Background:Nursing documentation as a pivotal part of nursing care has many implications for patient care in terms of safety and ethics.Objectives:To explore factors influencing nursing documentation from nurses’ perspectives in the Iranian nursing context.Methods:This qualitative study was carried out using a qualitative content analysis of data collected from 2018 to 2019 in two urban areas of Iran. Semi-structured interviews (n = 15), observations, and reviews of patients’ medical files were used for data collection.Ethical considerations:This study was conducted in accordance with the ethical principles of research and regulations in terms of confidentiality of data, anonymity, and provision of informed consent.Findings:The main theme of this study was “unsafe documentation.” Two categories, “types of errors in reporting” and “reasons of errors in reporting,” and 12 subcategories were developed indicating factors influencing nursing documentation in the Iranian nursing context.Conclusion:In general, individual, organizational, and national factors affected nursing documentation in Iran. In this respect, hiring more nurses, application of reforms in the healthcare management structure, devising appropriate regulations regarding division of labor, constant education of healthcare staff, establishment of clinical governance, improvement of interpersonal relationships, development of hardware and software techniques for documentation, and provision of support should be done to improve the quality of nursing documentation. The above-mentioned suggestions can help nurses with a safe, ethical, lawful, and reliable documentation in nursing practice.

Background:The long-term complications of hemodialysis deteriorate patients' quality of life and lead to physical and mental discomfort. Physiologically, sports activities can play an important role in reducing these side effects including muscle cramps. Objectives: The aim of this study was, to determine the impact of isotonic exercise on the frequency of muscle cramps. Methods: This clinical trial was carried out on 60 hemodialysis patients admitted to the dialysis units of Shahrekord and Borujen hospitals in 2014. The intervention included an isotonic exercise program that was implemented during 10 sessions of constant cycling (each lasting 10 minutes) immediately before dialysis. The outcome variable was the number of muscle cramps in patients during the hemodialysis session. The data were analyzed in SPSS-16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential tests (independent and paired t-tests). Results: The mean frequency of leg cramps before the intervention was not significantly different between the two groups (P = 0.10). However, it was significantly different between the groups after the intervention (P = 0.001). Moreover, the number of muscle cramps in the experimental group was significantly lower after the intervention than before implementing the program (P = 0.03). Conclusions:The isotonic exercise of constant cycling has a considerable effect on decreasing the number of muscle cramps in hemodialysis patients. Hence, it is suggested that dialysis units provide facilities for constant walking and cycling to accelerate patients' treatment.

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Background: Pain and weakening of muscle strength are the most important problems in orthopedic patients. Isometric movements are effective in reducing these problems. Due to the lack of studies in this field, this study was conducted with the aim of investigating the effect of isometric movements on pain control and muscle strength reversal of lower limb fractures. Methods: This clinical trial was carried out in 120 patients aged 15 -49 years suffering from lower limb fracture admitted to the Shahid Beheshti hospital of Sabzevar in 2016 with random allocation to intervention and control groups. In the intervention group, physiotherapy was performed by isometric movements four hours after the surgery and then, up to five consecutive days, each day four times of half an hour. The amount of pain and reversing muscle strength was investigated before and after the intervention in both groups. STATA 11 software was used to analyze the data at a significance level of 0.05. Results: In the intervention and control groups, there were 83% and 85% males, 17%, and 15% females, respectively. The age groups of 40 -49 years (37%) and 30 -39 years (35%) were the most frequent. The Wilcoxon test showed a significant difference between the amount of pain before (6.86 ± 1.18) and after (2.86 ± 1.89) the intervention (P < 0.001). Fischer's exact test showed a significant difference between the groups in terms of muscle strength after the intervention (P < 0.001). Conclusions: Isometric movements exercise is the most effective method for relieving pain and reversing muscle strength, which can be recommended by orthopedic doctors because it facilitates recovery and accelerates the return to normal life.

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Introduction: Ethical decision-making by nursing managers is influenced by various essential factors, such as courage, without which it is impossible to act on them. Objective: This study aimed to explore the experiences of nursing managers about courage in ethical decision-making. Materials and Methods: The current study was conducted in Iran by a qualitative content analysis approach in 2018. Nineteen nurse managers were selected purposefully from hospitals in Tehran and Shahrekord cities. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method. Results: Based on data analysis, we extracted 2 categories (obligation, decisiveness) and 8 subcategories (clearness in expressing decisions, the ability of the manager to make decisions in critical and complex situations, authority/decision-making as a religious responsibility, follow the decision process, being responsible, making compensatory decisions, making preventive decisions). Conclusion: The findings showed that managers who are committed to ethical decision-making have enough assertiveness to make the decisions. Educating, empowering, and sensitizing managers and enhancing their insight into ethical issues through problem-solving and role-playing techniques can play an essential role in promoting their commitment and responsibility.

Introduction: The role of inflammation and malnutrition in critically ill patients has been shown in some studies. The aim of the study is to determine the effect of symbiotic on serum systemic inflammatory marker (hs-CRP) and albumin in critically ill patients.Methods: Sixty patients admitted to the intensive care unit of Sabzevar Vasei hospital were randomized two groups that received symbiotic or placebo for 2 weeks. Levels of serum hs-CRP and albumin were measured before and after the study. Results:There was a significant differences between two groups the Levels of serum hs-CRP (P=0.0001) and albumin (P=0.0001). Conclusion:Results of study were showed that administration of symbiotic in critically ill patients reduced the levels of serum hs-CRP and increased the levels of serum albumin.

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