Aim: this study aimed to assess nurses' views about major barriers to reporting errors and adverse events in intensive care units. Method: a descriptive analytical study was used to examine barriers to reporting such events. A questionnaire was completed by 251 nurses across seven hospitals in Iran to elicit information about their views on reporting errors and adverse events. Results: the study identified three main areas that prevented the reporting of incidents—fear of the consequences after reporting an error, procedural barriers and management barriers. Conclusion: the most important approach to overcoming barriers that prevent nurses reporting adverse events would be to develop an atmosphere within which all nurses can report errors and the reasons that led to their occurrence honestly and without fear.

OBJECTIVE To investigate the roles of hemodynamic factors and oxygenation on the incidence of pressure ulcers in patients in the ICU on mechanical ventilation. METHODS This prospective analytical cross-sectional study was performed in several ICUs for a period of 8 months in Iran. Researchers checked patients for pressure ulcers on a daily basis. They collected demographic, hemodynamic, and oxygenation data until a pressure ulcer occurred, the patient’s artificial airway was removed, the patient died, or the patient was discharged. RESULTS From August 2017 to February 2018, a total of 2,581 patients were admitted to the study ICUs; of these, 133 patients were eligible for the study. The results indicated that 41.4% (n = 55) of the patients ended up with pressure ulcers. Investigation of the variables using a Cox regression model showed that, among other variables considered in this study, age, mean arterial pressure, and positive end-expiratory pressure in the mechanical ventilator can contribute to the risk of pressure ulcers. CONCLUSIONS Providers should pay attention to changes in hemodynamic parameters, especially mean arterial pressure; carefully determine the most appropriate positive end-expiratory pressure for patients connected to mechanical ventilation; and take special care of susceptible groups such as older adults and hospitalized patients to decrease the incidence of pressure ulcers.

Background: Brain injury can reduce consciousness and the ability to respond to environmental stimulation. Objectives: The aim of this study was to investigate the effects of familiar voices on the level of consciousness (LOC) among comatose patients with a brain injury hospitalized in the intensive care unit. Methods: In this randomized controlled trial, sixty comatose patients with head trauma were conveniently selected from an intensive care unit of a hospital in Rasht, Iran, and randomly allocated to either a control or an intervention group. Participants in the intervention group received auditory stimulation for three consecutive days and the level of consciousness was compared in two groups. The Glasgow Coma Scale was used to assess the patients’ level of consciousness. The data were analyzed through the Chi-square, the paired-samples t, student’s t test, and the repeated-measures analysis of variance.  Results: A significant increase was found in the mean LOC in the intervention group after every daily auditory stimulation (P<0.05). However, no significant changes were observed in the control group (P>0.05). The repeated-measures analysis of variance revealed that the time and interaction of time and groups were statistically significant (P<0.001). Conclusion: Auditory stimulation with familiar voice was effective in improving levels of consciousness among comatose patients with a brain injury after three days.

Background & Aims: Hemodialysis is currently a common treatment for chronic renal disease, which is associated with numerous limitations in the physical, mental and even social function of the patients. As such, self-care activities could significantly help hemodialysis patients to adapt to the course of their disease. The present study aimed to determine self-care agency and its influential factors in hemodialysis patients. Materials & Methods: This cross-sectional was conducted on the patients referring to Razi Educational-Therapeutic Hemodialysis Center in Rasht, Iran in 2017. In total, 126 patients were selected via random sampling. Data were collected using a two-section questionnaire of sociodemographic characteristics and modulated Chinese version of 28-statement self-care agency. Data analysis was performed using descriptive statistics (mean, standard deviation, frequency, and percentage) and analytical tests (independent t-test, correlation-coefficient, analysis of variance, and logistic regression analysis). Results: Approximately 71.4% of the patients had optimal self-care abilities, and a significant correlation was observed between age and self-care agency (P=0.013). Moreover, education level was significantly correlated with self-care agency (P<0.0001). The logistic regression analysis also indicated that the increased age of the patients from the mean age was associated with the reduction of their self-care agency by 1.5 times. Conclusion: Although the majority of the patients had optimal self-care abilities, the results also indicated that with increased age and due to the treatment procedure and disease complications, hemodialysis patients were faced with limitations in proper self-care. Therefore, it is recommended that proper measures be taken regarding the care program of these patients, so that they could fully contribute to their care process as a member of the healthcare team.

Background Moral distress is a common challenge among professional nurses when caring for their patients, especially when they need to make rapid decisions. Therefore, leaving moral distress unconsidered may jeopardize patient quality of care, safety, and satisfaction. Aim To estimate moral distress among nurses. Methods This systematic review and meta-analysis conducted systematic search in Scopus, PubMed, ProQuest, ISI Web of Knowledge, and PsycInfo up to end of February 2022. Methodological quality of included studies was assessed using the Newcastle Ottawa checklist. Data from included studies were pooled by meta-analysis with random effect model in STATA software version 14. The selected key measure was mean score of moral distress total score with its’ 95% Confidence Interval was reported. Subgroup analyses and meta-regressions were conducted to identify possible sources of heterogeneity and potentially influencing variables on moral distress. Funnel plots and Begg’s Tests were used to assess publication bias. The Jackknife method was used for sensitivity analysis. Ethical consideration The protocol of this project was registered in the PROSPERO database under decree code of CRD42021267773. Results Eighty-six manuscripts with 19,537 participants from 21 countries were included. The pooled estimated mean score of moral distress was 2.55 on a 0–10 scale [95% Confidence Interval: 2.27–2.84, I2: 98.4%, Tau2:0.94]. Publication bias and small study effect was ruled out. Moral distress significantly decreased in the COVID-19 pandemic versus before. Nurses working in developing countries experienced higher level of moral distress compared to their counterparts in developed countries. Nurses' workplace (e.g., hospital ward) was not linked to severity of moral disturbance. Conclusion The results of the study showed a low level of pooled estimated score for moral distress. Although the score of moral distress was not high, nurses working in developing countries reported higher levels of moral distress than those working in developed countries. Therefore, it is necessary that future studies focus on creating a supportive environment in hospitals and medical centers for nurses to reduce moral distress and improve healthcare.