STEP 1 Writing style Title: a. Yes, the title is focused. b.

STEP 1

Writing style

Title:

a. Yes, the title is focused.

b. The title includes the keywords clinical trials, COVID-19, Imogene King’s theory on goals, multiple sclerosis, and nursing process.

Authors

The Author(s), under exclusive license to Royal Academy of Medicine in Ireland 2022

Abstract

Yes

the abstract includes background, aims, methods, results, conclusions, keywords, and trial registration

Research Problem

The chronic nature of multiple sclerosis (MS) affects a patient’s activities of daily living (ADL) and quality of life (QOL). Nursing interventions based on patients’ active participation in goal setting can be beneficial in improving ADL and QOL.

This study aimed to determine the effect of applying the nursing process based on King’s Theory of Goal Attainment (TGA) on ADL and QOL of persons with multiple sclerosis (PwMS) during the COVID-19 pandemic

The problem is related to nursing interventions and based on improving ADL’s and quality of life during COVID-19 and was clinically practiced.

Purpose

This study was a pre-post clinical trial conducted between January and August 2021. A total of 70 PwMS (who met inclusion criteria) were enrolled using a convenience sampling method and randomly assigned into intervention and control groups using the quadruple block method.

Yes

Literature review

Yes

peer-viewed sources

Most of the references are current but a few go year back to 1963. The older ones are replication studies of ADL’s

The content is directly related to the intervention group and control group and the variables with MS

Framework or theoretical perspective

According to the literature, nursing interventions based on nursing theories and comprehensive approaches [22] could provide a framework and goals for the nursing process, leading to more effective and thorough clinical care [23].

This results in the development of professional nursing [24], improvement of patient care standards, reduction of health care costs [25], and improvement of patients’ QOL

Implementing a comprehensive nursing care program and applying nursing theories in clinical settings is achievable when efective human interactions exist between nurses and patients [27]. One of the most signifcant nursing theories regarding the nurse-patient relationship is King’s Theory of Goal Attainment (TGA), which is based on mutual perception between nurses and patients [28].

Framework map

Research objectives, questions, or hypotheses

In this process, the nurse and the patient perceive each other and, through communication, determine the goals and reach a consensus to achieve them, and their actions indicate the goal attainment [30].

Various studies have shown the efect of TGA on improving nursing care outcomes in chronic diseases. It includes improving care and adherence to treatment in patients with diabetes [32], improving the perception and self-care behavior in patients with diabetes [33], goal attainment in cancer patients undergoing chemotherapy [34], applying the nursing process in a case study of patients with heart failure [35], improving the life quality in patients with congestive heart failure [36], modifcation of lifestyle in patients with acute myocardial infarction [37], and improving the pharmacist-patient relationship [38].

Research design

This study was a pre-post clinical trial conducted between January and August 2021. A total of 70 PwMS (who met inclusion criteria) were enrolled using a convenience sampling method and randomly assigned into intervention and control groups using the quadruple block method.

The sample size was considered 35 participants based on the pilot study on 16 individuals, the standard deviation of s1 = s2 = 9.1, d = 7 in the two groups, 95% confidence interval, and test power of 0.9 according to the following formula: n = (s2 1+s2 2)(z1− 2 +z1− ) 2 d2 = 35

Inclusion criteria were age 20–50 years, at least primary school education, diagnosis and confirmation of the disease by a neurologist for at least 6 months, relapsing-remitting type of the disease, non-acute phase of the disease, being mentally balanced and alert to time, place, and person based on medical records and patient statements

Treatments:

The demographic and disease-related information questionnaire, including 9 questions (age, sex, marital status, level of education, occupation, income status, duration of illness, relapse frequency during the past year, patient’s EDSS).

SF-12 examines perceptions of general health, physical functioning, role physical, role emotional, body pain, social functioning, vitality, and mental health. The overall score is between 12 and 48, indicating poor (12–24), fair (36–25), and good (37–38) conditions. A higher score indicates a better QOL [40]. The permission of using a questionnaire has been accomplished for this study.

The ADL questionnaire was first introduced by Katz et al. (1963) [42]. In this study, the Persian version of the questionnaire was used; its validity, reliability, and localization were confirmed by Taheri Tanjani et al. The permission of using a questionnaire in Persian has been obtained for this study. This scale assesses ADL, which includes 8 questions: personal hygiene, eating, dressing, transfers, walking, bathing/showering, continence, and toileting.

The Lawton IADL standard scale was frst developed by Lawton and Brody (1969). The components of this questionnaire include using the telephone, handling medication, preparing food, housekeeping, shopping, using transportation, and handling income and expenses

Goal Attainment Scale (GAS) was originally described by Kirusek and Sherman in the context of mental health intervention in the 1960s, a scoring method of the level to which patient’s individual goals are accomplished during the intervention. So, each patient has own outcome level which scored in a standardized way as to allow statistical analysis GAS is an internationally documented measure broadly used in educational, counseling, and clinical settings to identify and evaluate individuals’ goals.

Groups

The mean age of PwMS in the intervention and control groups was 37.14 ± 7.46 and 37.34 ± 5.93 years, respectively. Of all participants, 82.9% in the intervention group and 85.7% in the control group were female.

Patients in both groups were homogeneous regarding all demographic and disease-related characteristics except for the EDSS score

The results of the present study showed that although at the beginning of the study, the QOL of the participants in the control group was significantly higher than the intervention group, after the intervention and adjustments to the impacts of disability severity, the QOL increased significantly only in the intervention group.

Along with our results, Arauji et al. (2018) showed that TGA led to compliance with the treatment and improved the QOL of the diabetes patients [32]. Also, using of the TGA for a patient with heart failure resulted to elimination of the modifable risk factors regarding the level of activity, diet, medication, and adherence to the treatment [35].

Nursing Process

1. Assessment stage King’s evaluation form was developed according to the literature [29, 31, 47]. To complete the questionnaires, face to-face interviews were conducted to establish perception, communication, and interaction with the patients and collect their health history, physical examinations, and profile. Finally, a list of problems was provided separately for each participant in the intervention and control groups, and the problem was scored based on GAS criteria.

2. Planning First, the identified goals were shared with the intervention group based on the nurse-patient interaction. In other words, the goals and their significance were discussed through a discussion, and the following questions were asked: “Which one is more important to you?” “Attaining which goal has the greatest impact on your daily living?” Participants were also requested to determine the chronological order of attaining the goals. After patients’ approval, goals were prioritized. Thus, a 2-way interactive and educational plan was created based on each patient’s goals, and a set of goals was documented, along with prioritization and measures, to attain them. Regarding predefined goals, educational, supportive, and functional content was designed to facilitate the goal attainment process.

3. Implementation The nursing procedures itemized in the previous stage were implemented through the nurse-patient interaction. Follow-up sessions were held for 4 consecutive weeks by phone (20–45 min) and on social networks based on the patient’s needs and desires. Participants actively participated in this stage, and at the end, educational content was provided to them.

4. Evaluation The evaluation was performed based on the goals set. The rate of goal attainment was scored using GAS criteria.