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INTRODUCTION: Early warning scores serve as valuable tools for predicting adverse events in patients. This study aimed to compare the diagnostic performance of National Early Warning Score, Hamilton Early Warning Score, Standardized Early Warning Score, and Triage Early Warning Score in forecasting intubation and mortality among patients with coronavirus disease 2019. METHODS: This predictive correlation study included 370 patients admitted to the emergency department of 22 Bahman Hospital in Neyshabur, Iran, from December 2021 to March 2022. The aforementioned scores were assessed daily upon patient admission and throughout a 1-month hospitalization period, alongside intubation and mortality occurrences. Data analysis used SPSS 26 and MEDCALC 20.0.13 software. We adhered to the Standards for Reporting of Diagnostic Accuracy Studies guidelines to ensure the accurate reporting of our study. RESULTS: The patients' mean age was 65.03 ± 18.47 years, with 209 (56.5%) being male. Both Standardized Early Warning Score and Hamilton Early Warning Score demonstrated high diagnostic performance, with area under the curve values of 0.92 and 0.95, respectively. For Standardized Early Warning Score, the positive likelihood ratio was 10.81 for intubation and 17.90 for mortality, whereas for Hamilton Early Warning Score, the positive likelihood ratio was 7.88 for intubation and 10.40 for mortality. The negative likelihood ratio values were 0.23 and 0.17 for Standardized Early Warning Score and 0.21 and 0.18 for Hamilton Early Warning Score, respectively, for the 24-hour period preceding intubation events and mortality. DISCUSSION: Findings suggest that Standardized Early Warning Score, followed by Hamilton Early Warning Score, has superior diagnostic performance in predicting intubation and mortality in patients with coronavirus disease 2019 within 24 hours before these outcomes. Therefore, serial assessments of Hamilton Early Warning Score or Standardized Early Warning Score may be valuable tools for health care providers in identifying high-risk patients with coronavirus disease 2019 who require intubation or are at increased risk of mortality.

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BACKGROUND: Preventing diabetes and identifying patients who are at risk for it is very important. This study was conducted to estimate the risk score of type 2 diabetes among adults living in Neishabour city in 2020. MATERIALS AND METHODS: This descriptive-analytical study was performed on 1000 people aged 25 years and older living in Neishabour (Iran) using a multi-stage sampling method. The data collection instrument included the American Diabetes Association Diabetes Risk Test (DRT), which is a screening instrument to assess the risk of type 2 diabetes. Data analysis was carried out using SPSS ver. 18, using independent t-test, Chi-squared, Fisher's Exact test, Mann-Whitney, path analysis, and regression of generalized estimating equation model at 95% confidence interval. RESULTS: The mean age of the subjects was 43.87 years (SD = 0.419) and 50.7% (n = 507) were female and the rest were male (n = 493). The risk of developing type 2 diabetes was high in 18.4% (n = 184) of the subjects. And the average risk of diabetes in people was 2.76 (SD = 0.057) out of 10 points. There was no significant relationship between gender and gestational diabetes with the risk of diabetes, but there was a significant relationship between age over 40 years, history of hypertension, family history of diabetes, lack of physical activity, and being overweight with the risk of type 2 diabetes. CONCLUSION: Approximately, one-fifth of the subjects had a high risk of developing type 2 diabetes. Therefore, the use of a simple and practical instrument such as DRT can be suitable for screening and early detection of Prediabetic state and type 2 diabetes.

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Background: Students are a significant source of data for the evaluation of clinical instructors' performance. This study was undertaken with the aim of adaptation and validation of the Persian version of the Maastricht Clinical Teaching Questionnaire (MCTQ). The main objective of the researchers in this study was to evaluation the psychometric properties of the Persian version of the Maastricht Clinical Training Questionnaire (P-MCTQ) in Iran, considering cultural and social differences. Materials and Methods: This methodological study was conducted from 2019 to 2021 at four teaching hospitals affiliated with Sabzevar University of Medical Sciences, Iran. Qualitative and quantitative face and content validity, and construct validity methods were used for the validity evaluation. Stability and internal consistency methods were used, respectively, for the reliability evaluation of the questionnaire. Exploratory Factor Analysis (EFA) stage, 264 students studying in the fields of nursing, midwifery, anesthesiology, operating room, emergency medicine, and laboratory sciences completed the P-MCTQ. Results: The value of scale-content validity index (0.92) is indicative of the overall content validity of the questionnaire. EFA extracted a single-factor structure that could explain the overall variance of the clinical education structure at about 76.61%. The alfa and intraclass correlation values were equal to 0.98 and 0.82, respectively, indicating the excellent internal consistency and high overall stability of the questionnaire. Conclusions: The P-MCTQ is a valid and reliable tool for the evaluation of the teaching performance of clinical instructors.

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BACKGROUND: The age of onset of substance abuse among adolescents has recently decreased worldwide. Parents play an important role in preventing their children from drug abuse. This study aimed to investigate the effect of web-based family-centered empowerment program in preventing the risk factors of substance abuse in students' parents, using the health promotion model (HPM). MATERIAL AND METHODS: This interventional study was based on 118 parents of high school students in Sabzevar, Iran (2019). Multi-stage random sampling was used to divide the participants into the experimental (n = 65) and control (n = 65) groups. The data were collected through a researcher-made questionnaire based on Pender's HPM. A website was designed to perform all stages of the study. The web-based educational intervention was performed for the experimental group. Both groups completed the questionnaires 2 months after the educational intervention. The data were analyzed using t-test, paired t-test, regression, correlation, and analysis of covariance. RESULTS: There was a significant difference between the scores of prior related behavior, perceived benefits of action, activity-related effect, situational influences, competitors, and commitment in the parents of the experimental group compared to the control group after the educational intervention (P-value < 0.05). Moreover, a significant difference was observed between preventive behaviors of substance abuse and the mean score of perceived barriers to action, perceived self-efficacy, interpersonal influences, and role model in the parents of the experimental group compared to the control group after the educational intervention (P-value < 0.05). CONCLUSION: Overall, designing an educational intervention based on the constructs of Pender's HPM could be an effective strategy for promoting preventive behaviors of substance abuse in parents.

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The concern about post-COVID-19 vaccine complications still remains. In addition, the evidence on Sinopharm, Sputnik V, Covaxin, and, in particular, COVIran Barekat, as well as comparisons between them by dosage after post-vaccination, is scarce. This study aimed to investigate and compare the prevalence of self-reported post-vaccination signs and symptoms following the first and second doses of different types of COVID-19 vaccines. Research design and methods: This prospective cohort study was conducted on more than 1500 health professionals who had received at least one dose of any type of Sputnik V, Sinopharm, Oxford AstraZeneca, Covaxin, and COVIran Barekat vaccines in Iran. The survey questionnaire was sent to participants online, 28 days after receiving each dose of the vaccine. Results: About 73% of health professionals reported at least one post-vaccination sign or symptom, developing mostly within the first 12 h (69.9%) and lasting up to 12 h (59.0%). Pain and tenderness at the injection site, fever, and muscle pain were the most common post-vaccination signs and symptoms in all vaccines, which were significantly higher in the Oxford AstraZeneca vaccine (p < 0.001) for both the first and second doses. The incidence rate of all post-vaccination signs and symptoms was significantly higher in the first dose than in the second dose (p < 0.05). Conclusion: The Oxford AstraZeneca vaccine showed the highest incidence rate, onset, and lasting time of signs and symptoms in both doses; however, they were not life-threatening. The onset time of signs and symptoms was significantly higher for the COVIran Barekat and Oxford AstraZeneca vaccines in both the first and second doses.

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AIM: This study aimed to assess the effects of telenursing on patients' activities of daily living and instrumental activities of daily living (ADLs and IADLs) following a myocardial infarction (MI). METHODS: This randomized, parallel-group, controlled trial was conducted on 95 patients post-MI from 2018 to 2019. Patients were randomly assigned to the intervention (telenursing) and control groups using permuted block randomization. Through telephone calls, telenursing was performed twice a week during the first six consecutive weeks, then once a week until week 12. ADL and IADL questionnaires were completed by both groups before intervention and 12 weeks later. The CONSORT 2010 checklist was used to report the study protocol. RESULTS: The mean age of patients was 56.8 ± 11.07 and 54.2 ± 9.8 years in the telenursing and control group, respectively. The mean ADL and IADL scores in the telenursing group were substantially greater than in the control group [4.57 (3.18, 5.97); P < 0.001 and 4.40 (3.06, 5.75); P < 0.001, respectively]. The odds of a higher degree of independence (no disabilities vs. mild disabilities and disability as well as no disabilities and mild disabilities vs. disability) regarding ADLs and IADLs were significantly greater in the telenursing group as compared with the control group (P < 0.001 and P < 0.001, respectively). CONCLUSIONS: Our findings suggest that the use of telenursing intervention may increase patients' ADLs and IADLs after an MI and may enhance their independence. Geriatr Gerontol Int 2022; 22: 616-622.

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BACKGROUND: As the core of a health-care team, nurses play a key role in promoting community health, and their job involves witnessing human suffering and pain in health-care settings. The present study aimed to evaluate the correlations between resilience coping strategies, and the underlying factors in the nurses working in COVID-19 hospitals. MATERIALS AND METHODS: This descriptive, cross-sectional study was conducted on 320 nurses working in COVID-19 wards for a minimum of 6 months in 2021. The participants were selected via multistage sampling. Data were collected using demographic, resilience, and coping strategy instruments. Data analysis was performed in SPSS version 20. RESULTS: The mean resilience score was 76.94 ± 11.33. The mean scores of emotion-focused and problem-focused strategies were 59.65 ± 4.40 and 96.08 ± 5.38, respectively. The assessment of the correlation between resilience with the emotion-focused and problem-focused strategies showed a positive significant correlation (r = 0.25; P < 0.001 and r = 0.33; P < 0.001, respectively). CONCLUSION: According to the results, the nurses working in COVID-19 wards mostly adopted problem-focused strategies in difficult work conditions depending on the required care provision. Both coping strategies significantly affected the subscales of resilience in the nurses. Therefore, it is recommended that special attention be paid to teaching strategies to cope with anxiety and resilience and develop problem-solving skills in nursing personnel during the emergence and outbreak of new diseases in order to reduce their anxiety.

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BACKGROUND: The COVID-19 pandemic has led to numerous psychological consequences and a drastic increase in the workload of nurses. The present study aimed to investigate the correlation of the job turnover intention of Iranian nurses with job satisfaction and burnout in the COVID-19 pandemic. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted on 300 nurses working in the hospitals in Sabzevar, Iran from October 2020 to January 2021. Data were collected using the questionnaires of turnover intention, Spector job satisfaction, and Maslach burnout in a self-report manner. Correlation analysis was used. Then, for assessing a predictive model used a simple linear regression and multiple linear regression analyses. Data analysis was performed using SPSS version 24. RESULTS: The results showed that the variables of burnout and job satisfaction are effective on nurses' willingness to job turnover. Furthermore, among the background variable, the findings showed that the economic status of nurses and the male gender of patients under their care can be effective on nurses "job turnover intention and can be used as predictor variables of nurses" job turnover intention. CONCLUSION: According to the results, special attention must be paid to the job satisfaction, burnout, and the economic situation (as a mediator variable) of nurses to prevent their job turnover in the COVID-19 pandemic. Therefore, it is recommended that health managers prevent the job turnover intention of nurses in the COVID-19 pandemic by taking psycho-socio-economic support measures.

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AIMS AND OBJECTIVES: This study was aimed at comparing the effect of injection site selection based on anthropometric indices and body shape pattern on pain injection. BACKGROUND: Pain is one of the common complications of intramuscular injection. Selecting the right place for gluteal injection is one of the challenges of nursing which can increase the safety and success of the injection and thereby reduce the pain severity caused by it. DESIGN: Open-label randomized controlled trial study. METHODS: In this study, 162 eligible subjects referred to the emergency unit of Vasei Hospital of Sabzevar, Iran were randomly assigned to three groups of control, anthropometric indices and body shape pattern. Subjects in the control group received dorsogluteal injection (traditional way). In the anthropometric group, body mass index (BMI), waist circumference (WC) and anterior superior iliac spine to iliac tubercle (ASIS-IT), and in body shape pattern group, observed body shape indices (OBS), BMI and sex were used to select the gluteal injection site. Pain injection was assessed using the Visual Analogue Scale (VAS). The CONSORT checklist was used. RESULTS: The mean age of the participant was 39.43 ± 13.16 and 43.21% (n = 70) were male. Based on multiple linear regression analysis, the mean pain injection was substantially lower in body shape pattern as compared to the control group (r2 : .26; bxy = -0.41; 95% CI: -0.81, -0.01; p = .043). The mean pain injection was significantly greater in the left leg injection than right one (r2 : .26; bxy = 0.44; 95% CI: 0.06, 0.81; p = .021). CONCLUSIONS: Findings of this study suggest that the selection of a gluteal injection site based on body shape pattern in comparison with traditional dorsogluteal injection method has a significant effect on pain injection relief. RELEVANCE TO CLINICAL PRACTICE: Nurses can choose the appropriate gluteal injection site based on the body shape pattern to reduce the pain of the intramuscular (IM) gluteal injections.

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BACKGROUND: Effective communication, including the complete and accurate transfer of information and the prevention of misrepresentation and misinterpretation of patient-centered data during handoff, can enhance the quality of patient care and safety. PURPOSE: This study was aimed at evaluating the impact of bedside handoff using the Situation, Background, Assessment, Recommendation (SBAR) technique, on the quality of nursing care. METHODS: The Quality Patient Care Scale (QUALPACS) was completed by the patient while nurses performed a verbal bedside shift handoff and after receiving education on the purpose and proper use of the SBAR communication tool. RESULTS: The mean age of subjects was 51.29 ± 8.02 years. We found a significant increase in the mean score of QUALPACS dimensions, namely psychosocial (P < .001), physical (P < .001), and communication (P < .001) after SBAR implementation. CONCLUSIONS: Findings suggest that using the SBAR handoff technique increases the quality of nursing care in all QUALPACS dimensions.

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BACKGROUND: Nurses in nursing homes are constantly faced with various moral decisions in terms of elderly care, which in turn causes moral distress. This study aimed to evaluate the moral distress status and its influential factors in the nursing homes in Khorasan provinces, Iran. MATERIALS AND METHODS: This descriptive-correlational study was conducted on 227 nurses engaged in the nursing homes of Khorasan provinces in 2019. The subjects were selected via census sampling. Data were collected using demographic, occupational, and care center characteristics questionnaire and a moral distress questionnaire. Data analysis was performed in SPSS version 16 using the Mann-Whitney U and Kruskal-Wallis test. RESULTS: The mean (SD) score of moral distress was 28.68 (19.19), and 93.83% of the subjects reported low levels of moral distress. Significant correlations were observed between moral distress and age, work experience, workplace, nurse-physician relations, motivation of the nurses, care facilities, and medical equipment. Furthermore, the highest mean (SD) score of moral distress belonged to the items regarding the lack of work experience 12.19 (3.12). CONCLUSIONS: According to the results, moral distress in the nurses of the studied nursing home was relatively low. Despite the favorable outcome of the study, the age discrimination of nurses by nursing homes should not be overlooked.

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INTRODUCTION: Assessment of early clinical warning signs and appropriate response can prevent serious adverse events in hospitalized patients. The Modified Early Warning Score (MEWS) is an applicable early warning sign system that can be used to predict serious adverse events. This study aimed to evaluate the predictive capacity of the MEWS to identify patients in an Iranian hospital who are at risk of developing serious adverse events. METHODS: In this prognostic study, 381 adult patients from the emergency department who were admitted to an inpatient hospital unit of an Iranian hospital from May 2018 to October 2018 were included. The MEWS tool was completed for each patient at the time of admission and then daily for a period of up to 30 continuous days after admission or until the development of a serious adverse event. Receiver operating characteristic, specificity, sensitivity, positive predictive values, and negative predictive values were calculated. RESULTS: In this study, a MEWS of ≥3 on admission was associated with an increased likelihood of developing serious adverse events within 30 days of admission with the area under the curve of 0.82 (95% confidence interval [CI]: 0.77-0.85), sensitivity of 82.81% (95% CI: 71.3-91.1), specificity of 75.39% (95% CI: 70.3-80), positive predictive value of 40.5% (95% CI: 35.2-45.9), and negative predictive value of 95.6% (95% CI: 92.7-97.4). DISCUSSION: A MEWS ≥3 on admission can predict the occurrence of serious averse events in patients admitted to an Iranian hospital for 30 continuous days.

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BACKGROUND: The high motivation of rescuers for cardiopulmonary resuscitation (CPR) can result in high-quality CPR. However, there is no instrument to measure the CPR motivation. The purpose of this study was to design the Cardiopulmonary Resuscitation Motivation Scale (CPRMS) and evaluate its psychometric properties. METHODS: Directed qualitative content analysis and other related instruments were used for the production of items pool, and then the psychometric properties of the CPRMS were evaluated using face, content and construct validities, and internal consistency, and stability for reliability. RESULTS: The CPRMS was consisted of 43 items. The Scale-Content Validity Index was reported as 0.97. Exploratory factor analysis led to eight factors, which in total accounted for 48.58% of observed variance. Confirmatory factor analysis also showed the average fit of the explored model. The values of alpha, omega and intraclass correlation coefficients were reported as 0.92, 0.76-0.86, and 0.90 respectively. CONCLUSION: CPRMS is a valid and reliable instrument for the measurement of CPR motivation in eight dimensions of facilitators of resuscitation, feeling of achievement, high chances of success, low chances of success, recognition and appreciation, accountability, perceived importance, and beliefs. CPRMS can differentiate between rescuers with high and low motivation.

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Qualitative content analysis consists of conventional, directed and summative approaches for data analysis. They are used for provision of descriptive knowledge and understandings of the phenomenon under study. However, the method underpinning directed qualitative content analysis is insufficiently delineated in international literature. This paper aims to describe and integrate the process of data analysis in directed qualitative content analysis. Various international databases were used to retrieve articles related to directed qualitative content analysis. A review of literature led to the integration and elaboration of a stepwise method of data analysis for directed qualitative content analysis. The proposed 16-step method of data analysis in this paper is a detailed description of analytical steps to be taken in directed qualitative content analysis that covers the current gap of knowledge in international literature regarding the practical process of qualitative data analysis. An example of "the resuscitation team members' motivation for cardiopulmonary resuscitation" based on Victor Vroom's expectancy theory is also presented. The directed qualitative content analysis method proposed in this paper is a reliable, transparent, and comprehensive method for qualitative researchers. It can increase the rigour of qualitative data analysis, make the comparison of the findings of different studies possible and yield practical results.

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Rescuers' psychological competence, particularly their motivation, can improve the cardiopulmonary resuscitation outcomes. Data were collected using semistructured interviews with 24 cardiopulmonary resuscitation team members and analyzed through deductive content analysis based on Vroom's expectancy theory. Nine generic categories were developed: (i) estimation of the chance of survival; (ii) estimation of self-efficacy; (iii) looking for a sign of effectiveness; (iv) supportive organizational structure; (v) revival; (vi) acquisition of external incentives; (vii) individual drives; (viii) commitment to personal values; and (ix) avoiding undesirable social outcomes. When professional rescuers were called to perform cardiopulmonary resuscitation, they subjectively evaluated the patient's chance of survival, the likelihood of achieving of the desired outcome, and the ability to perform cardiopulmonary resuscitation interventions. If their evaluations were positive, and the consequences of cardiopulmonary resuscitation were considered favorable, they were strongly motivated to perform it. Beyond the scientific aspects, the motivation to perform cardiopulmonary resuscitation was influenced by intuitive, emotional, and spiritual aspects.

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BACKGROUND: One dilemma in the end-of-life care is making decisions for conducting cardiopulmonary resuscitation (CPR). This dilemma is perceived in different ways due to the influence of culture and religion. This study aimed to understand the experiences of CPR team members about the do-not-resuscitate order. METHODS: CPR team members were interviewed, and data were analyzed using a conventional content analysis method. RESULTS: Three categories and six subcategories emerged: "The dilemma between revival and suffering" with the subcategories of "revival likelihood" and "death as a cause for comfort;" "conflicting situation" with the subcategories of "latent decision" and "ambivalent order;" and "low-quality CPR" with the subcategories of "team member demotivation" and "disrupting CPR performance." CONCLUSION: There is a need for the development of a contextual guideline, which is required for respecting the rights of patients and their families and providing legal support to health-care professionals during CPR.

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