Introduction: Staff nurses are exposed to many blood and other fluids in the course of their day to day activities in Intensive Care Unit. Purpose of this survey is to assess the level of knowledge, attitudes and practices of standard precaution among nurses in Intensive Care unit, in Middle East Hospital. Method: This was a cross-sectional study and undertaken among nurses by self-administered and anonymous questionnaire that randomly selected in Intensive Care Unit, Middle East Hospital. Results: Female nurses accounted for majority of the respondents which covered 66.7% (n = 44) while male nurses make up around 33.3% (n = 22) of the nursing workforce in the study. 53% (n = 35) of the respondents reported not having any basic exposure or training in infection control practices, while the other 47% (n = 31) respondents received their training or basic exposure in infection control practices. Majority of the participants had high level of knowledge. Conclusion: In accordance to the self-reported questionnaires, 77% (n = 51) of the respondents practice good practices of standard precaution. The knowledge, attitude and compliance among ICU nurses in the middle-east hospital towards standard precaution was adequate.

A model of aging perception in Iranian elders is presented. The findings suggested that hope had a significant and positive impact on aging perception. Implications for clinical practice and research are discussed.

Background: Simulated Patient (SP) is defined as a layperson that simulates to portray the role of a patient with health-related conditions. International Medical University (IMU) has been utilizing SP for more than 10 years, however, the SP's experience toward the SP-based simulation session yet to be explored, the aim of the study was to explore the SP's experience toward the SP-based simulation session. Methods: Total of 6 participants recruited for a focused group interview, with the inclusive criteria of participated at least an SP-based simulation session. The interviewer used a list of guide question to explore both the positive and negative experience of the SP-based simulation session. A combination of manual and computer software Program was used for data management and analysis. Manual transcribing and coding technique was used for data analysis, while Qualitative Data Analysis (QDA) was used for data management and additional analysis. Results: Three main themes and eleven sub-themes have emerged. The first theme was Effective learning session, with the sub-themes of Student learning attitude, Treated as real patient, Standardization among lecturer, Appropriate respond to student and Focused learning outcome; second theme was Motivation, with the sub-themes of Respect, Feedback, and Caring; the third theme was Preparation prior to class, with the sub-themes of Clear instruction, Role-play, and Script. Conclusions: SPs perceived that lecturers should pay attention to the students’ learning outcome and fully utilize SPs for teaching. Besides that, SPs wished to be treated as a real patient due to the lecturer who treated the SPs as they are real patient gave students a mind-set that the learners were actually dealing with a patient with real conditions. SPs supposed that another role of the lecturer was well-prepared the SPs prior to the actual sessions. SPs expressed that students who took the session seriously, well-preparation before the classes, active participation during the sessions and proactive attitude encouraged realistic portrayal of the character. While SP role was memorizing a series of information needed for the scenario, prepare mentally for portrayal certain emotional as well as physical symptoms. Lecturer, SP as well as student influence a successful SP-based simulation session.

Background Moral distress is a poorly defined and frequently misunderstood phenomenon, and little is known about its triggering factors during ICU end-of-life decisions for nurses in Iran. This study aimed to explore the experiences of nurses’ moral distress in the long-term care of older adults via a phenomenological study. Methods A qualitative, phenomenological study was conducted with 9 participants using in-depth semi-structured interviews. The purpose was to gain insight into the lived experiences and perceptions of moral distress among ICU nurses in hospitals affiliated with Tehran University of Medical Sciences during their long-term care of older adults. Results Five major themes are identified from the interviews: advocating, defense mechanisms, burden of care, relationships, and organizational issues. In addition, several subthemes emerged including respectful end of life care, symptom management, coping, spirituality, futile care, emotional work, powerlessness, relationships between patients and families, relationships with healthcare teams, relationships with institutions, inadequate staffing, inadequate training, preparedness, education/mentoring, workload, and support. Conclusions This qualitative study contributes to the limited knowledge and understanding of the challenges nurses face in the ICU. It also offers possible implications for implementing supportive interventions.

Introduction: A consistent approach to pain assessment for patients admitted to intensive care unit (ICU) is a major difficulty for health practitioners due to some patients’ inability, to express their pain verbally. This study aimed to assess pain behaviors (PBs) in traumatic brain injury (TBI) patients at different levels of consciousness. Methods: This study used a repeated-measure, within-subject design with 35 patients admitted to an ICU. The data were collected through observations of nociceptive and non-nociceptive procedures, which were recorded through a 47-item behavior-rating checklist. The analyses were performed by SPSS ver.13 software. Results: The most frequently observed PBs during nociceptive procedures were facial expression levator contractions (65.7%), sudden eye openings (34.3%), frowning (31.4%), lip changes (31.4%), clear movement of extremities (57.1%), neck stiffness (42.9%), sighing (31.4%), and moaning (31.4%). The number of PBs exhibited by participants during nociceptive procedures was significantly higher than those observed before and 15 minutes after the procedures. Also, the number of exhibited PBs in patients during nociceptive procedures was significantly greater than that of exhibited PBs during the non-nociceptive procedure. The results showed a significant difference between different levels of consciousness and also between the numbers of exhibited PBs in participants with different levels of traumatic brain injury severity. Conclusion: The present study showed that most of the behaviors that have been observed during painful stimulation in patients with traumatic brain injury included facial expressions, sudden eye opening, frowning, lip changes, clear movements of extremities, neck stiffness, and sighing or moaning.

Introduction: There are numerous dressings used to treat pressure ulcers (PUs), depending on their advantages to achieve optimum patient outcomes. This study aimed to compare hydrocolloid dressings and silver nanoparticles in treating PUs among patients with spinal cord injury (SCI). Methods: This randomized clinical trial was conducted on 70 patients with SCI in Iran. Participants were randomly divided into two equal groups (n=35) receiving silver nanoparticle dressing and hydrocolloid dressing, respectively. The groups were evaluated in four assessment periods using the Bates-Jensen Wound Assessment Tool (BWAT). Data analysis was performed using SPSS software version 13, repeated measures ANOVA, non-parametric tests, and chi-square. Results: Chi-square test was used to investigate the difference between the scores before the intervention, the results of which were not statistically significant. In repetitive measurements, the results of the analysis of variance showed that the average assessment score in both groups decreased and both dressings were effective in the treatment process. Although PU improvement status in the group that received silver nanoparticles was better, between-group analysis of variance did not show any statistically significant difference between the two groups. Conclusion: Our results indicated that silver nanoparticles and hydrocolloid dressings can be used interchangeably in the treatment of PUs.

Introduction: Many universities have been utilizing simulated patient (SP) programme for more than a decade for teaching sessions and simulation activities as well as Objective Structured Clinical Examination (OSCE), however the pre-clinical year medical student's experience toward the SP encounter yet to be explored. The aim of the study was to explore the pre-clinical year medical student's experience towards the SP-based simulation session. Methods: Total of 6 participants were recruited for a focused group interview, with the inclusive criteria of minimum enrolled into the medical program for more than a year. The interviewer used a list of guide question to explore both the positive and negative SP encounter experience during teaching and learning session as well as OSCE. A combination of manual and computer software Program was used for data management and analysis. Results: Three main themes and eight sub-themes have emerged. The first theme was Simulated patient as an effective learning tool, with the sub-themes of SP attitude and realism; second theme was Fairness, with the sub-themes of Appropriateness respond to student, Calibration of SP performance and Consistency; the third theme was Feedback from Simulated patient, with the sub-themes of Feedback on student's skill, Feedback on student social intelligence and Poor feedback skill. Conclusion: Student perceived that SP was proved as an effective learning tool only if the SP was able to portray a real patient role as well as able to demonstrate effective feedback skill. Moreover, standardization of the SP role portrayal and SP feedback influenced the fairness along the students' journey, especially during OSCE. Training SP for both realistic portrayals of the character and feedback is essential to optimize an SPbased simulation session.

BACKGROUND Simulated patient (SP) is defined as a trained individual who portrays the role of a patient with various health associated conditions. The term SP also refers to a healthy individual trained to portray a patient. Another definition has described SP as a layperson who simulates as a real patient based on differing levels of training (1-3). Combining these descriptions, SP can be defined as a layperson who simulates to portray the role of a patient with healthrelated conditions based on varying levels of training. SP can be interchangeably used with role player, trained patient, patient instructor, and actor-patient. SP can also play a variety of roles along the educational path for To cite this article: Goh L-K, Yee B-L. Experience towards simulated patient-based simulation session: an integrative literature review.