Hemodialysis patients face numerous physical and psychological stresses that result in reduced health. The aim of this study is to determine the impact of an empowerment program on self-efficacy, quality of life, clinical indicators of blood pressure and interdialytic weight gain, and laboratory results in these patients.

Background: Several lines of evidence suggest that early sensory stimulation and regular family visiting programs are potential nursing interventions to improve the outcomes of head injured comatose patients. However, little is known about the impacts of family involvement in providing sensory stimulation. Objectives: To determine the effects of a sensory stimulation program conducted by nurses and families on the consciousness, level of cognitive function, and basic cognitive sensory recovery of head injury comatose patients. Patients and Methods: This was a randomized clinical trial performed at the Shiraz level I trauma center including 60 head injured comatose patients with an initial Glasgow coma score (GCS) of less than 8. Patients were randomly assigned to receive sensory stimulation by a qualified nurse (nurse group; n = 20), by the family (family group; n = 20), or usual care (control group; n = 20). The sensory stimulation program involving the nurses and patients’ families was conducted, twice daily, in the morning and evening for 7 days. The level of consciousness, level of cognitive function, and basic cognitive sensory recovery of the patients were evaluated and monitored using the GCS, Rancho Los Amigos (RLA), and Western Neuro-Sensory stimulation profile (WNSSP). Data were analyzed by chi square, Kruskal-Wallis, and repeated-measures tests using SPSS. Results: All the patients were comparable regarding their baseline characteristics, level of consciousness, level of cognitive function, and basic cognitive sensory recovery determined by GCS, RLA, and WNSSP. Although the two intervention groups of the study improved, those who received the sensory stimulation program from their families had significantly higher GCS (P = 0.001), RLA (P = 0.001), and WNSSP (P = 0.001) scores after 7 days when compared to the two other groups. Conclusions: The application of sensory stimulation by families led to significant increases in the consciousness, level of cognitive function, and basic cognitive sensory recovery of comatose patients with severe injuries. Keywords: Coma; Sensory Stimulation; Traumatic Brain Injury; Consciousness Level; Cognitive Function

Background: Brain stroke is the main cause of death and disability worldwide. This disease can cause major complications in patients and place a great burden of care on caregivers. Therefore, this study was conducted to determine the effect of telenursing on the burden of care in caregivers and the rate of complications in patients with acute brain stroke discharged from neurological wards. Methods: This two-arm parallel-group single-blind randomized clinical trial study was carried out on 72 patients with acute brain stroke discharged from neurological wards in Qom, Iran, in 2019. The patients and their caregivers were divided to control and intervention groups using random block allocation. In addition to the usual training of the ward, the intervention group received training and counseling based on their needs through phone calls for 4 weeks. However, the control group received only the usual ward training. Immediately after discharge from the hospital and 1 month later, the average care load in caregivers and urinary problems, bedsores, and the number of falls in patients were measured. A demographic questionnaire, Caregiver Burden Inventory, Braden Scale, Morse Scale, and a urinary problem checklist were used for data collection. The data were analyzed using the chi-square test, Mann-Whitney U test, independent t-test, and paired t-test by SPSS software (version 24). Results: After the intervention, the mean scores of the caregiver’s burden of care in the control and counseling groups were 35.22 ± 17.215 and 8.00 ± 7.556, respectively (P < 0.001). In addition, the counseling group experienced remarkably fewer urinary problems (P < 0.001) and falling (P = 0.011). Conclusions: This study showed that telenursing reduced the burden of care in caregivers and decreased urinary tract infections and the number of falls in patients with acute stroke. Therefore, nurses and healthcare providers can use this program to improve the lifestyle of patients with acute brain stroke and their caregivers.

Background: The birth of premature newborns and their separation from family due to their hospitalization in the Neonatal Intensive Care Unit (NICU) cause stress in the parents, especially mothers. We conducted this study aimed to evaluate whether training the fathers to support their wives impacts premature newborn mothers’ stress and self-efficacy or not? Methods: A quasi-experimental (before-after study) including one experimental and control group was used. Data were collected from Seventy-five parents with newborns hospitalized in NICU (n = 30) in the intervention and (n = 45) in usual care groups. Settings were the NICUs of the two international, educational, specialty, and subspecialty Nemazee and Hafez hospitals of the Shiraz University of Medical Science. Fathers in the intervention group learned how to support their wives and provide care for their premature newborns. The control group received the usual care. Mother’s stress and self-efficacy were measured using validated questionnaires. Results: Data analysis showed that the mean scores of mothers’ stress and self-efficacy from pre-intervention to post-intervention were significantly decreased and increased respectively in the intervention group (p <0.001). At the same time, there was no significant difference in the control group. Conclusion: When fathers are trained to support their wives and do so, it relieves the stress and improves the mothers’ self-efficacy, and has a direct effect on providing care to their premature newborns. Therefore, it is recommended that measures should be taken so that the fathers be present, participate in providing care, and support their wives and newborns in NICU. Trial registration: IRCT20171130037691N1.

Background. The neonatal intensive care unit (NICU) is a sensitive ward for nurses. However, the low nurse-to-patient ratio has led to the hiring of novice nurses into the critical areas such as NICUs. These nurses are in need of help in the clinical environment as they have no much experience caring the neonates in the real clinical setting. Therefore, it is necessary to address the individual and psychological capacities with the help of which a person can overcome the difficult situations. This study aimed to investigate the relationship between metacognitions, clinical belongingness, and resilience of novice nursing staff in NICU wards. Method. This study is a descriptive-analytical study, and the research samples were composed of 78 novice nursing staff of Neonatal Intensive Care Units from teaching hospitals. Samples were selected via a purposive sampling method. Research tools included demographic, Wells and Hatton metacognitive beliefs, Jones Levitt belonging, and Connor–Davidson resilience questionnaires. SPSS 22 software was used for data analysis. Results. The mean score of metacognitive beliefs in novice nursing staff was 92.67 ± 13.69, and it was 116.69 ± 19.11 for belongingness and 78.78 ± 14.73 for resilience. There is positive and significant relationship between metacognitive beliefs and belongingness ( , r = 0.265). In addition, the relationship between metacognitive beliefs and resilience in novice nursing staff was positive and significant ( , r = 0.359). Conclusion. There is a positive relationship between metacognitive beliefs with belongingness and resilience of novice nurses; nursing managers can consider educational metacognition workshops to enhance the sense of belongingness and resilience of novice nursing staff leading to improve their clinical performance in neonatal care.

Background: One of the most dangerous complications after endotracheal intubation or tracheostomy is tracheal stenosis. Objectives: This study aimed to determine the personal and clinical characteristics of tracheal stenosis following intubation or tracheostomy in intensive care unit patients. Methods: This is a nested case-control study. Thirty-five patients who suffered from tracheal stenosis from March 2016 to March 2021 and had been intubated and tracheostomized in intensive care units (ICU) were selected for the case group. The control group included 105 patients intubated and tracheostomized in ICU during the same period without tracheal stenosis. A demographic and clinical characteristics questionnaire was used to collect data from the patients' medical records. Results: The mean length of intubation (P < 0.001), endotracheal and tracheostomy tube cuff pressure (P < 0.001), chronic obstructive pulmonary disease (COPD) (P = 0.043), intubation history (P = 0.045), and airway management (P < 0.001) showed significant differences between the case and control groups. The logistic regression model revealed that COPD (OR = 8.519, P = 0.037), intubation history (OR = 3.939, P = 0.013), length of intubation (OR = 1.118, P = 0.003), age (OR = 0.960, P = 0.030), and endotracheal and tracheostomy tube cuff pressure (OR = 1.988, P < 0.001) were associated with tracheal stenosis. The time interval between intubation/tracheostomy ranged from approximately 28 to 938 days. Conclusions: Given the impact of certain care practices during hospitalization on the occurrence of tracheal stenosis, such as the mean length of intubation, endotracheal and tracheostomy tube cuff pressure, and airway management, it is recommended that standardized training on these interventions be prioritized for staff in intensive care departments. Additionally, attention must be given to specific patient characteristics, such as age, COPD, and history of intubation.