Background & Aim: The Clinical Teaching Partner model (CTP) integrates theoretical knowledge with professional skills and brings the reality to workplaces. Closing educational and practical aspects in nursing discipline has been a challenging goal for nursing which requires cooperation between faculty instructors with nurse practitioners such collaboration will led to development and promotion of nursing discipline. Therefore selecting an effective and efficient approach in order to integrate theoretical knowledge with practical experiences would be crucial for nursing profession. This study was conducted in order to investigate the effect of CTP on nursing students&apos clinical skills outcome.
Methods & Materials: A quasi experimental, only post test design was applied. Study sample consisted of 1) three faculty instructors, 2) seven registered nurse practitioners who were staff nurses in three pediatric wards and voluntarily participated in the study and 3) fifty two nursing students which were in the 5th semester of nursing BSc. program and had eligible criteria to enter the study. Students were allocated randomly to the intervention (n=28) and control (n=24) groups. Participants in the control group, initially started their internship period in 3 pediatric wards and were evaluated by faculty instructors regarding their clinical skills at the end students in the intervention group, then started their clinical training course in the same ward as control group, but their clinical education was conducted by the nurse practitioners who voluntarily participated in the study and trained initially in the nursing faculties&apos skill lab. Students&apos clinical skills were evaluated by nursing mentors via some instruments at the end of the educational period in addition, clinical education outcomes and nursing students&apos satisfaction of achievement to apprenticeship goals were assessed at the end of the training period. Data were analyzed using the statistical tests including Chi square, Fisher exact test, Mann-Whiney U, and t-test in SPSS.
Results: Considering students demographic characteristics, both groups were homogenous. There was a significant difference in the students&apos clinical skills between two groups (P<0.001). A significant difference was shown in the nursing mentors and faculty instructors&apos satisfaction of application of cooperative education method between both groups (P=0.004). No significant differences were found between students&apos satisfaction of reaching to educational outcomes between both groups (P=0.058). There were also no statistical differences between nursing mentors and faculty instructors&apos satisfaction of achieving to clinical education outcomes (P=0.109).
Conclusion: According to this study, CTP is an effective approach in clinical education and development of clinical skills for nursing students therefore,
application of this method is recommended in clinical nursing education.
Background & Aim: Cardiac rehabilitation is one of the most effective ways of secondary prevention in patients with myocardial infarction manifestations. This study aimed to assess the effectiveness of cardiac rehabilitation on clinical manifestations of myocardial infarction in post-MI patients.
Methods & Materials: In this interventional study, 66 patients (58 males and eight females) with myocardial infarction who were hospitalized in public hospitals of Ahwaz were selected using purposeful sampling. The participants were randomly allocated into intervention and control groups. Data was collected using a self-structured valid and reliable instrument. The intervention group participated in an 8-week cardiac rehabilitation program. Data on the clinical manifestations were collected eight weeks later. Data were analyzed in SPSS.
Results: The results showed that there was significant differences between two groups in hypertension crisis (P=0.03), chest pain, dyspnea, fatigue and palpitation after the cardiac rehabilitation (P<0.001).
Conclusion: Cardiac rehabilitation program decreased the clinical manifestations of myocardial infarction in post-MI patients. It is recommended to perform this procedure in the post-MI patients.
Background & Objective: Conflict occurs more frequently in health care organizations than the other settings due to complexity, frequent interaction between personnel, variations in specialties, roles, and hierarchy. Although conflict is not harmful and destructive in its nature and some degrees of conflict can help to improve health care services, high levels of conflict or its continuity may be harmful. Therefore, it is necessary to manage and control conflict. This study was carried out to assess the relationship between components of the conflict control model.
Methods & Materials: In this cross-sectional study, we developed a questionnaire that probed the relationships between components of conflict control model. A total of 290 nurses were recruited to the study using multi-stage sampling procedure from general educational hospitals in Tehran. Data were gathered using a questionnaire. Content validity of the questionnaire was examined by the expert panel. The internal consistency of the questionnaire was 0.81. Data were analyzed in the SPSS using descriptive statistics and spearman statistical test.
Results: The range of age was 22-53 (34.5±8.2). The majority of the respondents (88.6%) were female, 57.6% were married and 84.8% were staff nurses. From the majority of nurses&apos perspective, the meaning of conflict was discoordination, disagreement and disparity. However, some of the nurses meant it as violence, and difficult issues. About 41.4% of the respondents used negotiation, when they faced up to conflict. Other strategies were aggression, disagreement, avoidance, forgiveness, ignorance, and imposing own ideas to the others. From the respondents&apos point of view, factors that might cause or control the conflict were "mutual understanding and interaction" (32.4%), personality of nurses and their individual characteristics (26.6%), and conditions of the job (21.7%). Interaction was recognized to be the core strategy in conflict control model. Interaction had also significant associations with the five main variables in this study.
Conclusion: Lack of appropriate and efficient communication was an important factor in occurrence of conflict from the nurses&apos point of view. It is essential to improve nurses&apos and managers&apos communication channels by helping personnel to use effective communication skills. This measurement can be helpful for staff in understanding each other and reducing misconceptions. In addition, recognizing additional factors and variables that increases the occurrence of conflict can help to modify effective approaches.
Background & Aim: Access to quality care is important in delivering health services. Patients' safety and satisfaction are indicators of quality of care evaluation. Competent nurses may deliver quality care . This study aimed to investigate the impact of using competent nurses on patients’ safety and satisfaction .
Methods & Materials: In t his interventional study with non-equivalent control group, we selected 120 patients admitted to the emergency department of Imam Khomeini hospital in 2012 using convenience sampling method . Nursing care for the experimental group (n=40 ) was provided by nurses who had high competency scores and in the control group ( n=80), nursing care was provided by usual emergency department nurses . Data were collected using the patient satisfaction with nursing care quality (PSNCQ), and patient safety inventory. Data were analyzed in the SPSS v.16 using descriptive and inferential statistics . The significance level for all statistical tests was considered at P<0.05 .
Results: Mean age of the intervention and control groups were 48.1 ( ±12.5) and 40.5 ( ±16.7), respectively (P<0.018). There was a significant difference between the two groups in terms of employment (P<0.009). The two groups were similar in terms of other variables such as gender, marital status, level of education, having health insurance , and the reasons for seeking admission . The results showed that there were significant differences between the two groups in patients’ safety and satisfaction with nursing care (P<0.001). Regression test was used to eliminate the effects of age and job satisfaction the results showed effect of intervention on the patients’ safety and satisfaction with nursing care .
Conclusion: These findings indicated that using competent nurses in providing nursing care promotes patients’ safety and satisfaction with nursing care. Training nurses focusing on the level of competency is required in scheduling, staffing, and implementing nursing care to enhance safety, patient satisfaction , and quality of care.
Background & Aim: The quality of clinical services is a major concern for healthcare systems throughout the world. Clinical Governance, a relatively new approach to improve quality of healthcare systems, plays a fundamental role in the establishment of primary healthcare strategies to provide high quality services. Moreover, regarding the importance of organizational culture as a powerful lever to improve organizational behavior, success of organizations in implementing strategies largely depends on the support receiving from organization. Accordingly the aim of this study was to examine the correlation between organizational culture with establishment of clinical governance in public hospitals in Rasht .
Methods & Materials: A cross-sectional correlation study with structural equation modeling was used. All 152 nurses working in managerial positions participated in the study. Data were collected using Denison Organizational Culture questionnaire, and research-made questionnaire on clinical governance. Validity and reliability of questionnaire were confirmed. Data were analyzed using the Pearson correlation coefficient test and confirmatory factor analysis in the SPSS and LISREL .
Results: There was a significant positive relationship between clinical governance and all components of organizational culture (P< 12
Conclusion: Improvement of organizational culture leads to sustainable establishment of clinical governance through which quality of healthcare services improves. Managers of hospitals should pay attention to instituting appropriate organizational culture in order to establish clinical governance .
Background & Aim: Nurses’ clinical judgment is an evolving complex concept. In order to understand the concept, clarification is needed. This study aimed to conduct the concept analysis of clinical judgment in nursing .
Methods & Materials: Based on the Rodgers’s evolutionary method, evolving concept of clinical judgment in nursing was analyzed. Literature was retrieved from scientific databases during 1980 to 2013. Based on the inclusion criteria, 42 articles, three books and one dissertation were analyzed using thematic analysis method .
Results: The results showed that clinical judgment in nursing was a complicated process with attributes including intention, observation, data collection and information process, interpretation, prioritization and inference. Antecedents included knowledge, experience, evidences, clinical reasoning, intuition, critical thinking and consequences included nursing diagnosis and clinical decision making .
Conclusion: Clinical judgment in nursing is a critical thinking process, situational based and beyond observation and assessment. This concept analysis could distinct the transposition concept of clinical judgment and other related concepts. The results of this study would help to develop theories and clinical judgment measurement instruments in practice, research and educational settings .
Background & Aim: Poor oral care for the ventilated patients in intensive care units (ICU) can result in the accumulation of pathogens and respiratory infections. In this regard, in addition to the chemical methods, a mechanical method has been recommended to be added. However, concerning its effect on pneumonia, different findings have been reported. Therefore, this study was conducted to compare the effects of chlorhexidine solution with or without toothbrushing on the development of ventilator-associated pneumonia among patients in ICUs.
Methods & Materials: This was a single-blind, randomized controlled clinical trial conducted in two selected hospitals of Ahvaz city in 2014. A convenience sample of 68 ventilated patients was randomly allocated to the toothbrush group (34 patients) or the gauze swab group (34 patients) using R software. Both groups received 0.2% Chlorhexidine solution. The intervention was performed in both groups for 3 minutes twice a day for five days. At the end of the fifth day, the development of pneumonia was assessed using the Clinical Pulmonary Infection Score (CPIS). Data were analyzed by Chi-square and t-independent test through SPSS v.16.
Results: The two groups were similar for age, sex, cause of admission, level of consciousness, medication and tobacco use. The majority of patients (58.8%) were diagnosed with pneumonia (Group A: 55.9% and Group B: 61.8%). The Chi-square test showed no significant difference between the two groups for the development of pneumonia (P>0.05).
Conclusion: The use of Chlorhexidine solution with toothbrushing compared to using Chlorhexidine with swab could not reduce the development of pneumonia. However, due to its importance, further research is needed in this regard.
Background & Aim: Randomized clinical trials (RCTs) are studies which are able to provide the most valid evidence to compare various interventions in health research. Biases can affect the quality of research and ultimately make the results of a study invalid. One of the most important biases is selection bias. The best way to reduce selection bias is the use of random allocation. The aim of this study is to provide comprehensive, practical and simple information regarding proper implementation of the random allocation process in randomized clinical trials.
Methods & Materials: A review study was performed using available resources and comprehensive analysis. For this purpose, we searched the relevant books & articles in databases including Medline, Scopus, Science Direct, Google Scholar and Magiran. Key words were randomization, random sequence, allocation concealment, randomized controlled trial, randomized clinical trial, and bias.
Results: From the literature review, we obtained 39 articles and one relevant book that their findings were presented in a simple language with practical examples in three parts including random sequences generation, random allocation concealment and implementation.
Conclusion: Selection bias in clinical trials has an adverse effect on the accuracy of results. In order to avoid it, researchers should employ proper methods in randomization and random allocation concealment, and report it in their articles properly. Therefore, researchers can obtain valid results through a better understanding of randomization and its proper implementation.
Background & Aim: Ultraviolet (UV) keratitis is an inflammation of the corneal epithelium and conjunctiva caused by UV radiation and is associated with the symptoms including severe eye pain, decreased visual acuity, severe tearing and red eye. The use of primary patching in the patients is doubtful. Therefore, this study aimed to determine the effect of eye patching on the improvement of clinical symptoms in patients with UV keratitis.
Methods & Materials: In this clinical trial, 120 patients with UV keratitis referred to the emergency department of Khatam Al Anbia center affiliated to Mashhad University of medical sciences, were randomly assigned into two groups (each group contains 60 patients) with patching and non-patching in 2015 (IRCT2015092124124N1). In one group, both eyes were patched and the other group was not patched. All other care was similar in both groups. Clinical symptoms were checked and compared between two groups before and after 12 hours. Data were analyzed by descriptive statistics, independent t-test, paired t-test, Chi-square and Wilcoxon using SPSS software version 23. A p-value less than 0.05 was considered significant.
Results: The results showed that redness (P<0.001) and tearing (P<0.001) were more improved in the non-patched group but there was no statistically significant difference between the two groups in visual acuity (P>0.05).
Conclusion: Eye patch does not have effect on the improvement of clinical symptoms such as tearing and redness, and these symptoms are more improved without patching.
Background & Aim: Randomized controlled trials often suffer from two major problems, i.e., noncompliance and missing outcomes. One potential solution to this problem is using the intention-to-treat (ITT) analysis approach. Therefore, the aim of this study was to review the concept of ITT and the most important issues related to it in practice since RCT researchers utilize it as a guide in order to improve the quality of RCT studies.
Methods & Materials: A review study was performed using available resources and comprehensive analysis. For this purpose, we searched the relevant articles in databases including Ovid/Medline, SCOPUS, Web of Science, Google scholar and Magiran. The key words that were used included randomized clinical trials, randomized controlled trials, intention-to-treat analysis, per-protocol analysis, ITT, as-treated.
Results: The advantages of ITT, the critique of ITT, the alternatives of ITT and their limitations, missing data and their management in clinical trial studies were discussed in this paper.
Conclusion: ITT approach, due to its adherence to the principles of randomization, protects clinical trials from confounding and bias and therefore leads to the generation of the highest quality scientific evidence in the clinical research field. ITT should be considered a strategy at all stages of research, including the design of study, implementation and data analysis, and it should not be considered only a statistical approach.
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