of recirculation. Therefore, this study aimed to investigate the effect of direction and distance of needle cannulation on recirculating of arteriovenous fistula in hemodialysis patients.
Methods & Materials: This clinical trial was performed on patients referred to the dialysis ward of Kamkar-Arabnia hospital affiliated to Qom University of Medical Sciences in 2016. The amount of recirculation was measured in 22 patients by urea based method, in four consecutive sessions. In each session, the distance and direction of the needles were three centimeters in opposite direction, three centimeters in same direction, six centimeters in opposite direction, and six centimeters in same direction. Data were analyzed using Stata and GEE test.
Results: The average age of participants was 53(16±0.75) years. In 41 dialysis cases (out of 88), the amount of recirculation was higher than 10%. The odds ratio for more than 10% recirculation for a distance of three centimeters compared to six centimeters was 2.05 (1.07-3.93) and for same direction compared to opposite direction was 1.98 (1.03-3.78).
Conclusion: The results of this study showed that the insertion of needles at a distance of six centimeters in opposite position had the lowest chance of recirculation. Therefore, the attention to proper insertion of needles can be effective in reducing recirculation and increasing the quality of dialysis.
Clinical trial registry: IRCT2016082929581N1
 

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Background & Aim: Empowerment is a dynamic, positive, interactive and social process, leading to the improvement of quality of life (QOL) in patients with chronic disease. The purpose of this systematic review and meta-analysis was to determine the effect of family-centered empowerment model (FCEM) on QOL in adults with chronic diseases.
Methods & Materials: By searching FCEM in Persian databases including SID, MagIran, IranMedex, IranDoc, and googlescholar, Scopus, Pubmed, Web-of-science, Proquest, and Sciencedirect, all relevant studies were extracted. The methodological quality of the papers was examined using Cochrane-risk-of-bias. Data analysis was carried out through the random effects model and heterogeneity by I² index. The data were analyzed using the STATA software version 11.0.
Results: Of the 647 initial studies, only 8 studies examined the effect of FCEM on the QOL in adult patients using SF-36. The pooled standardized mean difference of the 8-dimensions of QOL included: social-functioning (1.781), Physical role limitation (1.416), bodily pain (0.987), general health (1.352), social functioning (1.010), general health (1.122), emotional role limitation (0.656), and vitality (1.361).
Conclusion: The implementation of FCEM had a significant effect on the 8-dimensions of QOL based on the SF-36 questionnaire. The implementation of FCEM is recommended in order to improve the QOL of adult patients with chronic disease.
 

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Economic evaluation is an invaluable and important tool in healthcare decision- and policy-making. The volume-based paradigm has been a prominent tool to evaluate healthcare economy for consecutive decades. In this approach, the main focus is on volume of treated patients alongside to reduce healthcare costs. Despite this view and during recent years, there was a dramatic rising in healthcare costs without attaining excellence in quality and health outcomes. This status is escalating to the point at which governmental budgets, service providers, and patients are unwilling or unable to afford its related costs (1). There is a similar situation in high-income countries that spend several times more money on health than middle-income and low-income countries (2).
The experts believed that one of the most important and underlying causes of this situation is ineffective healthcare service models that resulted in fragmentation, lack of coordination, reduced quality of care, and finally increased health costs (3). It is assumed that the health service delivery models can seriously affect health costs. Accordingly, health economics does not only refer to health costs but also it includes quality improvement, access to, and equity of health services (4).
For the first time in 2006, “value-based care” was developed to evaluate healthcare economy (5). This paradigm which is also considered a kind of healthcare delivery model, is based on patient outcomes payment as an alternative for the fee-for-service model of payment. Based on this approach, healthcare providers such as physicians and nurses will be rewarded when their services improve the health of patients, reduce the complications, and help to make a healthier life for patients (6); while the population transition to old age and an increase in noncommunicable diseases which require behavioural approches for modifying risk factors in addition to acute care only, are also fueling the mandate for change. Therefore, 30% of healthcare payments in the US by the end of 2016 and 50% of payments by the end of 2018 were tied to the value-based care approach. Based on that, new institutions such as Accountability Care Organizations (ACOs), Advanced Primary Care and Integrated Care models were launched (7). The focus of these institutions is on effective care pathways which, along with the reduction in health care costs, lead to prevention and primary care (7). The principals of new payment model are greater teamwork and integration, more effective coordination of health providers across settings, greater attention to population-based healthcare, and providing information system to improve care for patients (7).
A report in 2011 entitled “The future of nursing: leading change, advancing health” asserted that despite the financial concerns, nursing service can on the one hand address the increasing demand for safer and high-quality healthcare and on the other hand, create equitable and affordable access to health services for societies (8).
The report believed that nursing practice covers a broad continium from health promotion, to disease prevention, to coordination of care, to cure-when possible-and to palliative care-when cure is not possible. Therefore, nurses have a direct and indirect effect on patient care. They can provide assessments and care in hospitals, nursing homes, clinics, schools, ambulatory settings, and workplaces and accordingly they can contribute to the provision of accessible, equitable, and high quality care in healthcare system.
From value-based model perspective, quality, access, and value are key indicators that are specific and sensitive to health service effects on health economics (1). Evidence reveals that nursing services can suprisingly affect these three indicators. However, there are few studies showing that the development of nursing services results in lower costs, along with increased service quality. Of course the evidence in favor of such a conclusion is growing. The current evidence on these indicators are as follows:
Nursing and health service quality
Although causation is difficult to prove, an emerging body of literature has revealed that the quality of care depends, in a large degree, on nurses.  The association between nursing care and quality of hospital care such as patient outcomes, including lenghts of stay, mortality, pressure ulcer, deep vein thrombosis, and hospital-acquired infections has been published in several studies (9-11). Studies have shown the role of nurses in improving the quality and efficacy of hospital (12,13). However, the extent to which nursing care has an impact on health and life or death issues is still ambiguous (8) Also, the patient-centered nursing care has recently been disscussed as a cause of patient satisfaction which is an indicator of the delivered service quality in all over the world (14,15).
Nursing and access to health services
Evidence suggests that access to quality care can greatly be expanded by developing the use of nurses in primary, chronic, and transitional care from hospital to home. For example, If nurses are involved in special roles such as care coordinators or primary healthcare providers, that increase the level of access to services, the hospitalization and rehospitalization rates of patients will be reduced. A 52% reduction in emergency department (ED) visits with a cost per admission of at least $800 has been mentioned as a result of nursing postoperative visits and telephone follow-ups (16). In the coordination of transitional care from hospital, nursing visits during a three-month transition period in patients with heart failure showed the average savings of $4,845 per patient with a significant increase in survival and fewer readmissions (17). Also, performed activities such as self medication management and referral care coordination by nurses in community-based or ambulatory care settings can save $686 per patient in a 12-month period (18).
Nursing and value of health services
The value in healthcare is expressed as the physical health and sense of well-being achieved relative to the cost. There is little evidence at the macro level indicating that the development of nursing services results in cost savings to society while promoting outcomes and ensuring quality (19).  For example, managing nursing work hours is dramatically associated with 1.5 million fewer hospital days, nearly 60,000 fewer inpatient complications, and 0.5 percent reduction in costs (20). 
Overall, it seems that we need to conduct precise studies at macro-level to assess the net economic effects resulting from nursing care delivery models in order to seriously integrate them into health policy. Also, undrestanding the impact of nursing care on the health system requires the data to enable nurses have more effects on healthcare transformation.   
 

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Background & Aim: Presenteeism and productivity are two crucial aspects within the realm of human resources. Presenteeism poses a significant challenge as it refers to employees being present at the workplace despite being unwell. In the context of nursing services, the productivity objective encompasses attaining a level of nursing care that is both suitable and cost-effective. Due to the importance of presenteeism and productivity, this study was conducted to determine the relationship between physical presenteeism and productivity of nurses in intensive care units of hospitals affiliated with Tehran University of Medical Sciences.
Methods & Materials: The present study is a descriptive-analytical study that was conducted in 2020-2021. The sample included 305 nurses working in intensive care units within hospitals affiliated with Tehran University of Medical Sciences. The participants were selected using a stratified simple random sampling technique. The data collection was conducted using a demographic questionnaire, the Stanford presenteeism Scale 6-item questionnaire and the Productivity Assessment Questionnaire. Data were analyzed through SPSS software version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (Pearson correlation coefficient, Spearman correlation coefficient, t-tests, ANOVA and regression analysis).
Results: The levels of presenteeism and productivity among nurses were found to be average based on the mean scores of 19.15±4.7 and 47.4±10.19, respectively. Furthermore, there was a significant inverse correlation between productivity and presenteeism (r=-0.345). Regarding the demographic variables, only age, working experience in intensive care units, hospital and current department showed a significant inverse relationship with nurses' productivity (P<0.001). The inclusion of these demographic variables and the two main research variables in the regression analysis produced a significant impact on this relationship.
Conclusion: The results of this study showed that nurses' presenteeism diminishes their productivity, which imposes considerable indirect costs on the organization. Given the high prevalence of presenteeism among nurses and its detrimental consequences, it is recommended to undertake various measures aimed at mitigating this issue. These measures can encompass adjusting organizational and managerial policies, revising administrative rules and regulations to permit sick leave during illnesses, and creating conditions conducive to employees taking time off when unwell.

 

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Background & Aim: Knee osteoarthritis as a common chronic illness leading to disability, imposes numerous challenges on individuals in terms of daily living and self-care. Therefore, the implementation of tele-rehabilitation nursing interventions that foster patients' internal health locus of control and enhance the development of self-care behaviors may be useful. This study aimed to determine the effect of tele-nursing rehabilitation on the health locus of control in patients with knee osteoarthritis.
Methods & Materials: In this randomized clinical trial study, a total of 34 patients with knee osteoarthritis referred to the rehabilitation clinics affiliated with Shiraz University of Medical Sciences in 2022 were enrolled. The intervention group participated in an 8-session tele-rehabilitation nursing program, while the control group received standard routine care. The Multidimensional Health Locus of Control scale was administered to both groups on three separate occasions. The data were subjected to descriptive and inferential statistical analyses using SPSS software version 26.
Results: According to the results from a two-way repeated measures analysis of variance (ANOVA), a statistically significant difference was observed solely in the trend of changes in the mean score of internal belief between the two groups and over the study time period (P<0.001). Specifically, the scores of the intervention group exhibited a significant increase over time, surpassing those of the control group.
Conclusion: The implementation of tele-rehabilitation nursing care, which emphasizes patient responsibility for their internal health locus of control can improve self-care. Therefore, it is recommended that nurses employ this approach in managing additional chronic conditions.
Clinical trial registry: IRCT20220216054038N1