Background: Intravenous (IV) cannulation is difficult, especially in patients undergoing chemotherapy due to frequent exposure to venous catheterization as well as the destructive effects of chemotherapy drugs on the vessel wall. Therefore, an easy, accessible, and fast method is needed to facilitate venous cannula insertion. Objectives: This study aimed to systematically review studies on the effects of local warming before insertion of peripheral venous cannulas on vascular access in adult patients receiving chemotherapy. Methods: This systematic review was conducted by searching databases including PubMed, Scopus, Cochrane, Embase, CINAHL, and ProQuest. The full search of information sources was conducted from the inception of the databases up to December 7, 2020, using the keywords namely “warming”, “heat”, “chemotherapy”, “cancer”, “vein score”, “catheterization”, “visibility,” and “palpability.” All randomized and nonrandomized trials that were in English language and full text were included. The search was based on the PRISMA guidelines, and finally, six articles were selected for the review. The 8-item JADAD scale was used to evaluate the quality of the included articles. Results: After a complete search, 244 articles were recovered and reviewed. Finally, six articles, including 516 samples, met the criteria for entering the study. Findings indicated that local warming at the IV insertion site increased insertion success rate at the first attempt, increased vein score, increased patient satisfaction and relaxation and reduced the catheterization time, reduced pain intensity, reduced pain perceived by the nurse, and reduced the number of pricks. Conclusion: Findings suggest that using local warming at the IV insertion sites in patients receiving chemotherapy is an effective, easy, and cost-effective method that can be performed using very simple tools and is recommended for all health care providers.

Background: Amniocentesis is the most common invasive procedure for diagnosing fetal abnormalities. Most pregnant women are anxious about fetal abnormalities and screening tests. Objectives: This study was conducted to determine the effect of H7 acupressure on amniocentesis anxiety in pregnant women. Methods: This clinical trial was conducted on 56 pregnant women candidates for amniocentesis. In the intervention group, acupressure was performed at H7 acupoint for 5 min in each hand, 30 min before amniocentesis, and then daily for 10 days. The control group did not receive any intervention. Data collection was done using a demographic questionnaire, the Spielberger state-trait anxiety inventory, and a daily acupressure recording checklist. Data were analyzed using the independent samples t-test, Chi-square test, repeated measures analysis, Bonferroni post hoc test, and paired t-test. Results: The mean state anxiety scores in the intervention group were 38.70 ± 5.64 and 30.22 ± 6.70 immediately and 10 days after amniocentesis. However, at the same times, the mean state anxiety scores in the control groups were 49.03 ± 2.30 and 50.86 ± 2.01, respectively, which were significantly higher than the intervention group (P < 0.001). The mean scores of trait anxiety were significantly lower in the participants of the acupressure group than the control group 10 days after amniocentesis (P < 0.001). Conclusion: The H7 acupressure could be effective in reducing state and trait anxiety in pregnant women during amniocentesis and when they are waiting for the test results.

Background: Operating room (OR) students experience varying levels of anxiety during their internship program in the OR. Educational technology has the potential for reducing anxiety. Objectives: This study aimed at assessing the effects of training based on virtual-augmented reality (VAR) on anxiety among OR students attending coronary artery bypass graft (CABG) surgery. Methods: This randomized controlled trial was conducted in 2020. Thirty-six OR students were conveniently recruited and randomly allocated to an intervention (n = 18) and a control (n = 18) group. Participants in the control group received conventional training, whereas their counterparts in the intervention group received VAR training through watching a 360-degree VAR video of CABG surgery in addition to conventional training. The State-Trait Anxiety Inventory was used for anxiety assessment in both groups at three time points, namely before entering the OR on the first day of the internship program, after entering the OR but before scrub, and on the last day of the program. The data were analyzed through the independent-samples t test, the Chi-square test, and the repeated-measures analysis of variance. Results: There was no significant difference between the intervention and the control groups regarding the pretest mean scores of state anxiety (40.61 ± 7.63 vs. 41.59 ± 5.09; P = 0.66) and trait anxiety (39.17 ± 7.39 vs. 39.29 ± 6.05; P = 0.96). However, the mean scores of state and trait anxiety in the intervention group were significantly less than the control group at both the first posttest (33.17 ± 6.16 vs. 45.06 ± 8.69 and 33.56 ± 6.19 vs. 42.59 ± 6.62; P < 0.001) and the second posttest (32.39 ± 4.62 vs. 42.35 ± 6.14 and 32.94 ± 5.20 vs. 41.0 ± 5.58; P < 0.001). Conclusion: VAR training is effective in significantly reducing anxiety among OR students attending CABG surgery.



Background: Older adults waiting for colonoscopy are anxious due to the lack of knowledge about the procedure, its preparations, and aftercare. Objectives: The aim of this study was to evaluate the effect of the Neuman systems model (NSM) on anxiety of older adults waiting for colonoscopy. Methods: A pre- and postintervention study was conducted on 72 older adults who were waiting for colonoscopy. The participants were randomly allocated to either a control (n = 36) or an intervention group (n = 36). The intervention was performed in four steps, namely determining the potential and actual stressors, setting the goals, nursing interventions, and evaluation, according to the four-step nursing process in the NSM. A need assessment checklist based on the NSM and the Geriatric Anxiety Scale was completed before and after the intervention. Data analysis was performed using Fisher’s exact, independent, and paired t-tests. Results: At baseline, the mean score of total anxiety was 35.66 ± 7.58 in the intervention group and 35.29 ± 6.52 in the control group. After the intervention, these values changed to 26.71 ± 7.48 and 34.06 ± 7.23. Before the intervention, there was no statistically significant difference between the anxiety scores of the two groups in cognitive, affective, and somatic dimensions and total anxiety scores (P > 0.05). However, after the intervention, statistically significant differences were found between the two groups in the mean scores of the aforementioned components (P < 0.001). Conclusion: Implementing an educational program based on NSM reduced anxiety in older adults waiting for colonoscopy. Nurses should be trained about the NSM to be able to use similar programs in reducing the anxiety of patients waiting for colonoscopy.

Background: There are inconsistencies about the best clinical teaching method for strengthening nursing students’ critical thinking (CT). Objective: This study is aimed to compare the effects of the one-min preceptor (OMP) and problem-based learning (PBL) clinical education on nursing students’ CT. Methods: This was a randomized controlled trial. All forty 3rd-year nursing students who had taken the Medical-Surgical Nursing III clinical course were recruited to the study through the census method in 2016 in Kashan University of Medical Sciences, Kashan, Iran. The students were randomly allocated into three groups of 13 to pass their clinical course via the OMP, the PBL, or the conventional clinical education methods, respectively. In the first session and at the end of the last session, the students completed the California CT Skills Test Form B. The one-way analysis of variance and the Kruskal–Wallis and Mann–Whitney tests were used to analyze the data. Results: Students’ mean age was 21.77 ± 1.32 years. There were no significant differences in baseline CT score among the conventional (11.17 ± 1.64), OMP (10.58 ± 1.34), and PBL (10.79 ± 1.18) groups (P = 0.894). However, at the end of the study, the difference among the groups regarding CT score was significant (12.17 ± 1.89, 13.69 ± 1.10, and 13.64 ± 1.44; P = 0.049). Conclusion: OMP and PBL can be potentially effective in improving students’ CT ability. Therefore, these methods can be used in clinical nursing education to improve students’ CT ability.

Background: Health-promoting lifestyle (HPL) is a major health concern among adolescents. Family function (FF) has potential effects on adolescents’ lifestyle and health. Objectives: This study aimed to evaluate the correlation between FF and HPL among female adolescents. Methods: This correlational study was conducted from January to February 2020 on 356 female adolescent students randomly recruited through multistage cluster sampling from four public junior high schools in the south of Tehran, Iran in 2020. Data were collected using a personal characteristics questionnaire, the Adolescent Health Promotion Short Form, and the McMaster Family Assessment Device. Data analysis was performed through Pearson’s correlation coefficient, the one-way analysis of variance, the independent-samples t test, and the linear regression analysis. Results: The average age of adolescents was 14.16 ± 0.76 years. The total mean scores of participants’ HPL and FF were 75.36 ± 12.43 (in the possible range of 21–105) and 3.02 ± 0.37 (in the possible range of 1–4), respectively. There was a significant positive correlation between FF and HPL (r = 0.399, P < 0.001). Among demographic characteristics, adequacy of family income, and among dimensions, the problem-solving, behavioral control, roles, and affective involvement dimensions of FF were significant predictors of HPL, explaining 24.5% of its total variance. Conclusion: The mean HPL and FF were greater than the possible median scores. Also, adequacy of family income and FF were significant predictors of HPL among female adolescents. Healthcare authorities and policymakers are recommended to pay greater attention to FF in developing health-promoting programs for adolescents.

Background: Patients’ companions have a great role in intensive care units (ICUs). They act as patients’ voice since a majority of patients are unable to communicate or make decisions. Objective: This study aims to investigate the comfort of patients’ companions in ICUs and its related factors in a selected hospital in Kashan, Iran in 2019. Methods: This cross-sectional study was conducted on a convenience sample of 375 family members of patients recruited from the ICUs. Data collection instruments were a demographic questionnaire and companions comfort scale (ECONF). Data were analyzed with independent-samples t-test, one-way analysis of variance, Pearson’s correlation analysis, and multiple linear regression analysis. Results: The mean score of companions’ comfort was 179.02 ± 37. The multiple regression analysis indicated that foot or low back pain, Iranian nationality, being a first-degree relative, present more than once per day as the patient’s companion, coma status of patients, and duration of hospitalization more than 1 week (P < 0.05) were associated with companions’ comfort. Companions’ gender, age, patient care alone, education level, income, history of an underlying disease, and connection to a ventilator were not related to the companions’ comfort. Conclusion: The comfort score of patients’ companions was above the moderate level. Some sociodemographic characteristics of the companions and clinical status of patients were related to comfort score. Further studies are necessary to assess cultural, demographic, and contextual aspects related to the comfort of patients’ companions in the ICUs.

Background: Affliction of a child by a chronic disease can significantly affect the whole family. Identifying the consequences of a child’s congenital heart disease (CHD) for parents can help health-care providers provide better care services to them. Objectives: This study aimed at exploring the consequences of a child’s CHD for parents. Methods: This study was conducted in 2020 using conventional content analysis. The 30 parents of 15 children afflicted with CHD were purposively recruited from a hospital and a physician’s private office in Sanandaj, Iran. Data were collected via semi-structured interviews and continued up to data saturation. Data analysis was performed via conventional content analysis suggested by Graneheim and Lundman. Results: The consequences of a child’s CHD for parents were grouped into three main categories, namely threatened family integrity (with three subcategories), psychological turmoil (with five subcategories)‌, and being in limbo (with three subcategories). The 11 subcategories of these three categories were the effects of CHD on parents, neglectful parenting for other family children, reluctance to have another child, anxiety, maternal depression and somatization, helplessness, fear over treatment failure, acceptance of an unchangeable reality, uncertain future, concern over hiding or not hiding a child’s CHD, and a heart full of pain, respectively. Conclusion: A child’s CHD can threaten family integrity, cause parents psychological turmoil, and put them in limbo. Health-care providers, particularly nurses, need to assess the needs of these parents and provide them with professional counseling and need-based emotional, informational, and financial support in order to reduce the negative effects of CHD on them.

Background: Nurses are the key members of the health-care team and play an important role in the assessment of the patients’ problems. Objectives: This study aimed to investigate Iranian nurses’ self-reported mastery and use of musculoskeletal assessment skills. Methods: This cross-sectional study was conducted from October 2018 to January 2019 on 200 nurses in Shahid Beheshti Hospital of Kashan, Iran. Data were collected using a two-part questionnaire including a demographic data form and 16 self-report items on nurses’ mastery in the assessment of the musculoskeletal system. The levels of self-reported mastery and use of the musculoskeletal assessment skills in patient care were assessed. Data analysis was done using descriptive statistics, independent samples t-tests, analysis of variance, and the Pearson correlation analysis. Results: Nurses obtained 83.25% of the score in the area of using health history taking skills, while they obtained 86.94% of the score of mastery in this field. Furthermore, nurses gained 33.77% of the score in the area of using physical examination skills, while they gained 44.53% of the score of mastery in this area. The most commonly used musculoskeletal assessment skills were “checking the range of motion of the joints” and “checking muscle strength” that were used in 20.5% of cases. However, nurses rarely used specific tests such as the Patrick’s, ballottement, and Lasègue tests. A significant direct correlation was found between nurses’ self-reported mastery in musculoskeletal assessment skills and the use of these skills (r = 0.44, P = 0.001). Conclusion: Despite the desirable levels of nurses’ self-reported mastery and use of history taking skills, the level of their self-reported mastery and use of musculoskeletal assessment skills are not satisfactory.

Background: Clinical education is the most stressful part of education for nursing students. This study investigated the relationship of nursing students’ personality traits with their perceived stress in clinical environment. Objectives: This study aimed at investigating the relationship of nursing students’ personality traits with their perceived stress in clinical environment. Methods: This cross-sectional study was conducted in October 2020 on 215 nursing students. Participants were selected through stratified random sampling from Zanjan University of Medical Sciences, Zanjan, Iran. Data collection instruments were a demographic questionnaire, the NEO Personality Inventory short form, and the Perceived Stress Scale. Data analysis was done through the independent-samples t-test, Pearson’s correlation analysis, and one-way analysis of variance. Results: The mean score of perceived stress was 43.74±10.25 out of 56, implying high level of stress. Neuroticism personality trait had significant positive correlation with perceived stress (P < 0.001), whereas extraversion and agreeableness personality traits had significant negative correlations with perceived stress (P < 0.05). Conclusion: Healthcare authorities need to employ strategies to identify nursing students who are at risk for stress and improve their psychological readiness for attending clinical environment.